糖尿病酮症酸中毒21例救治探讨

Clinical Analysis of 21 Cases of Diabetic Ketoacidosis

目的:探讨糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)抢救过程中的经验和体会。方法:对21例DKA患者的临床资料进行分析,21例酮症酸中毒患者经积极抢救治疗,在补液、祛除诱因及纠正电解质紊乱、酸碱平衡等治疗的基础上均给予小剂量普通胰岛素静脉滴注;治疗时小心处理液体和电解质的紊乱,严密监护有关并发症的临床和生化参数,包括低血钾,低血糖、脑水肿等,及时调整胰岛素的静脉输入量。随着酸中毒的的改善病情稳定后,胰岛素的静脉输入改为三餐前皮下注射,控制血糖浓度在8.3～13.9 mmol.L-1。结果:经综合治疗后,21例患者各项指标在3天内恢复至正常范围,治疗取得了良好的效果。结论:DKA的救治是个综合的过程,适时、合理的补液和使用胰岛素、抗感染、纠正酸中毒及电解质平衡紊乱对提高DKA的救治成功率具有重要的临床意义。

Objective： To investigate the experience and comprehension on diabetic ketoaeidosis （DKA） patients with comprehensive salvage. Methods： Clinical data of 21 patients with diabetic ketoacidosis （DKA） were analyzed. All DKA patients were given comprehensive treatment. Such as fluid infusion, elimination of incentives, correction of electrolyte disturbances and acid-base balance. In the same time, Low-dose insulin infusion was given to them. Management requires careful replacement of fluid and electrolyte deficits, intravenous administration of insulin, and closes monitoring of clinical and biochemical parameters directed towards timely detection of complications, including hypokalemia, hypoglycemia and cerebral edema. Following resolution of ketoacidosis, intravenous insulin is transitioned to subcutaneous route before meal, control dose to achieve glycemia to 8.3 - 13.9 mmol. L^-1. Rosults： All chemical analysis in- dexes of 21 patients returned to normal after comprehensive treatment within 3 d. The clinical effect we observed was satisfactory. Conclusion： The treatment of DKA is a comprehensive process, including fluid replacement and trypsin utilization at the fight moment, anti-infection, correction of acidosis and electrolyte disturbances, which has the fundamental clinical significance to increase remedy achievement ratio of DKA.