Potin M, Perret C
Département de médecine, Centre hospitalier universitaire vaudois, Lausanne, Suisse.
Rev Prat. 1990 Oct 1;40(22):2042-6.
Lactic acidosis is a relatively frequent acid-base disorder in a hospital setting. It is defined by the association of an arterial pH inferior to 7.35 and an arterial lactate level superior to 5 mmol/l. Classically, 2 types of acidosis are distinguished on the basis of their mechanisms of onset: the type A, with evident clinical signs of tissue hypoperfusion and the type B, more are, without apparent hypoxia. This last category is observed in various circumstances such as diabetes, acute liver failure, poisoning and, more rarely, inborn errors of carbohydrate metabolism. Treatment aims primarily at the correction of the cause. The efficacy of sodium bicarbonate is presently debated, considering the risk to worsen hyperlactatemia and to induce hyperosmolarity or rebound alkalosis. The administration of dichloroacetate, an activator of pyruvate dehydrogenase, permits to correct partially the lactic acidosis but is not harmless especially in case of prolonged administration. Other therapeutic modalities are evoked. Arterial lactate level is a reliable prognostic index of shock, because blood values do not depend only of the oxygen debt but also of the efficacy of hepatic and renal lactate uptake. Sequential measurements are recommended.
乳酸酸中毒是医院环境中较为常见的酸碱紊乱。它的定义是动脉血pH值低于7.35且动脉血乳酸水平高于5 mmol/L。传统上，根据酸中毒的发病机制可分为两种类型：A型，伴有明显的组织灌注不足临床体征；B型，多无明显缺氧表现。最后这种类型可见于多种情况，如糖尿病、急性肝衰竭、中毒，以及较少见的碳水化合物代谢先天性缺陷。治疗主要针对病因。目前对于碳酸氢钠的疗效存在争议，因为其有使高乳酸血症恶化以及诱发高渗或反跳性碱中毒的风险。给予丙酮酸脱氢酶激活剂二氯乙酸可部分纠正乳酸酸中毒，但并非无害，尤其是长期使用时。还提及了其他治疗方式。动脉血乳酸水平是休克的可靠预后指标，因为血液中的乳酸值不仅取决于氧债，还取决于肝脏和肾脏摄取乳酸的效率。建议进行连续测量。
