重症糖尿病酮症酸中毒的诊治体会

Experience with Diagnosis and Treatment of Severe Diabetic Ketoacidosis

目的：探讨重症糖尿病酮症酸中毒（DKA）的救治方法。方法对20例重症DKA患者的临床资料进行回顾性分析。探讨其起病诱因及治疗方法。结果20例重症DKA中，发病诱因不是单一的，最常见的诱因是感染。均采用小剂量胰岛素持续静脉滴注，积极纠正水、电解质紊乱及加强抗感染治疗，16例（80%）患者在24 h内临床症状缓解，血糖降至8.0～10.0 mmol·L-1，尿酮、血酮转阴，pH＞7.3，电解质恢复正常，神志转清，能正常进餐；2例（10%）于治疗后第2天达到上述标准。18例患者均治愈出院。2例死亡（均合并重症肺炎），病死率为10.0%。结论积极防治诱因、综合治疗，是防治重症DKA的关键；对急性脑水肿、急性呼吸窘迫综合征等要及早预防。

Objective To explore the emergency treatment of severe diabetic ketoacidosis （DKA）. Methods Clinical data of 20 patients were reviewed to analyze the cause and treatment of severe DKA. Results Severe DKA was induced by various causes and the most common cause of severe DKA was infection. After treatment with continuous infusion of small doses of insulin, correction of water-electrolyte imbalance and strengthening of anti-infection measures ,16 patients （80%）achieved clinical remission within 24 hours （8.0〈blood glucose 〈10.0 mmol·L-1,negative results for blood and urine ketone tests, pH〉7.3,normal electrolytes,clear consciousness, and normal eating）,and 2 patients（10%） achieved clinical remission based on the above criteria on the second day.Among the 20 patients, 18 were cured and discharged from hospital,and 2 died from the complication of severe pneumonia case fatality rate of 10.0%.Conclusion Active prevention and comprehensive treatment are the key to the prevention and treatment of severe DKA.In addition,acute cerebral edema and acute respiratory distress syndrome must be prevented and treated as early as possible.