Funk Georg Christian, Doberer Daniel, Kneidinger Nikolaus, Lindner Gregor, Holzinger Ulrike, Schneeweiss Bruno
Department of Respiratory and Critical Care Medicine, Otto Wagner Spital, Vienna, Austria.
Liver Int. 2007 Sep;27(7):901-9. doi: 10.1111/j.1478-3231.2007.01510.x.
BACKGROUND/AIMS: The equilibrium of offsetting metabolic acid-base disorders in stable cirrhosis might be lost during episodes of hepatic decompensation, haemorrhage or sepsis. The purpose of this study was to determine whether the acid-base state is destabilized in critically ill patients with cirrhosis and whether this is associated with mortality.
One-hundred and eighty-one consecutive patients with cirrhosis were investigated in a prospective observational cohort study on admission to a medical intensive care unit (ICU) of a university hospital. Arterial acid-base state was assessed according to the Gilfix methodology. Clinical data, ICU mortality and hospital mortality were recorded.
Patients had net metabolic acidosis owing to unmeasured anions and owing to hyperchloraemic, dilutional and lactic acidosis. Lactic acidosis, acidemia and acute renal failure on ICU admission were associated with increased mortality. Lactate and pH discriminated survivors from non-survivors. The presence of lactic acidosis could not always be recognized by customary acid-base parameters.
The stable equilibrium of acid-base disorders is lost when patients with cirrhosis become critically ill. Lactic acidosis and acidaemia are associated with increased ICU mortality caused by severe underlying organ dysfunction.
背景/目的：在肝硬化失代偿、出血或脓毒症发作期间，稳定期肝硬化中抵消性代谢酸碱紊乱的平衡可能会丧失。本研究的目的是确定肝硬化重症患者的酸碱状态是否不稳定，以及这是否与死亡率相关。
在一项前瞻性观察队列研究中，对一家大学医院内科重症监护病房（ICU）收治的181例连续肝硬化患者进行了调查。根据吉尔菲克斯方法评估动脉酸碱状态。记录临床数据、ICU死亡率和医院死亡率。
患者因未测定阴离子、高氯性、稀释性和乳酸性酸中毒而存在净代谢性酸中毒。入住ICU时的乳酸性酸中毒、酸血症和急性肾衰竭与死亡率增加相关。乳酸和pH值可区分存活者和非存活者。常规酸碱参数并不总能识别乳酸性酸中毒的存在。
肝硬化患者病情危重时，酸碱紊乱的稳定平衡会丧失。乳酸性酸中毒和酸血症与严重潜在器官功能障碍导致的ICU死亡率增加相关。
