糖尿病酮症酸中毒122例的急救处理

Clinical analysis of first-aid treatment in 122 cases with diabetic ketoacidosis

目的通过抢救122例糖尿病酮症酸中毒患者,探讨临床抢救方法。方法回顾笔者所在医院2011年1~12月收治的122例糖尿病酮症酸中毒患者临床资料,进行再分析,观察治疗经过、临床症状及运用胰岛素、补液、补碱治疗效果。结果经过积极抢救治疗,110例（90.16%）患者于2~20h内下降,12例（9.84%）于24~54h内下降,控制在8~13.9mol/L范围内;114例于24h内酮体消失,6例于5~6d内酮体消失,死亡2例;101例患者于24h内纠正酸中毒,19例于30~72h内纠正;死亡2例,均死于感染性休克、心律失常。结论糖尿病酮症酸中毒,只要是合理治疗诱因,积极预防并发症出现,发病后,积极补液扩容、持续小剂量胰岛素滴注、配合补碱和补钾,可以提高抢救成功率。抢救过程中,要根据患者实际变化,灵活掌握。

Objective To explore clinical rescue methods through 122 cases with diabetic ketoacidosis. Methods The clinical data of 122 cases with diabetic ketoacidosis who lived in our hospital from January to December 2011 were selected and analyzed retrospectively,observed the efficacy of the treatment process,clinical shymptoms,the use of insulin,rehydration,supplement alkali treatment. Results After aggressive salvage treatment,110 （90.16%） patients had decreased within 2-20 h,12（9.84%）patients had decreased within 24-54 h,controlled it within 8-13.9 mol/L;ketone bodies of 114 cases had disappeared within 24 h,and 6 cases had disappeared within 5-6 d;101 cases had been corrected the acidosis within 24 h,19 cases within 30-72 h,2 cases died;all dead cases because of septic shock and cardiac arrhythmia. Conclusion For diabetic ketoacidosis,it can improve the success rate if the incentive is treated reasonably and prevent complications actively,after the onset,give fluid expansion positively,continuous low-dose insulin infusion,give complement alkali and potassium . In rescue process,according to the patients＇ actual situation,changes methods flexibility.