实用临床医学
實用臨床醫學
실용림상의학
Practical Clinical Medicine
2014年
2期
10-12
,共3页
重症%糖尿病酮症酸中毒%胰岛素
重癥%糖尿病酮癥痠中毒%胰島素
중증%당뇨병동증산중독%이도소
severe%diabetic ketoacidosis%insulin
目的：探讨重症糖尿病酮症酸中毒（DKA）的救治方法。方法对20例重症DKA患者的临床资料进行回顾性分析。探讨其起病诱因及治疗方法。结果20例重症DKA中，发病诱因不是单一的，最常见的诱因是感染。均采用小剂量胰岛素持续静脉滴注，积极纠正水、电解质紊乱及加强抗感染治疗，16例（80%）患者在24 h内临床症状缓解，血糖降至8.0～10.0 mmol·L-1，尿酮、血酮转阴，pH＞7.3，电解质恢复正常，神志转清，能正常进餐；2例（10%）于治疗后第2天达到上述标准。18例患者均治愈出院。2例死亡（均合并重症肺炎），病死率为10.0%。结论积极防治诱因、综合治疗，是防治重症DKA的关键；对急性脑水肿、急性呼吸窘迫综合征等要及早预防。
目的：探討重癥糖尿病酮癥痠中毒（DKA）的救治方法。方法對20例重癥DKA患者的臨床資料進行迴顧性分析。探討其起病誘因及治療方法。結果20例重癥DKA中，髮病誘因不是單一的，最常見的誘因是感染。均採用小劑量胰島素持續靜脈滴註，積極糾正水、電解質紊亂及加彊抗感染治療，16例（80%）患者在24 h內臨床癥狀緩解，血糖降至8.0～10.0 mmol·L-1，尿酮、血酮轉陰，pH＞7.3，電解質恢複正常，神誌轉清，能正常進餐；2例（10%）于治療後第2天達到上述標準。18例患者均治愈齣院。2例死亡（均閤併重癥肺炎），病死率為10.0%。結論積極防治誘因、綜閤治療，是防治重癥DKA的關鍵；對急性腦水腫、急性呼吸窘迫綜閤徵等要及早預防。
목적：탐토중증당뇨병동증산중독（DKA）적구치방법。방법대20례중증DKA환자적림상자료진행회고성분석。탐토기기병유인급치료방법。결과20례중증DKA중，발병유인불시단일적，최상견적유인시감염。균채용소제량이도소지속정맥적주，적겁규정수、전해질문란급가강항감염치료，16례（80%）환자재24 h내림상증상완해，혈당강지8.0～10.0 mmol·L-1，뇨동、혈동전음，pH＞7.3，전해질회복정상，신지전청，능정상진찬；2례（10%）우치료후제2천체도상술표준。18례환자균치유출원。2례사망（균합병중증폐염），병사솔위10.0%。결론적겁방치유인、종합치료，시방치중증DKA적관건；대급성뇌수종、급성호흡군박종합정등요급조예방。
Objective To explore the emergency treatment of severe diabetic ketoacidosis (DKA). Methods Clinical data of 20 patients were reviewed to analyze the cause and treatment of severe DKA. Results Severe DKA was induced by various causes and the most common cause of severe DKA was infection. After treatment with continuous infusion of small doses of insulin, correction of water-electrolyte imbalance and strengthening of anti-infection measures ,16 patients (80%)achieved clinical remission within 24 hours (8.0<blood glucose <10.0 mmol·L-1,negative results for blood and urine ketone tests, pH>7.3,normal electrolytes,clear consciousness, and normal eating),and 2 patients(10%) achieved clinical remission based on the above criteria on the second day.Among the 20 patients, 18 were cured and discharged from hospital,and 2 died from the complication of severe pneumonia case fatality rate of 10.0%.Conclusion Active prevention and comprehensive treatment are the key to the prevention and treatment of severe DKA.In addition,acute cerebral edema and acute respiratory distress syndrome must be prevented and treated as early as possible.
