急性肾衰竭患者中基于乳酸盐与基于醋酸盐的血液滤过置换液的比较。

Comparison of a lactate-versus acetate-based hemofiltration replacement fluid in patients with acute renal failure.

作者信息

Morgera S, Heering P, Szentandrasi T, Manassa E, Heintzen M, Willers R, Passlick-Deetjen J, Grabensee B

机构信息

Department of Nephrology, Heinrich-Heine University, Düsseldorf, Germany.

出版信息

Ren Fail. 1997 Jan;19(1):155-64. doi: 10.3109/08860229709026270.

DOI:10.3109/08860229709026270

PMID:9044462

Abstract

The objective of the study was to determine the impact of a lactate- and an acetate-based hemofiltration replacement fluid (HF) on the acid-base status in patients with acute renal failure (ARF) and continuous venovenous hemofiltration (CVVH). The prospective, cohort study was carried out in the intensive care unit of the Heinrich-Heine University Hospital, Düsseldorf, FRG. Subjects were 84 critically ill patients with ARF and CVVH. Fifty-two patients were subjected to lactate-based (group 1) and 32 to acetate-based hemofiltration (group 2). Thirty-eight patients had a septic, 46 a cardiovascular origin of the ARF. Creatinine, BUN, serum bicarbonate, arterial pH, lactate and APACHE II score were noted daily. Mean CVVH duration was 9.8 +/- 8.1 days; mortality was 65%. The groups did not differ with regard to the main clinical parameters. Lacate-based hemofiltration led to significantly higher serum bicarbonate and arterial pH values as compared to the acetate-based hemofiltration. Baseline serum bicarbonate values were 23.3 +/- 8.3 mmol/L in group 1 and 21.6 +/- 4.3 mmol/L in group 2 (NS); values at 48 h after initiating CVVH treatment were 25.7 +/- 3.8 mmol/L and 20.6 +/- 3.1 mmol/L, respectively (p < 0.001). Arterial pH prior to CVVH treatment was 7.36 +/- 0.1 in group 1 and 7.34 +/- 0.1 in group 2 (NS), and 7.43 +/- 0.07 versus 7.37 +/- 0.06 (p < 0.001) on day 2. These findings were maintained throughout therapy. While a lack of increase in serum bicarbonate and arterial pH was correlated to a poor prognosis in lactate-based hemofiltration, no such observation could be made in acetate-based hemofiltration. Septic patients did not differ in their acid-base status from nonseptic patients. Lactic acidosis occurred in 8 septic patients irrespective of the substitution fluid. All 8 patients died. There was a significant increase in HCO3 and arterial pH values in lactate-based as compared to acetate-based HF.

摘要

本研究的目的是确定基于乳酸盐和基于乙酸盐的血液滤过置换液（HF）对急性肾衰竭（ARF）并接受持续静静脉血液滤过（CVVH）患者酸碱状态的影响。这项前瞻性队列研究在德国杜塞尔多夫海因里希 - 海涅大学医院重症监护病房进行。研究对象为84例患有ARF并接受CVVH的重症患者。52例患者接受基于乳酸盐的血液滤过（第1组），32例接受基于乙酸盐的血液滤过（第2组）。38例患者的ARF源于败血症，46例源于心血管疾病。每天记录肌酐、尿素氮、血清碳酸氢盐、动脉血pH值、乳酸盐和急性生理与慢性健康状况评分系统（APACHE II）评分。平均CVVH持续时间为9.8±8.1天；死亡率为65%。两组在主要临床参数方面无差异。与基于乙酸盐的血液滤过相比，基于乳酸盐的血液滤过导致血清碳酸氢盐和动脉血pH值显著更高。第1组基线血清碳酸氢盐值为23.3±8.3 mmol/L，第2组为21.6±4.3 mmol/L（无统计学差异）；开始CVVH治疗48小时后的数值分别为25.7±3.8 mmol/L和20.6±3.1 mmol/L（p<0.001）。CVVH治疗前第1组动脉血pH值为7.36±0.1，第2组为7.34±0.1（无统计学差异），第2天分别为7.43±0.07和7.37±0.06（p<0.001）。这些结果在整个治疗过程中持续存在。在基于乳酸盐的血液滤过中，血清碳酸氢盐和动脉血pH值缺乏升高与预后不良相关，但在基于乙酸盐的血液滤过中未观察到这种情况。败血症患者与非败血症患者的酸碱状态无差异。无论置换液如何，8例败血症患者发生了乳酸酸中毒。所有8例患者均死亡。与基于乙酸盐的HF相比，基于乳酸盐的HF中HCO3和动脉血pH值显著升高。