儿童糖尿病酮症酸中毒并发脑水肿的临床分析(1)
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[摘要] 目的 探讨儿童糖尿病酮症酸中毒并发脑水肿的临床特征及危险因素。 方法 回顾性分析我院2002年10月~2010年5月住院治疗的糖尿病酮症酸中毒并发脑水肿的10例患儿的临床特征及病因，并与23例未并发者进行对照比较。 结果 本研究中糖尿病酮症酸中毒患儿33例，有脑水肿表现10例，发生率为30.3%。与未发生脑水肿同等程度的酮症酸中毒患儿相比较，并发脑水肿患儿酸中毒更为严重，在治疗期间血钠上升缓慢并伴有持续低钠血症，尿素氮水平升高。10例患儿中有3例应用碳酸氢盐治疗，用量大于未并发组。 结论 糖尿病患儿并发酮症酸中毒易发生脑水肿。严重酸中毒、血钠上升缓慢或持续低钠血症、血尿素氮升高及碳酸氢盐的使用有可能增加脑水肿发生的危险性。
[关键词] 儿童；糖尿病酮症酸中毒；脑水肿
[中图分类号] R725.8 [文献标识码] A [文章编号] 1673-7210(2012)01(b)-051-03
Clinical analysis of diabetes mellitus ketoacidosis complicated by hydrocephalus in children
HUANG Chenghua MO Weixiong YAN Zhixian LU Yanzhen HE Junjun
Department of Pediatrics, the First People's Hospital of Zhaoqing City, Guangdong Province, Zhaoqing 526040, China
[Abstract] Objective To explore the clinical features and risk factors of diabetes mellitus ketoacidosis complicated by hydrocephalus in children. Methods 10 children with diabetes mellitus ketoacidosis complicated by hydrocephalus were collected from October 2002 to May 2010. The clinical features and the cause were analyzed retrospectively, and compared to 23 children without complication. Results 33 children were diagnosed as diabetes mellitus ketoacidosis, among them 10 cases were complicated with hydrocephalus, and the incidence rate was 30.3%. Compared to children without hydrocephalus, children with complicates had more severe acidosis, during treatment, their sodium blood rose slowly, with continuous hyponatremia and high urea nitrogen levels. 3 cases of the 10 children were treated by bicarbonate, the dosage was greater than those without complication. Conclusion Diabetes children with heavy ketoacidosis are easily happening cerebral edema. It may increase the risk of brain edema because of severe acidosis, blood sodium rising slow or continued low serum sodium concentration, blood urea nitrogen rising and bicarbonate using.
[Key words] Children; Diabetes mellitus ketoacidosis; Hydrocephalus
糖尿病酮症酸中毒时，不论是昏迷患者还是清醒患者，在治疗期间都可因脑水肿死亡[1]。1936年，Dinon在8例糖尿病酮症酸中毒昏迷的患者中发现了脑水肿。这些患者在其高血糖和酸中毒得到显著改善后的2~24 h内死亡。糖尿病酮症酸中毒在治疗后10 h内，脑脊液压力可升达高水平，而患者并无症状，以后脑脊液压力又恢复正常。但有些患者却在经治疗病情好转的4~16 h后 ......
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