Vincent J L, Blecic S, Preiser J C, Zhang H
Service des Soins Intensifs, Hôpital Erasme, Bruxelles.
Rev Med Brux. 1993 May;14(5):135-9.
Bicarbonate administration during lactic acidosis seems logical in view of the myocardial depression associated with the decrease in intracellular pH. This treatment has been recently challenged on the basis of observations showing an increase in the veno-arterial gradient for CO2 during acute circulatory failure. The partial transformation of bicarbonate in CO2 carries the risk of aggravating the phenomenon and thereby decreasing intracellular pH. Alternatives to sodium bicarbonate--carbicarb, THAM and dichloroacetate--are discussed.
鉴于乳酸酸中毒时细胞内pH值降低会导致心肌抑制，给予碳酸氢盐似乎是合理的。然而，最近基于急性循环衰竭期间二氧化碳静脉-动脉梯度增加的观察结果，这种治疗方法受到了质疑。碳酸氢盐部分转化为二氧化碳有加重这种现象从而降低细胞内pH值的风险。文中还讨论了碳酸氢钠的替代物——氨基甲酰碳酸氢钠、三羟甲基氨基甲烷和二氯乙酸。
