【摘要】 目的:探讨1型糖尿病儿童酮症酸中毒时乳酸酸中毒发生情况,乳酸酸中毒与双胍类药物副作用的关系,双胍类药物在治疗1型糖尿病病人时的乳酸水平。方法:测定1996年2月～1997年10月期间我院住院的1型糖尿病病人入院时乳酸水平,及纠正酸中毒后、双胍药治疗前后乳酸水平。结果:33例病人入院时发生酮症酸中毒的有23例(69.70%,血pH<7.35,尿酮体阳性),乳酸酸中毒1例(3.03%,乳酸>5mmol/L)。高乳酸血症10例(30.30%,乳酸>3mmol/L)。经胰岛素、补液、纠正酸中毒等综合治疗后,酸中毒消失,查肝肾功能等正常,加用双胍类药物(降糖灵29例,二甲双胍4例)。治疗前后血乳酸值差异无显著性(t=1.45,P>0.05)。双胍药治疗前后胰岛素日平均用量与治疗时间呈负相关,(r=-0.9805,t=12.72,P<0.01,回归方程为y=46.17-5.29x)。双胍类降糖药与胰岛素合用可减少胰岛素用量的2/3～3/4。全部病人出院后内分泌门诊随访6个月～2年,无1例出现乳酸酸中毒。结论:1型糖尿病儿童较少发生乳酸酸中毒,严格掌握用药指征,使用双胍类药物可不发生或较少发生乳酸酸中毒,可以安全有效地用于治疗1型糖尿病,从而减少注射胰岛素给病人带来的痛苦,减轻病人的医疗负担。更多还原

【Abstract】 Objective:In order to explore the lactic level and frequency of lactic acidosis (LA) as side effects of biguanide drugs. Methods:33 inpatients of IDDM children were treated with biguanides during Feb. 1996 to Oct. 1997.The dosage of phen-formin was 25 mg tid;or metformin 250 mg tid. Results:Only one case (3% ) had lactic acidosis (lactic level>5 mmol/L); 10 patients (30.3%) had hyperlacticemia (lactic level > 3 mmol/L); 21 patients (63.3%) had diabetes ketoacidosis (DKA). When DKA and LA were abolished with insulin therapy and liver and kidney functions were normal, biguanides had been given to them (phenformin for 29 cases; metformin for 4 cases). Before and after the treatment, the blood lactic levels showed no differences (t = 1.45,P>0.05). Rectilinear correlation analysis showed that there is negative correlation be-tween insulin dosage and time (r= - 0.980 5, P< 0.01) . Combination of biguanide agent and insulin therapy may decrease the dosage of insulin by 2/3 ~ 3/4. Conclusion: IDDM children treated with insulin and biguanide drugs, if dosage of bigua-nide was appropriate (phenformin 75 mg/d, metformin 750 mg/d) the blood lactic level would not be abnormal. Therefore biguanide agents could be a safe, effective treatment for IDDM,and reduced the sufferings caused by insulin injection and cost of medication.更多还原