成年人1型糖尿病酮症酸中毒治疗中电解质变化特点分析  

Characteristic analysis on electrolyte changes during treatment of adult type 1 diabetic ketoacidosis

作　　者：王兴洲[1] 张日东[1] 石敏[1] 高鹏霞[1] 张红[1] 

机构地区：[1]南京医科大学附属淮安第一医院内分泌科,江苏淮安223300

出　　处：《中国医学装备》2015年第12期4-7,共4页China Medical Equipment

基　　金：国家自然科学基金(81200595)"肾脏GLP-1受体信号通路调节TGF-β1改善糖尿病肾病机制的研究"

摘　　要：目的:观察成年人1型糖尿病(T1DM)合并酮症酸中毒(DKA)治疗过程中的电解质变化特点并分析其临床意义。方法:回顾性分析34例T1DM合并DKA患者,记录治疗过程血气、电解质及肾功能等指标。结果:1治疗后血尿素氮、肌酐、尿酸、血糖以及血渗透压较治疗前降低,差异有统计学意义(t=5.607,t=3.572,t=6.640,t=17.817,t=7.284;P<0.05);2治疗过程中碳酸氢根增高,阴离子间隙、钾、镁及磷降低,差异有统计学意义(F=238.647,F=88.143,F=13.900,F=5.803,F=25.263;P<0.05);而钠、氯、钙的变化无统计学意义(F=1.858,F=1.527,F=2.164;P>0.05);3碳酸氢根及阴离子间隙在治疗前、治疗中及治疗后两两比较均有差异。钾、镁、磷在治疗中、治疗后分别与治疗前相比均有差异;而其在治疗中与治疗后相比无差异。结论:在治疗成年人T1DM合并DKA时应注重血电解质的监测和个体化评估,可有助于改善其预后。Objective： To observe the characteristics of electrolyte changes during treatment of adult type 1 diabetic ketoacidosis and investigate the clinical significance. Methods： Retrospective analysis was done in 34 cases of type 1 diabetic ketoacidosis. Blood gases, electrolytes, renal function and other data during treatment were recorded. Results：（1）Levels of blood urea nitrogen, creatinine, uric acid, blood glucose and osmolality after treatment were lower than those before treatment（t=5.607, t=3.572, t=6.640, t=17.817, t=7.284; P〈0.05）.（2）Level of bicarbonate increased and levels of anion gap, potassium, magnesium, phosphate decreased during treatment（F=238.647, F=88.143, F=13.900, F=5.803, F=25.263; P〈0.05）, whereas the changes of sodium, chlorine and calcium had no statistic significance（F=1.858, F=1.527, F=2.164; P〈0.05）.（3）Bicarbonate and anion gap levels were significantly different between any two detected time points. Levels of potassium, magnesium and phosphate were significantly different in and after treatment compared respectively with those before treatment, whereas their levels were not significantly different in the treatment compared with those after treatment. Conclusion： Focusing on monitoring of blood electrolytes and making individual assessment during treatment of diabetic ketoacidosis may help to improve the prognosis.

关 键 词：1型糖尿病 糖尿病酮症酸中毒 电解质 

分 类 号：R587.2[医药卫生—内分泌]