两种连续性血液净化模式治疗严重糖尿病乳酸性酸中毒的对比分析

摘要

目的：比较两种连续性血液净化模式治疗严重糖尿病乳酸性酸中毒的效果。方法采用前瞻性随机对照研究方法,选取我院连续性血液净化治疗严重糖尿病乳酸性酸中毒80例临床资料,按完全随机化原则分成CVVH模式组(研究组)40例、CVVHD模式组(对照组)40例。观察分析两组病例治疗前及治疗后12、24、48h血乳酸水平,并统计两组患者的病死率,比较两组患者预后。结果在治疗前(Oh),两组患者血乳酸水平比较差异无统计学意义(P>0．05),治疗后12、24、48h,两组患者血乳酸水平均明显下降,下降幅度比较差异无统计学意义(P>0．05),但CVVH组APACHEⅡ评分改善明显优于CVVHD组,且CVVH组患者病死率及平均住院时间明显低于对照组,差异有统计学意义( P<0．05)。结论连续性血液净化治疗,无论CVVH模式还是CVVHD模式,均能改善严重糖尿病乳酸性酸中毒患者的内环境,维持酸碱平衡,具有清除血乳酸的作用,并能改善患者的预后,但采用CVVH模式可显著改善患者APACHEⅡ评分,降低患者病死率及平均住院时间,优于CVVHD模式。%Objective Comparison of two kinds of continuous blood purification modes for the treatment of severe diabetic lactic acidosis effect. Methods A prospective randomized control study,Our hospital continuous blood purification treatment of severe diabetic lactic acidosis clinical data 80 cases,According to the principle of completely random pattern into CVVH group (study group)40 cases,CVVHD group(control group)40 cases. Analysis of two groups of patients before treatment and after treat-ment 12,24,48 hours of blood lactic acid level in observation and statistics of two groups of patients,mortality rate,The prognosis of patients were compared. Results Before treatment( Oh) ,no significant difference was found between thepatients with blood lactate levels in the two groups(P>0. 05). After the treatment of 12,24,48h,blood lactic acid level of patients in two groups were signifi-cantly decreased,the decrease amplitude had no significant difference(P>0. 05). But CVVH group APACHEⅡscore improved sig-nificantly better than CVVHD group,and mortality in patients with CVVH group and the average hospital stay was significantly lower than the control group(P<0. 05). Conclusion Continuous blood purification therapy,either CVVH mode or CVVHD mode,can improve the internal environment of severe diabetic lactic acidosis in patients with clear,maintaining acid-base balance,blood lactic acid,and can improve the prognosis of patients,but using CVVH model can significantly improve the APACHE II score of patients, reduce the mortality of patients and the average the hospitalization time,better than the CVVHD model.