1例酮症酸中毒合并HHS并发胰腺损伤的初发糖尿病患者的护理体会  

Nursing Experience of a Newly Diagnosed Diabetic Patient with Ketoacidosis Combined with HHS and Pancreatic Injury

作　　者：邹莉[1] 朱国红 ZOU Li;ZHU Guo-hong(The Affiliated Taizhou People’s Hospital of Nanjing Medical University,Taizhou Jiangsu 225300,China)

机构地区：[1]南京医科大学附属泰州人民医院,江苏泰州225300

出　　处：《泰州职业技术学院学报》2023年第1期75-78,共4页Journal of Taizhou Polytechnic College

摘　　要：糖尿病酮症酸中毒(DKA)和高血糖高渗状态(HHS)是糖尿病严重的急性并发症。DKA主要特征为:(1)肝脏和脂肪组织中胰岛素绝对或相对不足;(2)胰岛素对抗性调节激素(ICRH,如胰高糖素、儿茶酚胺、皮质醇和生长激素),特别是胰高糖素升高;(3)因高血糖而导致的肾脏渗透性利尿而造成的。HHS的特征是高血糖和脱水,其机制与DKA类似,但有所不同。HHS不发生或较少发生酮症的原因是患者门静脉中还保持一定的胰岛素水平,肝脏能以不产生酮体的方式代谢游离脂肪酸FFA,而且高渗和脱水也会抑制脂肪分解,使进入肝脏的FFA不会太多。我科于2021年3月份成功救治了1例DKA及HHS并发胰腺损伤患者,采用降低血浆渗透压和血糖,纠正脱水和酸中毒,同时给予大量补液、降低胰液粘稠度,严密监测生命体征、血糖,防治合并症的发生并加强基础护理,取得满意效果。Diabetic ketoacidosis(DKA)and hyperglycemic hyperosmolar state(HHS)are serious acute complications of diabetes mellitus.DKA mainly includes:(1)absolute or relative deficiency of insulin in liver and adipose tissue;(2)increased insulin resistance regulatory hormones(ICRH,such as glucagon,catecholamines,cortisol and growth hormone),especially glucagon;(3)renal osmotic diuresis caused by hyperglycemia.HHS is characterized by hyperglycemia and dehydration,and the mechanism is similar to,but different from,DKA.The reason why ketosis does not occur or rarely occurs in HHS is that the portal vein of patients still maintains a certain level of insulin,and the liver can metabolize free fatty acid FFA without producing ketone bodies.Besides,hyperosmosis and dehydration also inhibit lipolysis,so that not too much FFA enters the liver.In March 2021,our department successfully treated a patient with DKA and HHS complicated with pancreatic injury by reducing the plasma osmotic pressure and blood sugar,correcting dehydration and acidosis,and providing a lot of rehydration to reduce pancreatic juice viscosity,The vital signs and blood sugar were closely monitored to prevent the occurrence of complications and basic nursing was strengthened,thus satisfactory effect was achieved.

关 键 词：糖尿病酮症酸中毒 高血糖高渗状态 初发糖尿病 

分 类 号：R473.58[医药卫生—护理学]