儿童I型糖尿病酮症酸中毒31例临床分析  

An clinical analysis of 31 children with type I diabetic ketoacidosis

作　　者：余明杰 余洽超[1] 张碧君[1] 何秀雯[1] 

机构地区：[1]开平市中心医院儿科广东医学院附属开平医院儿科,529300

出　　处：《国际医药卫生导报》2012年第23期3422-3424,共3页International Medicine and Health Guidance News

摘　　要：目的探讨非典型儿童I型糖尿病酮症酸中毒（diabetesketoneacidosis，DKA）的病例特点，提高诊断率，减少误诊发生。方法选择1996年至2011年我院诊治的31例儿童I型DKA患儿，将其分为典型组19例和非典型组12例，比较两组患儿的临床特征、实验室检查及治疗转归。结果典型组19例，均表现为多饮、多尿、多食，体重减轻；首诊确诊17例，确诊率89．4％，3天确诊率100．O％；典型组2例误诊疾病中，误诊为急性胃肠炎1例，误诊为败血症1例。非典型组12例中，表现为昏迷者3例，腹泻4例，疲乏、无力伴厌食9例，腹痛4例，不规则深长呼吸6例，不同程度脱水征12例，面色青灰、四肢厥冷1例，消瘦11例，12例病例均不明显出现多饮、多尿、多食；首诊确诊2例，确诊率16．7％。结论儿童I型DKA容易造成误诊，误诊原因与对糖尿病认识不足和儿童DKA早期症状不典型以及医生询问病史不详细有关。增强对儿童DKA的认识和警惕，结合必要的辅助检查，可提高正确诊断率，减少误诊。Objective To explore the features of children with atypical type I diabetic ketoacido- sis （ DKA ）, and to improve the diagnostic rate and reduce misdiagnosis. Methods 31 pediatric patients with type I DKA who had been treated during the period of 1996 to 2011 in our iospital were divided into typical group （ n=-19 ） and atypical group （ n=-12 ）. Clinical features, laboratory, findings, and treatment outcomes were compared between the two groups.Results In the typical group, the diagnosis was con- firmed in 17 of the 19 patients who developed symptoms of polydipsia, polyuria, polyphagia, and weight loss at the first visit with a rate of 89.4% and in 100% of the patients within three days. For the two patients who were misdiagnosed, one was diagnosed as acute gastroenteritis and the other as septicemia. In the atypical group, 3 of the 12 patients occurred coma, 4 developed diarrhea, 9 had fatigue, weakness, and anorexia, 4 had abdominal pain, 6 developed irregular deep breathing, 12 had dehydration at varying degrees, one had gray complexion with peripheral coldness, and 11 had weight los~ all of the 12 patients did not occurred obvious polydipsia, polyuria, and polyphagia, and the diagnosis was confirmed only in two patients at the first visit, with a rate of 16.7%. Conclusions Type I DKA of children is easily misdiagnosed. Misdiagnosis causes relate with lack of the knowledge about diabetes, atypical symptoms of child DKA, and no detail of diabetes history. Enhancing the awareness and vigilance of child DKA, combined with the necessary auxil- iary examinations, can increase the rate of correct diagnosis and reduce misdiagnosis.

关 键 词：儿童I型糖尿病 酮症酸中毒 临床分析 

分 类 号：R725.8[医药卫生—儿科]