Morgera S, Heering P, Szentandrasi T, Manassa E, Heintzen M, Willers R, Passlick-Deetjen J, Grabensee B
Department of Nephrology, Heinrich-Heine University, Düsseldorf, Germany.
Ren Fail. 1997 Jan;19(1):155-64. doi: 10.3109/08860229709026270.
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.
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。
