奥曲肽联合胰岛素治疗糖尿病酮症酸中毒的效果  

Effect of Octreotide Combined with Insulin in the Treatment of Diabetic Ketoacidosis

作　　者：李明 翟晓丹 杨宽 张立绘 LI Ming;ZHAI Xiaodan;YANG Kuan;ZHANG Lihui(Department of Emergency Medicine,the Second Hospital of Zhangjiakou City,Zhangjiakou,Hebei 075000,China;Department of Internal Medicine,the Second Hospital of Zhangjiakou City,Zhangjiakou,Hebei 075000,China)

机构地区：[1]张家口市第二医院急诊科,河北张家口075000 [2]张家口市第二医院内科,河北张家口075000

出　　处：《临床误诊误治》2024年第8期46-50,共5页Clinical Misdiagnosis & Mistherapy

基　　金：张家口市重点研发计划项目(2021130H);河北省医学科学研究课题计划项目(20211713)。

摘　　要：目的探讨奥曲肽联合胰岛素治疗糖尿病酮症酸中毒(DKA)的效果。方法选取2021年1月—2023年5月收治的DKA 106例,按照随机数字表法将其分为研究组和对照组2组各53例。研究组给予奥曲肽联合胰岛素加补液急救措施治疗,对照组给予胰岛素加补液急救措施治疗。比较2组治疗效果、临床症状和体征改善情况、酸中毒指标[血乳酸(Lac)、β-羟丁酸(β-HB)、硫胺素、二氧化碳结合力(CO_(2)CP)]、炎性因子[白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]及不良事件发生情况。结果研究组总有效率93.34%(50/53)高于对照组81.13%(43/53)(P<0.05)。研究组血酮体转阴时间、尿酮体转阴时间和pH纠正时间短于对照组(P<0.01)。治疗1周后,2组Lac、β-HB和IL-6、IL-10、TNF-α、CRP较治疗前下降,且研究组低于对照组;硫胺素和CO_(2)CP较治疗前升高,且研究组高于对照组(P<0.05,P<0.01)。治疗期间,研究组不良事件发生率与对照组相比无显著差异(P>0.05)。结论奥曲肽联合胰岛素加补液急救措施治疗DKA患者效果确切且安全,可显著改善患者临床症状,调控炎性因子。Objective To investigate the effect of Octreotide combined with insulin in the treatment of diabetic ketoacidosis(DKA).Methods A total of 106 patients with DKA treated from January 2021 to May 2023 were selected and divided into research group(n=53)and control group(n=53)according to random number table method.The research group was treated with Octreotide combined with insulin and rehydration solution as emergency measures,while the control group was treated with insulin and rehydration solution as emergency measures.The therapeutic effect,improvement of clinical symptoms and signs,acidosis indexes[blood lactic acid(Lac),β-hydroxybutyric acid(β-HB),thiamine,carbon dioxide combining power(CO_(2)CP)],inflammatory factors[interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)]before and after treatment,as well as incidence of adverse events,were compared between the two groups.Results The total effective rate of the research group was 93.34%(50/53),which was higher than that of the control group[81.13%(43/53)](P<0.05).Time to positive-to-negative conversion of blood ketone body,time to positive-to-negative conversion of urine ketone body and time to pH correction were shorter in the research group than in the control group(P<0.01).At 1 week after treatment,Lac,β-HB,IL-6,IL-10,TNF-αand CRP in the two groups were lower than those before treatment,and lower in the research group than in the control group,while thiamine and CO_(2)CP were higher than those before treatment,and higher in the research group than in the control group(P<0.05,P<0.01).There was no significant difference in the incidence of adverse events between the research group and the control group during treatment(P>0.05).Conclusion Octreotide combined with insulin and rehydration solution as emergency measures is effective and safe in the treatment of DKA patients,which can significantly improve clinical symptoms and regulate inflammatory factors.

关 键 词：奥曲肽 胰岛素 补液 糖尿病酮症酸中毒 血乳酸 Β-羟丁酸 硫胺素 白细胞介素-6 肿瘤坏死因子-α 

分 类 号：R587.22[医药卫生—内分泌]