新型冠状病毒肺炎合并糖尿病酮症酸中毒的临床诊治

Clinical features and management of COVID-19 patients combined with diabetic ketoacidosis(report of 3 cases)

目的:探讨新型冠状病毒肺炎(COVID-19)合并糖尿病酮症酸中毒(DKA)的临床特征,提升诊疗水平。方法:分析2020年2月10日到17日在华中科技大学同济医学院附属同济医院抢救治疗的3例COVID-19合并DKA昏迷患者的临床资料。结果:3例患者中1例为男性,2例为女性;2例为2型糖尿病,1例可能为1型糖尿病;病程中患者随机静脉血糖均大于30 mmol/L,血气分析示pH值均小于7.0;1例心肌酶谱显著升高,考虑心肌炎可能;1例血胰腺淀粉酶和脂肪酶显著升高,胰腺损伤严重;2例患者炎性因子(白介素、肿瘤坏死因子)等显著升高;3例患者均出现了凝血功能障碍。3例患者出现DKA后3~4 d病情迅速恶化,其中2例出现心跳骤停,1例经ICU抢救后病情平稳转入普通病房继续治疗。结论:COVID-19诊治期间要积极预防诱因,避免DKA昏迷发生;DKA一旦发生常病情极危重,可合并胰腺、心脏、肝脏等多脏器的功能损害,出现不良结局。

Objective:To analyze the clinical features and management of novel coronavirus pneumonia(COVID-19)patients with diabetic ketoacidosis(DKA)and summarize the experience of clinical diagnosis and treatment.Methods:Clinical data of 3 COVID-19 patients complicated with DKA coma who were rescued and treated in Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from February 10 to 17,2020 were reported and analyzed.Results:Three patients were recruited in our study,including 1 male and 2 females.Two cases were diagnosed as type 2 and the other was likely to be type 1 diabetes.The random venous blood glucose of all patients were higher than 30 mmol/L and the pH value in blood gas analysis was less than 7.0.One patient had a significantly elevated myocardial enzyme profile,considering as myocarditis.The amylase and lipase of the blood pancreas were significantly increased in one patient,which might indicate that the pancreas was seriously damaged.Inflammatory factors(interleukin,tumor necrosis factor)were significantly increased in 2 patients.Three patients all suffered from coagulation dysfunction.The condition of 3 patients rapidly worsened within 3-4 d after DKA occurred,2 patients were dead,and 1 patient was transferred to the general ward for further treatment after ICU rescue.Conclusions:During the treatment of COVID-19,triggers should be actively avoided to prevent diabetic ketoacidotic coma.Once DKA occurs,it is often very serious,which would be combined with many organs failure including pancreas,heart,and liver,and leading to adverse prognosis.