糖尿病酮症酸中毒治疗问题探讨(附100例分析)

<正> 糖尿病酮症酸中毒是内科常见急诊之一,如抢救及时,方法正确,可转危为安,若措施不当或延误治疗,则造成死亡。据美国统计,在大部分糖尿病治疗中心,该病的死亡率为5—15%,这只是反应了一些对糖尿病有一定治疗水平的医院的情况,在一般医院里其死亡率为20—30%,老年人高达50%或更多。目前国内糖尿病的发病率也较高,所以这是一个很值得重视的问题。现仅就我院二十五年来收治糖尿病酮症酸中毒100例的分析,简略探讨其治疗等有关问题。

A Study on the Treatment of Ketoacidosis in Diabetes Mellitus-Analysis of 100 Cases

Of 807 Cases of Diabetes mellitus, 100 were ketoacidosis with or with-ot coma(40 Cases among them with coma), 55 were males, 45 females. Therange of age was 5 to 76 years. There were 39 cases of ketonemia with ju-venile diabetes, and the incidence was 29. 5 per cent of 137 cases. 61 werefound to have ketonemia with adult dialetes, the incidence being 10. 2 percent of 594 cases. Blood glucose level was 166. 7 to 1000mg/dl. The mostcommon precipitating causcs of ketonemia were infection and the dis-continue of insulin treatment(58 per cent). According to the dosage of insu-lin, our patients were divided into two groups. One was a small dosagegroup(the total mean dose 25. 5 ± 3. 1 u), the other was a large dosage group(the first 8 hours' mean dose 121. 67 ± 102u, the fitst 24 hours' mean dose206. 62 ± 18. 01) There were on death and severe complications of insulintherapy in the small dosage group, but 13 (16 per cent) were died in thelarge dosage group, in which there took place such complications as hypo-kele mia(11 per cent), hypoglycemia (26 per cent) and encephaledema (3. 8per cent). Also, the negative acetone bodies occured faster in the smalldosage group. For this reason, we consider the effect of the treatment inthe small dosage group was better. Recently, we have controlled alkelidosage more strictly than before. 100-200ml of 4% Bicarbonate was givento the patient if the blood CO_2 combinedpower was lower than 20 Vol pe,