中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2014年
11期
1263-1267
,共5页
彭绵%方伟强%蔡举瑜%简小莉
彭綿%方偉彊%蔡舉瑜%簡小莉
팽면%방위강%채거유%간소리
持续静脉-静脉血液滤过%持续静脉-静脉血液透析%乳酸酸中毒
持續靜脈-靜脈血液濾過%持續靜脈-靜脈血液透析%乳痠痠中毒
지속정맥-정맥혈액려과%지속정맥-정맥혈액투석%유산산중독
Continuous venous-venous hemofiltration%Continuous venous-venous hemodialysis%Lactic acidosis
目的 比较持续静脉-静脉血液滤过(CVVH)和持续静脉-静脉血液透析(CVVHD)两种肾脏替代治疗方法对乳酸酸中毒纠正的效果.方法 采用前瞻性随机对照的研究方法,选择2009年4月到2013年4月期间在香港大学深圳医院及汕头大学医学院第一附属医院重症监护科(ICU)住院的危重症患者137例.入选标准:符合乳酸酸中毒诊断的患者.排除标准:晚期恶性肿瘤患者和临终状态者.按随机对照的原则,将137例入选患者分为两组,其中接受持续静脉-静脉血液滤过治疗组70例,接受持续静脉-静脉血液透析治疗组67例.两组患者均在CRRT治疗前及治疗后4、8、12、24、48 h监测血乳酸及动脉血气,统计两组患者的住院病死率及ICU留治时间.统计使用SPSS 15.0统计分析软件.结果 相同剂量的CVVH和CVVHD在清除血乳酸的效率[血乳酸水平治疗后4 h (11.65±3.39) mmol/L vs.(11.12±2.65) mmol/L;8 h(8.78 ±2.35)mmol/L vs.(8.59 ±2.09) mmol/L; 12 h(6.91±1.67) mmol/L vs.(6.74±1.76) mmol/L; 24 h(1.66±0.39) mmol/L vs.(1.51 ±0.30) mmoL/L; 48 h(0.95±0.24) mmol/L vs.(0.66 ±0.20)mmol/L,P＞0.05]及对pH值的影响[pH值治疗后4 h(6.93±0.14) vs.(7.05±0.09);8 h(7.04±0.10) vs.(7.12±0.05);12h (7.13±0.07) vs.(7.20±0.04); 24 h(7.30±0.03)vs.(7.38 ±0.04);48 h(7.41 ±0.03) vs.(7.46 ±0.02),P＞ 0.05]方面差异无统计学意义,CVVH和CVVHD两组患者的住院病死率(11.4％ vs.10.4％,P=0.854)及存活患者的ICU留治时间[(9.5±2.4) dvs.(8.8±2.9)d,P=0.329],差异亦无统计学意义.结论 CVVH和CVVHD两种方式的持续血液净化均能有效清除患者的血乳酸,纠正患者的酸碱平衡失调;两种方式对患者留治ICU的时间及住院病死率的影响无明显差别.
目的 比較持續靜脈-靜脈血液濾過(CVVH)和持續靜脈-靜脈血液透析(CVVHD)兩種腎髒替代治療方法對乳痠痠中毒糾正的效果.方法 採用前瞻性隨機對照的研究方法,選擇2009年4月到2013年4月期間在香港大學深圳醫院及汕頭大學醫學院第一附屬醫院重癥鑑護科(ICU)住院的危重癥患者137例.入選標準:符閤乳痠痠中毒診斷的患者.排除標準:晚期噁性腫瘤患者和臨終狀態者.按隨機對照的原則,將137例入選患者分為兩組,其中接受持續靜脈-靜脈血液濾過治療組70例,接受持續靜脈-靜脈血液透析治療組67例.兩組患者均在CRRT治療前及治療後4、8、12、24、48 h鑑測血乳痠及動脈血氣,統計兩組患者的住院病死率及ICU留治時間.統計使用SPSS 15.0統計分析軟件.結果 相同劑量的CVVH和CVVHD在清除血乳痠的效率[血乳痠水平治療後4 h (11.65±3.39) mmol/L vs.(11.12±2.65) mmol/L;8 h(8.78 ±2.35)mmol/L vs.(8.59 ±2.09) mmol/L; 12 h(6.91±1.67) mmol/L vs.(6.74±1.76) mmol/L; 24 h(1.66±0.39) mmol/L vs.(1.51 ±0.30) mmoL/L; 48 h(0.95±0.24) mmol/L vs.(0.66 ±0.20)mmol/L,P＞0.05]及對pH值的影響[pH值治療後4 h(6.93±0.14) vs.(7.05±0.09);8 h(7.04±0.10) vs.(7.12±0.05);12h (7.13±0.07) vs.(7.20±0.04); 24 h(7.30±0.03)vs.(7.38 ±0.04);48 h(7.41 ±0.03) vs.(7.46 ±0.02),P＞ 0.05]方麵差異無統計學意義,CVVH和CVVHD兩組患者的住院病死率(11.4％ vs.10.4％,P=0.854)及存活患者的ICU留治時間[(9.5±2.4) dvs.(8.8±2.9)d,P=0.329],差異亦無統計學意義.結論 CVVH和CVVHD兩種方式的持續血液淨化均能有效清除患者的血乳痠,糾正患者的痠堿平衡失調;兩種方式對患者留治ICU的時間及住院病死率的影響無明顯差彆.
