婴儿糖尿病酮症酸中毒3例分析  

Analysis of 3 cases of diabetic ketoacidosis in infants

作　　者：梅玲华 王婉霞[1] 贺兆平 杨永宏[1] 鱼建飞 MEI Ling-hua;WANG Wan-xia;HE Zhao-ping;YANG Yong-hong;YU Jian-fei(Pediatric Department, Yulin No.2 Hospital, Yulin 719000, China)

机构地区：[1]陕西省榆林市第二医院儿科

出　　处：《临床医学研究与实践》2019年第19期140-141,共2页Clinical Research and Practice

摘　　要：目的通过对3例婴儿糖尿病酮症酸中毒(DKA)的病例特点及诊治进行分析,进一步探讨婴儿DKA的临床表现及鉴别诊断,以降低误诊率。方法对我院收治的3例Ⅰ型DKA婴儿的性别、首发症状、确诊时间、血糖、血气分析、糖化血红蛋白、误诊情况、治疗及转归进行回顾性分析。结果婴儿糖尿病酮症酸中毒临床表现形式多样,患儿常以呻吟、恶心、呕吐、呼吸困难、精神萎靡、昏迷、抽搐等症状就诊,易误诊。主要实验室指标:随机血糖(32.02±6.36)mmol/L,糖化血红蛋白(12.8±3.57)%,血气分析pH(6.96±0.57),C肽(0.11±0.07)pmol/L。血常规示白细胞增多或核左移。明确诊断后予胰岛素联合补液、对症治疗后4~10h临床症状明显好转。结论婴儿糖尿病临床较少见,多起病急且有感染诱发因素,“三多一少”症状多不典型,多以酮症酸中毒发病,极易被误诊,临床医师需予以重视。Objective Through the analysis of the characteristics, diagnosis and treatment of 3 cases of diabetic ketoacidosis(DKA) in infants, the clinical manifestation and differential diagnosis of DKA in infants were further discussed to reduce the misdiagnosis rate. Methods The gender, initial symptoms, diagnostic time, blood sugar, blood gas analysis, glycosylated hemoglobin, misdiagnosis, treatment and prognosis of 3 cases of DKA in infants were retrospectively analyzed. Results The clinical manifestations of diabetic ketoacidosis in infants were various, children often treated with moaning, nausea, vomiting, dyspnea, mental depression, coma, convulsions and other symptoms, and were easily misdiagnosed. Main laboratory indexes: random blood glucose was (32.02±6.36) mmol/L, glycosylated hemoglobin was (12.8±3.57)%, blood gas analysis pH was (6.96±0.57), C-peptide was (0.11±0.07) pmol/L. Blood routine showed increased leukocytosis or left shift of nucleus. After definite diagnosis, the clinical symptoms improved markedly after combined insulin infusion and symptomatic treatment for 4 to 10 hours. Conclusion Infant with diabetes is rare in clinic, with more acute onset and infectious inducing factors, it has atypical "three more and one less" symptoms, and most cases are caused by ketoacidosis, which is easily misdiagnosed. Cliniclans should pay attention to it.

关 键 词：婴儿 糖尿病酮症酸中毒 误诊 

分 类 号：R725.8[医药卫生—儿科]