儿童糖尿病酮症酸中毒的危险因素及诊治

Risk Factors and Diagnosis or Treatment of Diabetic Ketoacidosis in Children

目的探讨儿童糖尿病酮症酸中毒的危险因素及诊治方法。方法对2010年1月—2014年12月,该科收治的15例儿童糖尿病酮症酸中毒的危险因素、临床表现、实验室检查及诊治进行总结分析。结果 15例小儿糖尿病发生酮症酸中毒的患者中,危险因素：感染者8例（53.3%）,其中伴有急性上呼吸道感染的患者有4例,1例患者发生肺部感染,1例患者发生急性肠炎,发生尿路感染的有2例;突然停用胰岛素的有2例（1.34%）;饮食控制不良者1例（0.69%）;没有典型诱因的有4例（26.7%）。反复发作多次酮症酸中毒者有2例。所有患者在住院救治24-48 h,血糖下降到8.0-10.0 mmol/L,尿糖、尿酮、血酮继续转阴,CO2CP〉20 mmol/L,电解质调整至正常范围,神志恢复清醒,进食恢复正常。经1-2周的调整、治疗,患儿胰岛素用量及血糖达到了稳定。15例患儿均痊愈出院,住院时间为（10.5±3.9）d。结论感染是诱发儿童糖尿病酮症酸中毒的主要危险因素,有效控制感染、小剂量胰岛素静脉滴注纠正糖代谢紊乱是治疗小儿糖尿病酮症酸中毒成功的关键。

Objective To investigate the risk factors and treatment method of diabetic ketoacidosis in children.Methods Since January of 2010 to December of 2014, 15 cases of diabetic ketoacidosis in children admitted to our department from the clinical manifestations, risk factors, laboratory examination and treatment were summarized and analyzed. Results 15 cases of pediatric diabetes risk in patients with diabetes ketoacidosis, factors： 8 cases of infection（53.3%）, which accompanied with acute upper respiratory tract infection in 4 cases, pulmonary infection occurred in 1 patients, 1 patients occurred acute enteritis, the occurrence of urinary tract infection in 2 cases; 2 abrupt discontinuation of insulin cases（1.34%）; diet control adverse in 1 cases（0.69%）; no typical incentive in 4 cases（26.7%）. Repeated episodes of ketoacidosis has many times in 2 cases. All patients in treatment of 24-48 hours in the hospital, blood sugar dropped to 8-10.0mmol/L, urine, urine ketone, blood ketone to negative, CO2CP20 mmol/L, electrolyte is adjusted to the normal range, was restored soberly, feeding back to normal. After adjustment, the treatment of children with one to two weeks, insulin dosage and blood glucose was stable. 15 patients were discharged from the hospital, hospitalization time was（10.5±3.9） days. Conclusion The risk factors of diabetic ketoacidosis in children were infection, followed by diet control adverse, suddenly stopping insulin. Diagnosis, timely and correctly small dose insulin infusion to correct the disorder of glucose metabolism is the treatment of diabetic ketoacidosis in children is the key to success.