生酮饮食治疗癫癎启动期微量血糖动态监测  

Monitoring of capillary blood sugar in ketogenic diet therapy initiation for childhood intractable epilepsy

作　　者：陈彦[1] 李永利[1] 肖志田[1] 廖建湘[1] 路新国[1] 操德智[1] 胡雁[1] 陈黎[1] 李冰[1] 黄铁栓[1] 蒋玉梅[1] 李成荣[1] 

机构地区：[1]深圳市儿童医院癫痫中心,广东深圳518026

出　　处：《中国实用儿科杂志》2008年第3期177-179,共3页Chinese Journal of Practical Pediatrics

摘　　要：目的观察适合中国人饮食习惯的生酮饮食方案治疗小儿药物难治性癫痫启动期血糖的动态变化。方法2004年10月至2006年12月深圳儿童医院对难治性癫痫住院患儿启动生酮饮食治疗,用毛细血管微量血法动态监测血糖变化。禁食48h或禁食已达到酮症状态后开始全量生酮饮食：脂肪与碳水化合物加上蛋白质的质量比为4∶1。使用适合中国人饮食习惯的配餐软件辅助配餐。对文献报道的有关并发症进行监测。结果禁食开始后（26.7±16.4）h达到酮症状态。96h内低血糖阳性例次检出率3.7%（16/427）。毛细血管微量血糖法检测低血糖发生率30.0%（9/30）,症状性低血糖发生率10.0%（3/30）。对低血糖患者给予牛奶10~20mL口服,患者很快恢复,没有出现严重低血糖症。拒食、呕吐可能加重低血糖。结论用适合中国人饮食习惯的生酮饮食治疗小儿药物难治性癫痫启动期,特别是禁食期间血糖波动,需要密切监测,及时处理低血糖。生酮饮食启动期是安全的。Objective To monitor the blood sugar level of patients with childhood medically intractable epilepsy during the initiation of ketogenie diet with special formula of Chinese food. Methods Patients were admitted to Shenzhen Chil- dren＇s Hospital from Oct. 2004 to Dee. 2006 for initiation of ketogenie diet. The capillary blood sugar level was monitored every four hours. Patients were fasted for 48 hours or until significant ketosis was achieved then all calculated calorie of ketogenie diet was given. The ratio of ketogenie diet was 4 ： 1. Results Significant ketosis was achieved by （ 26. 7 ± 16.41 hours. The positive rate of hypoglycemia during the first 96 hours of hospitalization was 3.7% （ 16/427 ）. The incidence of hypoglycemia was 30% （9/301. The symptomatic hypoglycemia occurred in 10% （3/301. About 20 ml of pure milk was given, and the patients recovered quickly. No severe hypoglycemia occurred. Apastia and vomiting might aggravate hypoglycemia. Conclusion The blood sugar level fluctuates during the initiation of ketogenie diet for childhood medically intractable epilepsy with special formula of Chinese food, especially during fasting. It needs careful monitoring and timely management. The ketogenie diet therapy is safe during initiation.

关 键 词：生酮饮食 难治性癫痫 血糖 

分 类 号：R72[医药卫生—儿科]