儿童糖尿病酮症酸中毒伴脑水肿临床特征和危险因素分析  

Clinical characteristics and risk factors of diabetic ketoacidosis complicated with cerebral edema in children

作　　者：李杰玉[1] 林玉玲[1] 金文波[1] 郭权 郭献山[3] 

机构地区：[1]南阳市中心医院内分泌科,473000 [2]南阳市中医院老年病科 [3]新乡市中心医院内分泌科

出　　处：《中国糖尿病杂志》2016年第5期451-454,共4页Chinese Journal of Diabetes

摘　　要：目的分析儿童糖尿病酮症酸中毒(DKA)伴脑水肿临床特征和危险因素,为临床诊治提供参考依据。方法选取DKA伴脑水肿患儿(DKA+脑水肿组)10例及单纯DKA患儿(DKA组)60例,比较两组临床资料,并进行分析。结果 DKA+脑水肿组治疗前血糖和BUN高于DKA组[(43.2±13.1)vs(34.3±9.9)mmol/L;(9.1±3.3)vs(7.7±2.1)mmol/L],pH值和血Na低予DKA组[(6.7±0.1)vs(7.0±0.6);(134.9±3.5)vs(141.9±6.9)mmol/L](P<0.05)。DKA+脑水肿组治疗前PaCO_2、HCO_3^-及Scr均高于DKA组,但差异无统计学意义(P>0.05)。治疗后,DKA+脑水肿组血糖、BUN、HCO_3^-及Scr较治疗前下降,pH值、PaCO_2及血Na较治疗前升高(P<0.05或P<0.01)。DKA+脑水肿组碳酸氢盐使用率和使用量均高于DKA组[100%(10/10)vs 65%(39/60),P<0.05;(4.9±2.5)vs(2.2±1.0)ml/kg,P<0.01]。结论 DKA伴脑水肿患儿酸中毒较严重,低钠血症难以纠正;过量使用碳酸氢钠及BUN升高者,易出现脑水肿。Objective To analyze the clinical features and risk factors of diabetic ketoacidosis complicated with cerebral edema in children so as to provide reference for clinical diagnosis and treatment.Methods 10 children with diabetic ketoacidosis and cerebral edema（DKA＋cerebral edema group） and 60 children with diabetic ketoacidosis only（DKA group） were collected.The clinical data were compared and analyzed between two groups.Results Before treatment,compared with DKA group,PG and BUN levels were higher in DKA＋cerebral edema group[（43.2±13.1） vs（34.3± 9.9） mmol/L;（9.1±3.3）vs（7.7±2.1） mmol/L],pH values and serum Na～＋ were lower[（6.7±0.1） vs（7.0±0.6）;（134.9 ±3.5） vs（141.9±6.9） mmol/L]（P〈0.05）;the levels of PaCO2,HCO3＂ and Scr were higher（P〈0.05）.After treatment,the levels of PG.BUN,HCOO3～- and Scr were reduced in DKA＋cerebral edema group as compared with that before treatment,but pH,PaCO2 and Na were increased（P〈0.05 or P〈0.01）;The usage rate and the dosage of bicarbonate were higher in DKA＋cerebral edema group than in DKA group[100%（10/10） vs 65%（39/50）,P〈0.05;（4.9±2.5） vs（2.2±1.0） ml/kg,P〈0.01].Conclusion Acidosis is more serious and hyponatremia is more difficult to correct in children with diabetic ketoacidosis and cerebral edema.The excessive use of sodium bicarbonate and elevated BUN are risk factors for cerebral edema.

关 键 词：糖尿病 酮症酸中毒 脑水肿 儿童 

分 类 号：R725.8[医药卫生—儿科]