高渗性非酮症糖尿病昏迷的血液透析治疗

目的:探讨血液透析救治高渗性非酮症糖尿病昏迷(HNDC)的疗效及临床应用适应证。方法:将36例HNDC患者随机分为2组,观察组19例,采用血液透析和一般疗法相结合治疗;对照组17例,采用一般治疗方法,包括输液、小剂量胰岛素应用、纠正电解质紊乱和抗感染等。观察两组患者治疗前和治疗后4、12、24、48、72h血生化指标、血浆渗透压的变化及患者清醒时间、并发症和病死率。结果:观察组治疗后4、12、24、48、72h血糖、血钠、血尿素氮、血浆渗透压均明显降低(P<0.05),患者清醒时间早,并有效地降低了心力衰竭、脑水肿、肺水肿的发生,降低了死亡率。观察组较对照组疗效明显(P<0.05)。结论:血液透析是临床救治HNDC的有效方法之一。

Study on the Clinical Value of Hemodialysis for Hyperosmolar Nonketotic Diabetic Coma

Objective:To investigate the clinical curative effect and clinical indications of hemodialysis for hyperosmolar nonketotic diabetic coma(HNDC). Methods: Thirty-six patients with HNDC were randomly divided into two groups. 19 patients as study group received hemodialysis associated with conventional therapy. 17 patients as control group were given conventional treatment that included fluid replacement, intravenous small dose insulin, correction of electrolytes disturbances and anti-infection, et al. The changes of plasma biochemical indexes and plasma osmotic pressure of the two groups were observed before and at 4?12?24?48?72h after the treatment, meanwhile, the patients, consciousnesss, complications and mortality rate were monitored. Results: Compared with conventional therapy, plasma glucose, blood sodium, urea nitrogen and osmotic pressure markly decreased in study groupes after treatment(P< 0.05 ), and the patients recovered conscious earlier, the occurrence of heart failure, cerebral edema, pulmonary edema and mortality were decreased evidently. The changes of study group were more obvious than those of control group(P< 0.05 ). Conclusion: Hemodialysis is one of the effective means in treating HNDC.