糖尿病酮症和糖尿病酮症酸中毒的发生及诱发因素的分析

Study on the occurrence and inducement of ketosis and ketoacidosis in patient with diabetes mellitus

目的探讨糖尿病酮症(diabetic ketosis,DK)和糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)患者的发病情况及诱发因素。方法302例DK和DKA患者为研究对象,采用描述性研究方法,调查与分析DK和DKA患者的发病情况及诱发因素。结果302例患者共发生DK和DKA382例次,78.01%的DK和DKA患者有明确诱发因素,感染(55.37%)、胰岛素剂量不足或中断(12.75%)、口服控制血糖药物中断或剂量不足(11.07%)、应激状态(10.40%)为常见的诱发因素,其他因素有饮食失调(6.71%)、过度疲劳(4.36%)、妊娠和分娩(0.67%)。初发糖尿病110例(28.79%),发生1次258例,发生2次29例,发生3次以上14例,发生17次1例。结论应高度重视对DK和DKA患者的诱发因素评估,复习发生前情况,关注导致DK和DKA的诱发因素(感染、中断胰岛素、不合理治疗等)。加强对DK和DKA患者的教育,预防感染,提高患者治疗依从性,坚持注射胰岛素和口服控制血糖药物,对预防、减少DK和DKA的发生有重要意义。

Objective To study the occurrence and the inducements of Ketosls （DK） and Ketoaeidosis （DKA） in Patients with Diabetes Mellitus. Methods 302 diabelic patients with DK and DKA （with the average age of 38.86±17.01 years old, 201 males and 181 females） were studied. The study adopted the descriptive research method, and investigated and analyzed the occurrence and the inducing factors among the patients with DK and DKA. Results 382 times DK and DKA were recorded in the 302 patients. 78.01% cases had a definite cause, comprising the usual inducers infection （55. 37%） including break--off or under--dosage in insulin injection （17.54 %）, break--off or under dosage of the administration of oral hypoglycemic agents （ 11.07 % ）, stringent state （ 10.40 % ） ; and the other inducers including drinking and eating irregularly （6.71 %）, overtiredness（4.36 %）, and gravidity and accouchement （ 0.67 %）. There were 110 cases with primary diabetic. 258 cases suffered from one times, 29 cases with two times, 14 cases over three times, and 1 case with seventeen times. Conclusions To prevent DK and DKA, special attention should be paid to the history of infection, break--off insulin, ir rationality of treatment and related factors that may cause DK and DKA. Education is an important way in helping the patient to learn the knowledge of DK and DKA, prevent infection, and improve the patient＇s ability of perseverance treatment and self management. It also is important to prevent and decrease the occurrence of DK and DKA.