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目的提高对双胍类药物引起的乳酸酸中毒的认识。方法在中国期刊全文数据库中(1994—2007年)检索,对符合诊断标准的41篇病例报告文献进行分析。结果共52例患者,其中苯乙双胍40例,二甲双胍12例,63.5%(33/52)的乳酸酸中毒与超量服用双胍类药物有关。发生乳酸酸中毒后,血乳酸和阴离子间隙显著升高,动脉血pH和HCO_3~-显著下降,死亡组pH值和HCO_3~-较存活组明显下降(P<0.01)。17例死亡者中,11例死于严重休克。结论双胍类药物使用不当是发生乳酸酸中毒的重要原因,代谢性酸中毒伴阴离子间隙增高是此类酸中毒的主要特征,休克是死亡的主要原因。
Objective To improve the knowledge of biguanide-induced lactic acidosis. Methods The Chinese Journal Full-text Database (1994-2007) was searched, and 41 case report documents meeting the diagnostic criteria were analyzed. Results A total of 52 patients, 40 cases of phenformin, metformin in 12 cases, 63.5% (33/52) of lactic acidosis and overdose of biguanide drugs. After lactic acidosis, the gap between blood lactic acid and anion was significantly increased, the arterial blood pH and HCO 3 - decreased significantly, and the pH value and HCO 3 - in the death group were significantly decreased (P <0.01). Of the 17 deaths, 11 died of severe shock. Conclusions The inappropriate use of biguanides is the main reason for lactic acidosis. Metabolic acidosis with an increase of anion gap is the main characteristic of such acidosis. Shock is the main cause of death.