碳酸氢钠林格治疗糖尿病酮症酸中毒患者的临床研究  

Clinical trial of sodium bicarbonate ringer's in the treatment of patients with diabetic ketoacidosis

作　　者：黄小菲[1,2] 周甜甜 倪海滨 张晓震[1,2] HUANG Xiao-fei;ZHOU Tian-tian;NI Hai-bin;ZHANG Xiao-zhen(Department of Emergencyand Critical Care Medicine,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese1 Medicine,Nanjing 210028,Jiangsu Province,China;Department of Emergency and Critical Care Medicine,Jiangsu Province Academy of Traditional Chinese Medicine(Jiangsu Province Hospital on Integration of Chinese and Western Medicine),Nanjing 210028,Jiangsu Province,China)

机构地区：[1]南京中医药大学附属中西医结合医院急重症医学科,江苏南京210028 [2]江苏省中医药研究院(江苏省中西医结合医院)急重症医学科,江苏南京210028

出　　处：《中国临床药理学杂志》2025年第3期316-319,共4页The Chinese Journal of Clinical Pharmacology

基　　金：江苏省卫生健康委科研基金资助项目(ZDB2020032)。

摘　　要：目的比较碳酸氢钠林格注射液与0.9%NaCl作为复苏液体治疗糖尿病酮症酸中毒(DKA)患者的临床疗效和安全性。方法将DKA患者随机分为试验组和对照组。入组后,试验组立即给予碳酸氢钠林格注射液进行液体复苏;对照组用0.9%NaCl进行液体复苏,其他针对DKA的治疗方案2组均一致。比较2组患者入院96 h高氯血症的发生率、血氯变化值(96 h血氯最大值-基线血氯值)、24 h总输液量、24 h尿量,以及急性肾损伤(AKI)发生率,同时记录2组患者在96 h内低钾血症的发生情况,并评估安全性。结果试验组入组20例,脱落2例,最终有18例纳入统计分析;对照组入组20例,脱落1例,最终有19例纳入统计分析。试验组和对照组的96 h高氯血症发生率分别为27.78%(5例/18例)和73.68%(14例/19例),96 h血氯变化值分别为11.05(9.30,13.13)和19.10(14.10,29.10)mmol·L^(-1),在统计学上差异均有统计学意义(均P<0.05)。试验组和对照组的24 h总输液量分别为3410.00和3600.00 mL,24 h尿量分别为2075.00和2950.00 mL,AKI发生率分别为0(0例/18例)和5.26%(1例/19例),在统计学上差异均无统计学意义(均P>0.05)。试验组的低钾血症发生率(2.22%)显著低于对照组(57.89%),在统计学上差异有统计学意义(P<0.05)。结论用碳酸氢钠林格注射液对糖尿病酮症酸中毒患者进行液体复苏,可减少96 h高氯血症的发生,且安全性较好。Objective To compare the clinical efficacy and safety of sodium bicarbonate ringer's injection and 0.9%NaCl as resuscitation fluid in the treatment of patients with diabetic ketoacidosis(DKA).Methods Patients with DKA were randomly divided into treatment group and control group.After enrollment,the treatment group was immediately given sodium bicarbonate ringer's,and the control group was given 0.9%NaCl for fluid resuscitation.Other treatment protocols for DKA were the same in two groups.The incidence of hyperchloremia in 96 hour the change value of chloride in 96 hours(with the maximum value minus the baseline value),the total volume of fluid administered over 24 hours,the volume of urine produced over 24 hours,and the incidence of acute kidney injury(AKI)were compared between the two groups.Additionally,the incidence of hypokalemia in the two groups during the 96-hour observation period was recorded,and the safety of the intervention was evaluated.Results The study cohort comprised 20 cases in the treatment group,of whom two were dislodged,finally 18 cases were included in the statistical analysis.In the control group,20 cases were enrolled,with one case being dislodged,leaving 19 cases included in the statistical analysis.The incidence of 96 hour hyperchloraemia in the treatment group and the control group was 27.78%(5 cases/18 cases)and 73.68%(14 cases/19 cases),respectively.Furthermore,the change values of chloride in 96 hour were 11.05(9.30,13.13)and 19.10(14.10,29.10)mmol·L^(-1),respectively.Notably,the differences between the two groups were statistically significant(all P<0.05).The total fluid volume was 3410.00 and 3600.00 mL,the 24 hour urine output was2075.00 and 2950.00 mL,and the incidence of AKI was 0%(0 cases/18 cases)and 5.26%(1 cases/19 cases)in the treatment group and the control group,respectively.No statistically significant differences were observed in any of the statistical comparisons(all P>0.05).However,the incidence of hypokalaemia in the treatment group(22.22%)was lower than that in th

关 键 词：碳酸氢钠林格注射液 糖尿病酮症酸中毒 高氯血症 肾损伤 

分 类 号：R97[医药卫生—药品]