CAJ | 학술논문

目的探讨非典型儿童Ⅰ型糖尿病酮症酸中毒(diabetes ketone acidosis,DKA)的病例特点,提高诊断率,减少误诊发生.方法选择1996年至2011年我院诊治的31例儿童Ⅰ型DKA患儿,将其分为典型组19例和非典型组12例,比较两组患儿的临床特征、实验室检查及治疗转归.结果典型组19例,均表现为多饮、多尿、多食,体重减轻;首诊确诊17例,确诊率89.4％,3天确诊率100.0％;典型组2例误诊疾病中,误诊为急性胃肠炎1例,误诊为败血症1例.非典型组12例中,表现为昏迷者3例,腹泻4例,疲乏、无力伴厌食9例,腹痛4例,不规则深长呼吸6例,不同程度脱水征12例,面色青灰、四肢厥冷1例,消瘦11例,12例病例均不明显出现多饮、多尿、多食;首诊确诊2例,确诊率16.7％.结论儿童Ⅰ型DKA容易造成误诊,误诊原因与对糖尿病认识不足和儿童DKA早期症状不典型以及医生询问病史不详细有关.增强对儿童DKA的认识和警惕,结合必要的辅助检查,可提高正确诊断率,减少误诊.
목적 탐토비전형인동Ⅰ형당뇨병동증산중독(diabetes ketone acidosis,DKA)적병례특점,제고진단솔,감소오진발생.방법 선택1996년지2011년아원진치적31례인동Ⅰ형DKA환인,장기분위전형조19례화비전형조12례,비교량조환인적림상특정、실험실검사급치료전귀.결과 전형조19례,균표현위다음、다뇨、다식,체중감경;수진학진17례,학진솔89.4％,3천학진솔100.0％;전형조2례오진질병중,오진위급성위장염1례,오진위패혈증1례.비전형조12례중,표현위혼미자3례,복사4례,피핍、무력반염식9례,복통4례,불규칙심장호흡6례,불동정도탈수정12례,면색청회、사지궐랭1례,소수11례,12례병례균불명현출현다음、다뇨、다식;수진학진2례,학진솔16.7％.결론 인동Ⅰ형DKA용역조성오진,오진원인여대당뇨병인식불족화인동DKA조기증상불전형이급의생순문병사불상세유관.증강대인동DKA적인식화경척,결합필요적보조검사,가제고정학진단솔,감소오진.
Objective To explore the features of children with atypical type Ⅰ diabetic ketoacidosis (DKA),and to improve the diagnostic rate and reduce misdiagnosis.Methods 31 pediatric patients with type Ⅰ DKA who had been treated during the period of 1996 to 2011 in our iospital were divided into typical group (n=19) and atypical group (n=12).Clinical features,laboratory findings,and treatment outcomes were compared between the two groups.Results In the typical group,the diagnosis was confirmed in 17 of the 19 patients who developed symptoms of polydipsia,polyuria,polyphagia,and weight loss at the first visit with a rate of 89.4％ and in 100％ of the patients within three days.For the two patients who were misdiagnosed,one was diagnosed as acute gastroenteritis and the other as septicemia.In the atypical group,3 of the 12 patients occurred coma,4 developed diarrhea,9 had fatigue,weakness,and anorexia,4 had abdominal pain,6 developed irregular deep breathing,12 had dehydration at varying degrees,one had gray complexion with peripheral coldness,and 11 had weight loss all of the 12 patients did not occurred obvious polydipsia,polyuria,and polyphagia,and the diagnosis was confirmed only in two patients at the first visit,with a rate of 16.7％.Conclusions Type Ⅰ DKA of children is easily misdiagnosed.Misdiagnosis causes relate with lack of the knowledge about diabetes,atypical symptoms of child DKA,and no detail of diabetes history.Enhancing the awareness and vigilance of child DKA,combined with the necessary auxiliary examinations,can increase the rate of correct diagnosis and reduce misdiagnosis.