限制性补充碳酸氢钠对二甲双胍相关糖尿病乳酸酸中毒患者的救治.docVIP

·2458 · · 短 篇 论 著 · 限制性补充碳酸氢钠对二甲双胍相关糖尿病乳酸酸中毒 患者的救治 于占彪，黄煜湘，崔娜，白杰，董谓楣 【摘要】 自的 探讨糖尿病患者口服二甲双胍相关乳酸酸中毒的临床表现及患者对碳酸氢钠治疗的反应。方法 选取我科2010年收治的5例二甲双胍相关乳酸酸中毒的糖尿病患者，回顾性分析患者的临床表现、治疗及转归。结 果 5例患者糖尿病病程为5～20年，均服用二甲双胍类降糖药物，均以恶心、呕吐、腹胀等消化道症状为首要表现， 严重者出现血压下降及多脏器功能损害。实验室检查显示： pH 值明显下降，乳酸水平和阴离子间隙明显增高。患者经 限制性补充碳酸氢钠、补液、维持组织灌注、抗感染等治疗后均痊愈出院。结论 糖尿病二甲双胍相关乳酸酸中毒患 者需要综合治疗，其中限制性补充碳酸氢钠可取得较好效果。 【关键词】 糖尿病；二甲双胍；酸中毒，乳酸性；碳酸氢钠 【中图分类号】 R587.1 【文献标识码】 B 【文章编号】1007-9572(2012)07-2458-03 Li mited Supply of NaHCO, for Diabetes Patients with Metformin Associated Lactic Acidosis YU Zhan-biao,HUANG Yu -xiang,CUI Na, et al. Intensive Care Unit, Affliated Hospital of Hebei University,Baoding 071000,China 【Abstract] Objective To study the clinical features of metformin assaciated lactic acidosis in diabetes patients and their response to NaHCO? treatment. Methods Clinical features, treatment and outcome of five diabetes patients with metformin associated lactic acidosis admitted to our department in 2010 were retrospectively analyzed. Results The diabetes courses of the five cases were five years to 20 years and all of them had been taking metformin with primary manifestations of digestive symptoms like retching, vomiting and abdominal distension. The severe cases had hypotension and multi - organ injuries. Laboratory test showed that pH decreased significantly, lactate level and anion gap(AG) increased significantly. All the patients recovered and discharged atter limited supply of NaHCO; and fluid, tissue maintaining perfusion and anti - infection treatment. Conclusion Diabetes patients with metformin associated lactic acidosis should be treated comprehensively and limited supply of NaHCO3 can a- chieve satisfactory efficacy. 【Key words】 Diabetes mellitus; Metformin;Acidosis,lactic; Sodium bicarbonate 糖尿病乳酸酸中毒是糖尿病三大急性 并发症之一，较少见但严重，其中大量服 用双胍类降糖药物尤其是苯乙双胍是诱发 乳酸酸中毒的病因之一，称为双胍类药物 相关乳酸酸中毒“。苯乙双胍由于其乳 酸酸中毒发生概率较高，在西方国家已被 禁用，在我国也逐渐被淘汰。二甲双胍相 关乳酸酸中毒在国内外文献中仍常见报 道，虽经认识的提高和支持治疗的改进， 病死率明显下降，但其发