联合补液与小剂量胰岛素治疗糖尿病非酮症高渗性昏迷的临床价值研究  

Clinical Value of Combined Fluid Therapy and Low-Dose Insulin in the Treatment of Diabetic Non-Ketotic Hyperosmolar Coma

作　　者：续楠楠 张放 樊宽鲁 XU Nannan;ZHANG Fang;FAN Kuanlu(Xuzhou Mining Group General Hospital Endocrine Department Xuzhou,Xuzhou 221000,China)

机构地区：[1]徐州矿务集团总医院内分泌科,江苏徐州221000

出　　处：《中华灾害救援医学》2025年第2期200-203,共4页Chinese Journal of Disaster Medicine

摘　　要：目的探讨联合补液加小剂量胰岛素治疗老年糖尿病非酮症高渗性昏迷(Hyperosmolar Nonketotic Diabetic Coma,HNDC)的临床价值。方法回顾性分析2020年1月至2024年6月在徐州矿务集团总医院就诊的92例HNDC老年患者的临床资料。根据急救方案的不同分为观察组(联合补液+小剂量胰岛素治疗方案,46例)和对照组(单一补液+大剂量胰岛素治疗方案,46例)。比较两组患者相关生化指标改善情况、临床症状改善时间、不良反应发生情况、死亡情况。结果两组患者经抢救后,各项生化指标水平均明显改善,其中血糖、血钠、血尿素氮、血浆渗透压水平明显降低(P<0.001),血钾水平明显升高(P<0.001);且急救后,观察组患者血糖、血钠、血尿素氮、血浆渗透压水平明显低于对照组(P<0.001),血钾水平明显高于对照组(P<0.001)。观察组患者脱水纠正时间、意识恢复正常时间、渗透压恢复正常时间均明显短于对照组(P<0.001)。观察组患者的不良反应总发生率明显低于对照组(P<0.05)。观察组患者死亡率明显低于对照组(P<0.05)。结论联合补液与小剂量胰岛素的急救方案可促进老年HNDC患者意识恢复,改善脱水状态,较快纠正患者渗透压和生化指标,降低并发症发生率。Objective To explore the clinical value of combined fluid therapy and low-dose insulin in the treatment of hyperosmolar nonketotic diabetic coma(HNDC)in elderly patients.Methods A retrospective analysis was conducted on the clinical data of 92 elderly patients diagnosed with HNDC who were treated at Xuzhou Mining Group General Hospital between January 2020 and June 2024.Patients were divided into two groups based on the different emergency treatment protocols:the observation group(n=46)received combined fluid therapy with low-dose insulin,while the control group(n=46)received standard fluid therapy with high-dose insulin.We compared the improvement of relevant biochemical parameters,time to resolution of clinical symptoms,incidence of adverse reactions,and mortality between the two groups.Results Following treatment,both groups exhibited significant improvements in various biochemical parameters,including substantial reductions in blood glucose,serum sodium,blood urea nitrogen,and plasma osmolality(P<0.001),along with a significant increase in serum potassium levels(P<0.001).Notably,the observation group showed significantly lower levels of blood glucose,serum sodium,blood urea nitrogen,and plasma osmolality compared to the control group(P<0.001),while serum potassium levels were significantly higher(P<0.001).The observation group also demonstrated significantly shorter times for correction of dehydration,normalization of consciousness,and restoration of osmolality compared to the control group(all P<0.001).The overall incidence of adverse reactions in the observation group was significantly lower than that in the control group(P<0.05),and the mortality rate was also significantly reduced in the observation group(P<0.05).Conclusion The emergency treatment protocol combining fluid therapy with low-dose insulin can effectively promote the recovery of consciousness in elderly patients with HNDC,improve dehydration status,rapidly correct osmolality and biochemical parameters,and reduce the incidence of complications.

关 键 词：糖尿病 非酮症高渗性昏迷 急救 

分 类 号：R587.2[医药卫生—内分泌]