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目的提高对双胍类药物引起的乳酸酸中毒的认识,探讨降低糖尿病乳酸酸中毒病死率的方法。方法回顾性分析2006年至2010年河南宏力医院收治的21例糖尿病乳酸酸中毒患者的临床资料。结果老年患者服药依从性不高,双胍类药物使用不当,肝、肾功能损害是服用双胍类药物的糖尿病患者出现乳酸酸中毒的易发因素,严重乳酸酸中毒可引起多器官功能衰竭及死亡。本组21例中9例死亡,死亡组pH值、HCO3-、阴离子间隙较存活组明显下降(P<0.05)。结论严格掌握双胍类降糖药的禁忌证,提高患者的依从性,可减少糖尿病乳酸酸中毒的发病,早期给氧、充分补液、应用葡萄糖加小剂量胰岛素、尽早血液透析是治疗糖尿病乳酸酸中毒成功的关键。
Objective To improve awareness of the biguanide-induced lactic acidosis and to explore ways to reduce the mortality of lactic acidosis in diabetic patients. Methods The clinical data of 21 cases of diabetic lactic acidosis admitted to Henan Grace Hospital between 2006 and 2010 were retrospectively analyzed. Results Elderly patients had poor medication compliance, improper use of biguanides, impaired liver and kidney function, and the incidence of lactic acidosis in diabetic patients taking biguanide drugs. Serious lactic acidosis caused multiple organ failure and death. Nine of the 21 patients died in this group, the death group pH, HCO3-, anion gap significantly decreased compared with the survival group (P <0.05). Conclusions Strict mastery of biguanide hypoglycemic agents contraindications to improve patient compliance can reduce the incidence of diabetic lactic acidosis, early oxygen, adequate rehydration, the application of glucose plus a small dose of insulin, as soon as hemodialysis treatment of diabetic lactic acidosis the key to success.