连续性静-静脉血液滤过治疗老年严重糖尿病乳酸性酸中毒的研究

摘要

目的 研究连续性静-静脉血液滤过(CVVH)对老年严重糖尿病乳酸性酸中毒的治疗效果. 方法 回顾性分析梅州市人民医院2013年1月至2015年12月收治的49例老年严重糖尿病乳酸性酸中毒病人,15例为常规治疗组,予以常规治疗,34例为CVVH组,除常规治疗外行CVVH治疗,观察治疗前及治疗后2组24 h、48 h血生化指标、血清C反应蛋白(CRP)、血碳酸氢根、血乳酸、血pH值的变化及死亡情况,并进行统计分析. 结果 2组病人治疗后,血乳酸、血肌酐、尿素氮、血钾和CRP水平均明显下降,血碳酸氢根、pH值明显升高;治疗后48 h,CVVH组血碳酸氢根、血pH值、血乳酸水平恢复正常;治疗后24 h和48 h与常规治疗组比较,CVVH组血乳酸、血肌酐、尿素氮和CRP水平明显下降,且血乳酸下降速度明显增快,血碳酸氢根明显升高(P<0.05);常规治疗组死亡8例,病死率为53.3%,CVVH死亡5例,病死率为14.7%,2组病死率比较,差异有统计学意义(χ2=6.11,P=0.014). 结论 CVVH治疗老年严重糖尿病乳酸性酸中毒疗效确切,可有效清除体内乳酸,纠正酸中毒,改善肾功能,维持内环境稳定,消除炎症介质,明显降低病死率.%Objective To study the effects of continuous veno-venous hemofiltration (CVVH) in the treatment of severe lactic acidosis in the elderly patients with diabetes.Methods The clinical data of 49 cases with senile severe diabetic lactic acidosis admitted to department of endocrinology in Meizhou People's Hospital from January 2013 to December 2015 were retrospectively analyzed.All cases were divided into two groups, the conventional therapy group(15 cases) treated with conventional therapy, the CVVH group(34 cases) treated with conventional therapy combined with CVVH.Changes in blood biochemical index, serum C-reactive protein (CRP), blood bicarbonate root, blood lactic acid, pH and the mortality rate before treatment and 24 h,48 h after treatment were observed and statistically analyzed.Results After treatment, the levels of blood lactic acid, serum creatinine, blood urea nitrogen,potassium and CRP were significantly decreased, levels of blood bicarbonate root and pH were significantly increased in two groups.Levels of blood bicarbonate root, pH and blood lactic acid in CVVH group returned to normal level at 48 h after CVVH treatment.Compared with the conventional treatment group, levels of blood lactic acid, serum creatinine, blood urea nitrogen and CRP were significantly decreased, descent velocity of blood lactic acid was faster, and level of blood bicarbonate root was significantly increased (P<0.05) at 24 h and 48 h after CVVH treatment.There were five dead cases(14.7%) in CVVH group and eight dead cases(53.3%) in the conventional treatment group, and there was a statistical difference in the mortality rates between two groups (χ2=6.11, P=0.014).Conclusions CVVH can effectively remove lactic acid in the body, correct acidosis, improve renal function, maintain a stable internal environment, eliminate inflammation medium and significantly reduce the case fatality in the elderly patients with diabetic lactic acidosis.