安徽医学
安徽醫學
안휘의학
ANHUI MEDICAL JOURNAL
2014年
7期
931-933
,共3页
糖尿病酮症酸中毒,儿童%胰岛素抵抗%胰岛素%临床分析
糖尿病酮癥痠中毒,兒童%胰島素牴抗%胰島素%臨床分析
당뇨병동증산중독,인동%이도소저항%이도소%림상분석
Diabetic ketoacidosis,children%Insulin resistance%Insulin%Clinical analysis
目的：总结儿童糖尿病酮症酸中毒（diabetic ketoacidosis，DKA）的临床特点及治疗经验。方法回顾性分析30例儿童糖尿病酮症酸中毒患儿的临床表现、实验室检查及治疗方案。结果男性19例，女性11例；1型糖尿病28例，2型糖尿病2例；年龄≤2岁14例（47％），≤5岁4例（13％），≤10岁9例（30％），＞10岁3例（10％）；27例（90％）有明显的皮肤干燥、皮肤弹性减退等脱水表现；有典型的多饮、多尿、多食伴消瘦病例仅10例（33％），且均为1型糖尿病患儿；以呕吐、腹痛等消化道症状起病的13例（43％）；以气促、胸闷症状起病的20例（67％）；8例（27％）表现发热、3例（10％）发生惊厥；30例尿糖及尿酮体均为强阳性，血气分析均提示代谢性酸中毒。30例全部给予液体复苏，普通胰岛素持续静脉滴注，经过积极治疗，30例DKA患儿均恢复出院，未有因并发脑水肿预后不良。结论儿童DKA临床表现复杂多样，无特异性，易漏诊误诊，提高认识、早期诊断、合理治疗是降低DKA致死率的重要途径。
目的：總結兒童糖尿病酮癥痠中毒（diabetic ketoacidosis，DKA）的臨床特點及治療經驗。方法迴顧性分析30例兒童糖尿病酮癥痠中毒患兒的臨床錶現、實驗室檢查及治療方案。結果男性19例，女性11例；1型糖尿病28例，2型糖尿病2例；年齡≤2歲14例（47％），≤5歲4例（13％），≤10歲9例（30％），＞10歲3例（10％）；27例（90％）有明顯的皮膚榦燥、皮膚彈性減退等脫水錶現；有典型的多飲、多尿、多食伴消瘦病例僅10例（33％），且均為1型糖尿病患兒；以嘔吐、腹痛等消化道癥狀起病的13例（43％）；以氣促、胸悶癥狀起病的20例（67％）；8例（27％）錶現髮熱、3例（10％）髮生驚厥；30例尿糖及尿酮體均為彊暘性，血氣分析均提示代謝性痠中毒。30例全部給予液體複囌，普通胰島素持續靜脈滴註，經過積極治療，30例DKA患兒均恢複齣院，未有因併髮腦水腫預後不良。結論兒童DKA臨床錶現複雜多樣，無特異性，易漏診誤診，提高認識、早期診斷、閤理治療是降低DKA緻死率的重要途徑。
목적：총결인동당뇨병동증산중독（diabetic ketoacidosis，DKA）적림상특점급치료경험。방법회고성분석30례인동당뇨병동증산중독환인적림상표현、실험실검사급치료방안。결과남성19례，녀성11례；1형당뇨병28례，2형당뇨병2례；년령≤2세14례（47％），≤5세4례（13％），≤10세9례（30％），＞10세3례（10％）；27례（90％）유명현적피부간조、피부탄성감퇴등탈수표현；유전형적다음、다뇨、다식반소수병례부10례（33％），차균위1형당뇨병환인；이구토、복통등소화도증상기병적13례（43％）；이기촉、흉민증상기병적20례（67％）；8례（27％）표현발열、3례（10％）발생량궐；30례뇨당급뇨동체균위강양성，혈기분석균제시대사성산중독。30례전부급여액체복소，보통이도소지속정맥적주，경과적겁치료，30례DKA환인균회복출원，미유인병발뇌수종예후불량。결론인동DKA림상표현복잡다양，무특이성，역루진오진，제고인식、조기진단、합리치료시강저DKA치사솔적중요도경。
Objective To summarize the clinical characteristics and therapy experiences of children diabetic ketoacidosis (DKA). Methods A retrospectively analysis of clinical data,including clinical manifestations and examinations,and treatments,from thirty pediatric DKA patients in endocrinology department of Anhui provincial children’s hospital during five years from February 2009 to March 2014 was performed.Results In the total thirty children patients,19 patients were male and 1 1 patients were female.Twenty eight patients wete typeⅠdiabetes and only two patients were typeⅡdiabetes.The ages of fourteen patients (47%)were less or equal to two years.The ages of four patients (13%)between two to five years,nine patients (30%)between five to ten years and three patients (10%)older than ten years. Twenty seven patients (90%)had signs of xerosis cutis and reduction of skin elasticity.Ten patients (33%)had the classic symptoms of e-maciation accompanied by polydipsia,polyphagia and polyuria and they all are typeⅠdiabetes.Thirteen patients began with symptom of diges-tive tract including vomiting and abdominal pain,tweenty patients began with tachypnea and dyspnea eight patients (27%)began with fever and three patients (10%)began with convulsion.All thirty cases had urine glucose,urinary ketone bodies positive and metabolic acidosis. They were all treated by resuscitate of liquid and continuous intravenous injection of insulin.After energetic treatment,all DKA children recov-ered well and nones of them had poor prognosis such as cerebral edema.Conclusion Symptoms of children DKA are varied and complex and have nospecificities.So it is easy to make missed and mistake diagnosis.Awareness raising,early diagnosis and energetic treatedment are im-portant means to reduce the lethality of children DKA.
