急性心肌梗死合并糖尿病酮症酸中毒高病死率临床分析  

The Clinica Analysis on Highmortality of Acute Myocardial Infarction with Diabetic Ketoacidosis

作　　者：林国钦[1,2] 刘文捷[1] 蔡金明[1] 

机构地区：[1]福建省莆田学院附属医院心血管内科,351100 [2]福建中医学院

出　　处：《实用心脑肺血管病杂志》2010年第5期549-551,共3页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的探讨急性心肌梗死（AMI）合并糖尿病酮症酸中毒（DKA）高病死率的原因。方法回顾性分析我院2000—2009年10例AMI合并DKA患者的临床资料。结果 2000—2009年共检出AMI合并DKA患者10例;起病前出现胃肠道症状（恶心、呕吐、腹泻）者6例（60%）;出现意识障碍（嗜睡、昏迷、昏睡、谵妄）者6例（60%）;有多饮、多食、多尿症状明显者5例（50%）;起病时出现气促者4例（40%）。6例（60%）于入院后5h明确诊断为DKA,3例（30%）患者死亡后明确合并DKA。Killip分级入院时6例（60%）处于Ⅱ-Ⅳ级,4例（40%）处于I级;治疗后9例（90%）属于Ⅳ级,1例（10%）I级,好转。治疗上基本上能按AMI及DKA原则处理,注重补液量,补液速度快,AMI保守治疗,经抢救治疗因多脏器功能衰竭死亡9例（90%）。结论 AMI合并DKA病死率高,主要原因与疾病本身重,且与治疗措施不当有关。Objective To investigate the clinical features and dicuss the highmortality of acute myocardial infarction（AMI）complicated with diabetic ketoacidocsis（DKA）.Methods Ten cases of patients complicated with AMIand DKA who hadbeen diagnosed with Type 2 diabetesmellitus（T2DM） between 2000 to 2009 in our hospital were retrospectively analyzed.Results AMI 2000—2009 combined DKA patients were detected in 10 cases;before the onset of gastrointestinal symptoms（nausea,vomiting,diarrhea）,6 cases（60%）;appeared consciousness（drowsiness,coma,drowsiness,delirium） were 6 cases（60%）;more drinks,more food,more urinary symptoms in 5 patients（50%）;onset of shortness of breath when you were 4 cases（40%）.6 cases（60%） was diagnosed after admission 5h clear DKA,3 patients（30%） were clear after the death of the merger DKA.Killip classification on admission in 6 cases（60%） in grade Ⅱ - Ⅳ,4 cases（40%） in the I-level;treatment in 9 cases（90%） were grade Ⅳ,1 case（10%） I-level,better.Basically the treatment of DKA by AMI and principles,focusing on fluid volume,fluid speed,AMI conservative treatment,after emergency treatment for multiple organ failure in 9 cases（90%）.Conclusion DKA may cooccur at the same time with AMI or later than AMI.The AMI patients complicated with DKA are more likely to experience typical symptoms and have been suffering from serious cardiacinsufficiency,and there is a highmortality in these patients.

关 键 词：糖尿病酮症酸中毒 急性心肌梗死 糖尿病 冠心病 

分 类 号：R541.4[医药卫生—心血管疾病]