合并高血钠糖尿病酮症酸中毒患者的抢救方案分析

Analysis on Rescue Plan to Patients with Diabetic Ketoacidosis and Hypernatremia

目的避免合并高血钠的糖尿病酮症酸中毒患者抢救过程中出现医源性高渗昏迷,旨在寻找更安全、便捷、有效的抢救方案,降低患者痛苦及病死率。方法回顾性分析2008年~2015年川北医学院附属医院内分泌科住院的98例合并高血钠的糖尿病酮症酸中毒患者的抢救方案,按照补液方法的不同(其他抢救措施相同)分为两组(每组49例):(1)传统抢救方案组:按照第七版内科学所述糖尿病酮症酸中毒补液方案进行抢救,早期使用生理盐水补液,待血糖下降至13.9 mmol/L以下后再改用糖水+胰岛素;(2)改变抢救方案组:早期即使用5%糖水+胰岛素补液。比较两组患者的治疗效果及预后的差异。结果与传统抢救方案组比较,改变后的抢救方案组患者在治疗过程中未再出现渗透压继续升高、脏器功能进一步恶化情况,该组患者的神志转清时间明显缩短,病死率明显下降。结论早期即使用5%糖水补液抢救合并高血钠的糖尿病酮症酸中毒患者较传统方案疗效更佳,病死率更低。

Objective In order to avoid iatrogenic hypertonic coma in the rescue process of patients with diabetic ketoacidosis and hypematremia, we explore the more safe, efficient, convenient rescue scheme. Methods By retrospective analysis two different kinds of rescue plan to 98 patients with diabetic ketoacidosis and hypematremia in our department from 2008 to 2015. According to the different methods of fluid resuscitation （other rescue meastwes are the same） divided into two groups （49 cases each）： ①Traditional rescue plan group： emergency medicine according to the seventh edition of the solution of diabetic ketoaeidosis, early use of physiological saline, when blood sugar drops to below 13.9mmol/L, using sugar ＋ insulin. ②Changed rescue plan group： use 5% glucose ＋ insulin infusion from the beginning. We compare the difference of therapeutic effect and prognosis. Results Compared with the traditional treatment group, the patients in changed rescue plan group hadno osmotic pressure continued rising, organ function further deterioration during treatment, and their consciousness turned clear time is shortened obviously, and the death rate is lower. Conclusion Early that the use of 5% glucose water infusion than traditional treatment effect is better, safer and more convenient.