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目的探索糖尿病酮症酸中毒(DKA)的发病、临床表现及防治措施,尽可能降低DKA误诊率、发生率和病死率。方法对医院2009年3月-2011年8月共收住院27例DKA患者发病诱因、实验室检查、影像学检查、治疗及护理措施等临床资料进行回顾性分析。结果 27例DKA患者中感染引起者21例(77.8%),医源性DKA 3例(11.1%),停用降糖药者2例(7.4%),不控制饮食者1例(3.7%)。临床表现上有昏迷、低血压休克、循环衰竭者3例(11.1%),嗜睡、精神萎靡者5例(18.5%)。27例患者经积极地补液扩容、小剂量胰岛素静脉点滴等综合治疗后,死亡2例,占总病例7.4%。痊愈25例,占总病例92.6%。其中6例误诊,占总病例22.2%。结论 DKA的首发症状可以多种多样,极具隐蔽性。为了降低DKA的发生率,提高DKA的诊治正确率和抢救成功率,做好全社会的糖尿病宣教工作十分必要。
Objective To explore the incidence, clinical manifestations and prevention and treatment of diabetic ketoacidosis (DKA) and to minimize the misdiagnosis, incidence and mortality of DKA. Methods The clinical data of 27 DKA patients admitted to the hospital from March 2009 to August 2011 were retrospectively analyzed in terms of the causes, laboratory tests, imaging examination, treatment and nursing measures. Results Among the 27 patients with DKA infection, 21 (77.8%) were caused by infection, 3 (11.1%) were iatrogenic DKA, 2 (7.4% . Clinical manifestations of coma, hypotensive shock, circulatory failure in 3 cases (11.1%), drowsiness, mental distress in 5 cases (18.5%). 27 patients after active rehydration expansion, low-dose insulin intravenous drip and other comprehensive treatment, the death of 2 cases, 7.4% of the total cases. Healed in 25 cases, accounting for 92.6% of the total cases. Six cases were misdiagnosed, accounting for 22.2% of the total cases. Conclusion DKA’s first symptom can be varied and very subtle. In order to reduce the incidence of DKA and improve the diagnosis and treatment of DKA and rescue success rate, it is necessary to do a good job in the whole society of diabetes mission.