목적 비교지속정맥-정맥혈액려과(CVVH)화지속정맥-정맥혈액투석(CVVHD)량충신장체대치료방법대유산산중독규정적효과.방법 채용전첨성수궤대조적연구방법,선택2009년4월도2013년4월기간재향항대학심수의원급산두대학의학원제일부속의원중증감호과(ICU)주원적위중증환자137례.입선표준:부합유산산중독진단적환자.배제표준:만기악성종류환자화림종상태자.안수궤대조적원칙,장137례입선환자분위량조,기중접수지속정맥-정맥혈액려과치료조70례,접수지속정맥-정맥혈액투석치료조67례.량조환자균재CRRT치료전급치료후4、8、12、24、48 h감측혈유산급동맥혈기,통계량조환자적주원병사솔급ICU류치시간.통계사용SPSS 15.0통계분석연건.결과 상동제량적CVVH화CVVHD재청제혈유산적효솔[혈유산수평치료후4 h (11.65±3.39) mmol/L vs.(11.12±2.65) mmol/L;8 h(8.78 ±2.35)mmol/L vs.(8.59 ±2.09) mmol/L; 12 h(6.91±1.67) mmol/L vs.(6.74±1.76) mmol/L; 24 h(1.66±0.39) mmol/L vs.(1.51 ±0.30) mmoL/L; 48 h(0.95±0.24) mmol/L vs.(0.66 ±0.20)mmol/L,P＞0.05]급대pH치적영향[pH치치료후4 h(6.93±0.14) vs.(7.05±0.09);8 h(7.04±0.10) vs.(7.12±0.05);12h (7.13±0.07) vs.(7.20±0.04); 24 h(7.30±0.03)vs.(7.38 ±0.04);48 h(7.41 ±0.03) vs.(7.46 ±0.02),P＞ 0.05]방면차이무통계학의의,CVVH화CVVHD량조환자적주원병사솔(11.4％ vs.10.4％,P=0.854)급존활환자적ICU류치시간[(9.5±2.4) dvs.(8.8±2.9)d,P=0.329],차이역무통계학의의.결론 CVVH화CVVHD량충방식적지속혈액정화균능유효청제환자적혈유산,규정환자적산감평형실조;량충방식대환자류치ICU적시간급주원병사솔적영향무명현차별.
Objective To investigate the effect of continuous venous-venous hemofiltration (CVVH) and continuous venous-venous hemodialysis (CVVHD) on patients with lactic acidosis.Methods A total of 137 cases with lactic acidosis were included in this prospective randomized control study.lhe patients were collected from the University of Hong Kong-shenzhen Hospitall and the First Affiliated Hospital of Shantou University Medical College from April 2009 to April 2013.Inclusion criteria were patients with lactic acidosis.Exclusion criteria were patients with end-stage malignancy or terminal stage of illnesses.The patients were randomly divided into two groups:CVVH group and CVVHD group,and patients of both group were intervened with conventional treatments as well.For each group,the lactic acid and blood gas analysis were tested before CRRT,and at 4 hours,8 hours,12 hours,24 hours,and 48 hours of CRRT.The patients' mortality and length of ICU stay time were analysed and recorded.Statistical analysis was performed using SPSS 15.0software.Results When the length of time for treatment was the same,the efficacy between CVVH group and CVVHD group showed no difference in blood lactic acid level [4 h:(11.65 ± 3.39) mmol/L vs.(11.12±2.65) mmol/L; 8 h:(8.78±2.35) mmol/L vs.(8.59±2.09) mmol/L; 12 h:(6.91 ±1.67)mmol/Lvs.(6.74±1.76) mmol/L;24h:(1.66±0.39) mmol/Lvs.(1.51±0.30) mmol/L; 48 h:(0.95 ±0.24) mmol/L vs.(0.66 ±0.20) mmol/L,P ＞ 0.05) and pH value [4 h:(6.93 ±0.14) vs.(7.05±0.09);8h:(7.04±0.10)vs.(7.12±0.05); 12h:(7.13±0.07)vs.(7.20±0.04);24h:(7.30±0.03) vs.(7.38±0.04); 48h:(7.41 ±0.03) vs.(7.46±0.02),P＞ 0.05].There are also no difference in the hospital mortality (11.4％ vs.10.4％,P=0.854) and length ofICU stay time [(9.5 ±2.4) d vs.(8.8 ± 2.9) d,P =0.329].Conclusions Both CVVH and CVVHD can effectively correct hyperlactemia,enhance acid-base balance,contributing no differences in length of ICU stay time and patients' hospital mortality.
