限制性补充碳酸氢钠对二甲双胍相关糖尿病乳酸酸中毒患者的救治

Limited Supply of NaHCO3 for Diabetes Patients with Metformin Associated Lactic Acidosis

目的探讨糖尿病患者口服二甲双胍相关乳酸酸中毒的临床表现及患者对碳酸氢钠治疗的反应。方法选取我科2010年收治的5例二甲双胍相关乳酸酸中毒的糖尿病患者,回顾性分析患者的临床表现、治疗及转归。结果 5例患者糖尿病病程为5～20年,均服用二甲双胍类降糖药物,均以恶心、呕吐、腹胀等消化道症状为首要表现,严重者出现血压下降及多脏器功能损害。实验室检查显示:pH值明显下降,乳酸水平和阴离子间隙明显增高。患者经限制性补充碳酸氢钠、补液、维持组织灌注、抗感染等治疗后均痊愈出院。结论糖尿病二甲双胍相关乳酸酸中毒患者需要综合治疗,其中限制性补充碳酸氢钠可取得较好效果。

Objective To study the clinical features of metformin associated lactic acidosis in diabetes patients and their response to NaHCO3 treatment.Methods Clinical features,treatment and outcome of five diabetes patients with metformin associated lactic acidosis admitted to our department in 2010 were retrospectively analyzed.Results The diabetes courses of the five cases were five years to 20 years and all of them had been taking metformin with primary manifestations of digestive symptoms like retching,vomiting and abdominal distension.The severe cases had hypotension and multi-organ injuries.Laboratory test showed that pH decreased significantly,lactate level and anion gap（AG） increased significantly.All the patients recovered and discharged after limited supply of NaHCO3 and fluid,tissue maintaining perfusion and anti-infection treatment.Conclusion Diabetes patients with metformin associated lactic acidosis should be treated comprehensively and limited supply of NaHCO3 can achieve satisfactory efficacy.