早期纠正慢性肾脏病患者代谢性酸中毒的临床意义

Clinical Significance of Early Correction of Metabolic Acidosis in Patients with Chronic Kidney Disease

目的探讨早期纠正慢性肾脏病患者代谢性酸中毒的临床意义。方法将该院于2014年1月—2014年12月收治的符合慢性肾脏病2、3期且TCO2〉22 mmol/L的80例患者随机分为治疗组和对照组。对照组给予常规治疗,治疗组在对照组的基础上给予Na HCO3片1.0~1.5 g/d,分次口服,同时给予产碱的水果蔬菜。主要观察指标为血尿素氮、血肌酐、血p H值、血TCO2、电解质及血压。结果治疗组血p H值、血TCO2有所提高,血尿素氮、血肌酐略有升高,但差异无统计学意义。对照组血p H值、血TCO2进一步下降,血尿素氮、血肌酐明显升高,差异有统计学意义。两组治疗前后电解质、血压均无明显变化。结论Na HCO3片和产碱的水果蔬菜饮食疗法能纠正血浆TCO2〉22 mmol/L慢性肾脏病患者的代谢性酸中毒,并延缓肾功能进展,具有肾脏保护作用,且不引起电解质紊乱及血压升高。

Objective To study the clinical effect of early correction of metabolic acidosis in patients with chronic kidney disease（CKD）. Methods A total of 80 patients from 2014 January to 2014 December in our hospital with CKD at stages II-III and TCO222mmol/L were enrolled in the study. The patients were randomly divided into treatment group and control group. The control group was given conventional treatment. The treatment group was given Na HCO31.0 ~1.5 g/d and alkali production of fruits and vegetables based on conventional treatment. The main parameters including serum urea nitrogen, serum creatinine, PH value,TCO2, electrolyte and blood pressure were measured. Results The PH, TCO2, blood urea nitrogen, and serum creatinine slightly improved in treatment group, but there was no significant difference. The p H value and TCO2 fell further and serum urea nitrogen and serum creatinine significantly improved. There was significant difference after treatment. There were no obvious changes in electrolytes and blood pressure before and after treatment between two groups. Conclusion Bicarbonate and diet therapy can correct metabolic acidosis in patients with CKD and TCO2 〉22mmol/L.They can delay the progress of renal function and have renal protection effect, and do not cause electrolyte disorders and high blood pressure.