65例糖尿病酮症酸中毒的救治研究

Emergency Treatment Clinical Analysis of 65 Cases of Diabetes Mellitus Ketoacidosis

目的探讨糖尿病并发酮症酸中毒的救治方法。方法选取2010年1月至2014年5月发生糖尿病酮症酸中毒患者共65例,根据血钠浓度及血渗透压分为2组。A组:合并血钠浓度>150 mmol/L,血渗透压>330 m Osm/L,共31例;B组:血钠浓度<145 mmol/L,血渗透压<330 m Osm/L,共34例。两组均进行大量补液及小剂量胰岛素治疗,联合胃肠补液,当血糖降至13.9 mmol/L改为5%葡萄糖液。结果 65例患者总的治疗效果为有效59例(有效率90.7%),死亡6例(9.3%),其中6例年龄均>65岁,且合并心功能不全,肾功能障碍等基础疾病。A组患者治疗效果为有效26例(83.9%),死亡5例(16.1%)。B组患者治疗效果为有33例(97.1%),死亡1例(2.9%)。结论及时对糖尿病酮症酸中毒患者进行正确的抢救能有效地降低酮症酸中毒的病死率。其中糖尿病酮症酸中毒合并高渗状态,以及老年患者预后不佳,是导致死亡的重要因素。

Objective To study the emergency method of diabetes mellitus ketoacidosis. Methods 65 patients with diabetes mellitus ketoacidosis who were treated with a large number of fluid and small doses of insulin, gastrointestinal fluid in our hospital from January 2010 to May 2014. When blood glucose descends to 13.9 mmol/L, replace with 5% glucose solution. According to the serum sodium concentration and plasma osmotic pressure, the patients were divided into group A and group B. 31 cases in group A with blood serum concentration〉150 mmol/L and blood osmotic pressure〉330 mOsm/L; while 34 cases in group B with blood serum concentration〈145 mmol/L and blood osmotic pressure〈330 mOsm/L. Results The therapeutic effect of 65 cases with total effective in 59 cases（total efficiency 90.7%）, there were 6 cases of death （total death rate 9.3%）, with aged 〉65 years in average and background dieses such as incomplete function of heart and kidney. The therapeutic effect in group A was 26 cases（efficiency 83.9%） and death rate was 16.1%; while effective 33 cases in group B （efficiency 97.1%） and death rate 2.9%. Conclusion Timely and effective rescue of patients with diabetic ketoacidosis could effectively reduce the mortality of diabetic ketoacidosis. Diabetes mellitus ketoacidosis complicated with hyperglycemic hyperosmolar state and gerontism were important factors leading to death, the prognosis were worse.