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目的:探讨二甲双胍诱发糖尿病乳酸性酸中毒(MALA)的临床特点、预测死亡的危险因素和评价血液净化的治疗作用。方法:回顾性分析2003年1月至2013年1月我科收治的二甲双胍诱发MALA患者24例的临床资料。结果:本组入围24例患者死亡率为30%,凝血酶原时间(PT)是死亡的唯一独立危险因素。虽然血液净化组APACHEⅡ评分更高,但是其死亡率与非净化组相似(36.3%vs 30.8%)。结论:MALA死亡的最佳预测因素是评价急性肝功能衰竭的PT,血液净化可能会起到较好的治疗作用。
Objective: To investigate the clinical features of metformin-induced lactic acidosis (MALA) in diabetes mellitus, to predict the risk factors of death and to evaluate the therapeutic effect of blood purification. Methods: The clinical data of 24 patients with MALA induced by metformin in our department from January 2003 to January 2013 were retrospectively analyzed. Results: The mortality of 24 patients was 30%. Prothrombin time (PT) was the only independent risk factor for death. Although the APACHE II score was higher in the blood purification group, its mortality was similar to that of the non-decontamination group (36.3% vs 30.8%). CONCLUSIONS: The best predictor of MALA death is PT for the evaluation of acute liver failure, and blood purification may play a better therapeutic role.