中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2013年
1期
45-47
,共3页
张淇钏%方喜斌%蔡志雄%李智业%陈伟宏%陈纪平%吴苏武
張淇釧%方喜斌%蔡誌雄%李智業%陳偉宏%陳紀平%吳囌武
장기천%방희빈%채지웅%리지업%진위굉%진기평%오소무
早期%连续性血液净化%乳酸酸中毒%病死率
早期%連續性血液淨化%乳痠痠中毒%病死率
조기%련속성혈액정화%유산산중독%병사솔
Early stage%Continuous blood purification%Lactic acidosis%Mortality
目的 观察早期连续性血液净化(CBP)对乳酸酸中毒患者的治疗效果.方法 采用前瞻性随机对照研究方法,选择2010年1月至2012年4月重症监护病房(ICU)41例乳酸酸中毒患者,按完全随机化原则分成CBP组21例、对照组20例.治疗前及治疗12、24、72 h时检测患者血气分析、血乳酸、血生化,应用急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分对患者进行评估,记录患者住ICU时间及28 d病死率.结果 两组治疗后血乳酸水平、APACHEⅡ评分均逐渐下降.CBP组治疗12、24、72 h后血乳酸值(mmol/L)明显低于对照组(12 h:8.23-3.94比12.47±4.62,24 h:4.46±1.57比10.54±3.48,72 h:2.69±1.03比5.74±1.56,均P＜0.01)；治疗12、24、72 h APACHEⅡ评分(分)均明显低于对照组(12h:18.23±5.85比21.64±5.38,24 h:16.49±4.62比20.61±5.71,72 h:11.54±3.67比16.02±4.34,均P＜0.05)；CBP组住ICU时间(d)明显短于对照组(6.58±3.45比11.65±4.94,P＜0.05),28 d病死率明显低于对照组(23.8％比45.0％,P＜0.05).结论 早期CBP治疗乳酸酸中毒患者能够减少病死率.
目的 觀察早期連續性血液淨化(CBP)對乳痠痠中毒患者的治療效果.方法 採用前瞻性隨機對照研究方法,選擇2010年1月至2012年4月重癥鑑護病房(ICU)41例乳痠痠中毒患者,按完全隨機化原則分成CBP組21例、對照組20例.治療前及治療12、24、72 h時檢測患者血氣分析、血乳痠、血生化,應用急性生理學與慢性健康狀況評分繫統Ⅱ(APACHEⅡ)評分對患者進行評估,記錄患者住ICU時間及28 d病死率.結果 兩組治療後血乳痠水平、APACHEⅡ評分均逐漸下降.CBP組治療12、24、72 h後血乳痠值(mmol/L)明顯低于對照組(12 h:8.23-3.94比12.47±4.62,24 h:4.46±1.57比10.54±3.48,72 h:2.69±1.03比5.74±1.56,均P＜0.01)；治療12、24、72 h APACHEⅡ評分(分)均明顯低于對照組(12h:18.23±5.85比21.64±5.38,24 h:16.49±4.62比20.61±5.71,72 h:11.54±3.67比16.02±4.34,均P＜0.05)；CBP組住ICU時間(d)明顯短于對照組(6.58±3.45比11.65±4.94,P＜0.05),28 d病死率明顯低于對照組(23.8％比45.0％,P＜0.05).結論 早期CBP治療乳痠痠中毒患者能夠減少病死率.
목적 관찰조기련속성혈액정화(CBP)대유산산중독환자적치료효과.방법 채용전첨성수궤대조연구방법,선택2010년1월지2012년4월중증감호병방(ICU)41례유산산중독환자,안완전수궤화원칙분성CBP조21례、대조조20례.치료전급치료12、24、72 h시검측환자혈기분석、혈유산、혈생화,응용급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분대환자진행평고,기록환자주ICU시간급28 d병사솔.결과 량조치료후혈유산수평、APACHEⅡ평분균축점하강.CBP조치료12、24、72 h후혈유산치(mmol/L)명현저우대조조(12 h:8.23-3.94비12.47±4.62,24 h:4.46±1.57비10.54±3.48,72 h:2.69±1.03비5.74±1.56,균P＜0.01)；치료12、24、72 h APACHEⅡ평분(분)균명현저우대조조(12h:18.23±5.85비21.64±5.38,24 h:16.49±4.62비20.61±5.71,72 h:11.54±3.67비16.02±4.34,균P＜0.05)；CBP조주ICU시간(d)명현단우대조조(6.58±3.45비11.65±4.94,P＜0.05),28 d병사솔명현저우대조조(23.8％비45.0％,P＜0.05).결론 조기CBP치료유산산중독환자능구감소병사솔.
Objective To observe the therapeutic effect of early continuous blood purification (CBP) on lactic acidosis patients.Methods Using prospective randomized study method,41 patients with lactic acidosis in intensive care unit (ICU) from January 2010 to April 2012 were randomly divided into CBP group (n=21) and control group (n =20).Among them,blood gas analysis,lactic acid,blood biochemistry were prospectively monitored at the time before treatment,12,24 and 72 hours after treatment.They were also evaluated with acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,and length of stay in ICU and mortality in 28 days were recorded.Results Lactic acid level and APACHE Ⅱ score were gradually decreased after treatment in both groups.Compared with control group,lactic acid (mmol/L) at 12,24 and 72 hours in CBP group was obviously lowered (12 hours:8.23 ± 3.94 vs.12.47 ±4.62,24 hours:4.46 ± 1.57 vs.10.54 ±3.48,72 hours:2.69 ±1.03 vs.5.74 ± 1.56,all P＜0.01),while the APACHE Ⅱ score at 12,24 and 72 hours in CBP group was also significantly lowered (12 hours:18.23 ± 5.85 vs.21.64 ±5.38,24 hours:16.49 ±4.62 vs.20.61 ±5.71,72 hours:11.54 ±3.67 vs.16.02 ±4.34,all P＜0.05).Compared with control group,length of stay in ICU (days) was also significantly shorter in CBP group (6.58 ± 3.45 vs.11.65 ± 4.94,P＜0.05),and 28-day mortality was significantly lower in CBP group (23.8％ vs.45.0％,P＜0.05).Conclusion Early correction of lactic acidosis with CBP could reduce the mortality of lactic acidosis.
