平衡晶体液与生理盐水治疗成人糖尿病性酮症酸中毒的临床疗效对比

Comparison of clinical efficacy between balanced crystalloid solution and normal saline in treatment of adult diabetic ketoacidosis

目的比较平衡晶体液与生理盐水对成人糖尿病性酮症酸中毒(DKA)治疗的临床效果。方法选取2019年1月至2020年3月在长垣市人民医院200例DKA并具有完整随访记录的患者,按照随机抽签法分为平衡晶体组和生理盐水组,各100例。比较两组在急诊科(ED)、重症监护病房(ICU)、ED和ICU的总等渗晶体体积、平衡晶体液体积、生理盐水体积、ED和ICU晶体体积占总体积的百分比,比较两组DKA缓解时间、停止注射胰岛素时间、胰岛素持续输注人数、30 d内主要肾脏不良事件、ED高钾血症、ED低钾血症人数等情况。结果在ED、ICU、ED和ICU,平衡晶体组与生理盐水组总等渗晶体体积比较,差异无统计学意义(P>0.05);平衡晶体组平衡晶体液体积高于生理盐水组(P<0.05);平衡晶体组生理盐水容量低于生理盐水组(P<0.05)。平衡晶体组ED和ICU占100%总等渗晶体体积的例数高于生理盐水组(P<0.05)。平衡晶体组DKA缓解时间、停止注射胰岛素时间、ED低钾血症人数低于生理盐水组(P<0.05)。平衡晶体组与生理盐水组胰岛素持续输注人数、30 d内主要肾脏不良事件、ED高钾血症人数比较,差异无统计学意义(P>0.05)。结论与生理盐水比较,平衡晶体治疗可使DKA更迅速地消退,这表明对于成人DKA的急性治疗,平衡晶体液可能优于生理盐水,值得临床推广。

【Objective】To compare the clinical effect of balanced crystal solution and normal saline in the treatment of adult diabetic ketoacidosis(DKA).【Methods】A randomized clinical trial was conducted in our hospital from January 2019 to March 2020.A total of 200 patients with DKA with complete follow-up records were enrolled and assigned by random lotting to a balanced crystal group(observation group)or normal saline group(control group).In the balanced crystal group,there were 100 patients(age 32.45±3.95 years),43 males and 57 females;in normal saline group,there were 100 patients(age 32.40±3.68 years),46 males and 54 females.In ED,ICU,ED and ICU,total isotonic crystal volume,the balance crystal volume,the normal saline volume,the percentage of ED and ICU crystal volume in total volume were compared between the two groups.The remission time of DKA,the time to stop insulin injection,the number of continuous insulin infusion,the major renal adverse events within 30 days,the number of ED hyperkalemia,the number of ED hypokalemia were compared between the two groups.【Results】In ED,ICU,ED and ICU,there was no significant difference in total isotonic crystal volume between the balanced crystal group and the saline group(P>0.05);the volume of balanced crystal in the balanced crystal group was significantly higher than that in the normal saline group(P<0.05);the volume of normal saline in the balanced crystal group was significantly lower than that in the normal saline group(P<0.05);the number of cases in which ED and ICU accounted for 100%of the total isotonic crystal volume in the balanced crystal group was higher than that in the normal saline group(P<0.05).The remission time of DKA,the time to stop insulin injection and the number of ED hypokalemia in balanced crystal group were significantly lower than those in normal saline group(P<0.05).There were no significant differences between the balanced crystal group and the normal saline group in the number of continuous insulin infusion,major renal adverse events within 30 days and ED hyperkalemia(P>0.05).【Conclusion】Compared with normal saline,balanced crystal solution can induce more rapid regression of DKA,which indicates that balanced crystal solution may be superior to normal saline in the acute treatment of adult DKA and is worthy of clinical promotion.