《中华医学会儿科学分会内分泌遗传代谢学组儿童糖尿病酮症酸中毒诊疗指南》(2009年版)解读

<正>1指南制定背景糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)在1型糖尿病(T1DM)及2型糖尿病(T2DM)患者中均可发生,是儿童糖尿病患者发病和死亡的首要原因。DKA发生率存在地域差异,与糖尿病发生率并不相符。     

儿童糖尿病酮症酸中毒25年回顾分析

为了解低儿童糖尿病酮症酸中毒（ＤＫＡ）的发病率,提高儿科治疗ＤＫＡ的成功率。回顾分析了２５年胰岛素依赖型糖尿病住院儿童１１４例（其中ＤＫＡ５３例）的资料。１９９０年￣１９９８年和１９７４年￣１９７９年或１９８０年￣１９８９年比较,ＤＫＡ发病率明显下降,年龄越小,ＤＫＡ发病率越高,父母文化程序低的农村儿童发病率明显高于城镇儿童,ＤＫＡ的诱因中,感染列首位（４９．１％）。停用胰岛素其次（２０．８％）。     

儿童糖尿病酮症酸中毒的治疗

糖尿病酮症酸中毒是儿童常见危急重症,治疗延误或治疗不当会影响糖尿病患儿的预后。国内儿科内分泌遗传代谢学组发布的糖尿病酮症酸中毒处理方案极大地提高了国内儿科救治水平,美国糖尿病学会2006年发布了小儿糖尿病酮症酸中毒治疗方案,与国内方案比较更为细化,在胰岛素治疗开始时间、纠正酸中毒指征及补钾等方面均有所不同,且更强调脑水肿的发现与治疗,值得借鉴。     

儿童糖尿病酮症酸中毒诊治新进展

糖尿病酮症酸中毒(DKA)是儿科临床上最常见的内分泌急症之一,如延误诊断或处理不当可能危及患儿生命.现参照国际儿童及青少年糖尿病协会颁布的2006统一指南,对儿童DKA的诊断及治疗进展作一综述.     

儿童糖尿病酮症酸中毒17例

本文对17例儿童糖尿病酮症酸中毒的临床资料进行分析,着重探讨了酮症酸中毒的治疗。认为胰岛素疗法仍应用于儿童糖尿病酮症酸中毒的治疗,而小剂量胰岛素治疗则是一种简便、安全、有效的治疗方法,值得推广。同时应积极纠正水、电解质及酸硷平衡的紊乱。     

儿童糖尿病酮症酸中毒7例

本文作者通过抢救7例儿童糖尿病酮症酸中毒(DKA)有如下体会。1.首次以腹痛、昏迷就诊者应想到DKA的可能性,并及时送检尿糖和酮体,并扼要讨论了DKA患儿腹痛的发生机制。2.感染是     

儿童糖尿病酮症酸中毒的急救

酮症酸中毒是儿童糖尿病最重要的并发症,也是糖尿病患儿死亡的主要原因。50～70％的糖尿病病儿发生过1次或多次酮症酸中毒,约有1/3的儿童糖尿病患者以酮症酸中毒为首发症状。我科近15年来共收治糖尿病患儿20例,占同期住院人数之1.3‰,其中17例(85％)有酮尿,8例(40％)有酸中毒,4例     

儿童肺炎链球菌性疾病防治技术指南(2009年版)

[编者按] 为提高广大卫生专业人员对肺炎链球菌性疾病(pneumococal diseases,PDs)的基本认识,进一步规范PDS的预防、诊断和治疗,中华医学会儿科学分会、中华预防医学会联合组织国内有关专家,在参考国内外最新PDs研究进展的基础上,制定了<儿童肺炎链球菌性疾病防治技术指南>(以下简称<指南>).     

儿童糖尿病酮症酸中毒监护与处理

儿童糖尿病酮酸中毒（ＤＫＡ）是一种发生于胰岛素依赖型糖尿病严重的代谢紊乱。其病死率约１５％。因其危及生命，患有这种病的儿童应转送至儿科监护病房。安全转送需了解此病的发病机制及并发症。     

Diagnosis and treatment of diabetic ketoacidosis in children and adolescents

Diabetic ketoacidosis (DKA) continues to be a common presentation of both type 1 and type 2 diabetes in children and adolescents. Early recognition and treatment in patients with new-onset diabetes are essential to the prevention of this potentially life-threatening complication of diabetes. DKA management protocols for paediatric patients differ from adult protocols, and therefore, it is important to have clear written guidelines and that in-patient care occur in centres with experience in the management of paediatric DKA. The present article outlines recommendations regarding the diagnosis and management of DKA. It also discusses management guidelines for intercurrent illness, with a view to reducing the frequency of DKA in children and adolescents with established diabetes.     

儿童糖尿病酮症酸中毒的诊断和治疗

糖尿病酮症酸中毒（DKA）是儿童糖尿病的急性并发症，发生率为每年0．5％～0．8％，通常见于1型糖尿病患儿，但高达25％的病例为新诊断的糖尿病，大多为感染所诱发。据国外报道，DKA的病死率为2％～5％，主要死因为延误诊治。目前糖尿病的发病率正逐年上升，因此DKA的诊断和治疗已引起高度关注。[第一段]     

ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents

Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus (TIDM). Mortality is predominantly related to the occurrence of cerebral oedema; only a minority of deaths in DKA are attributed to other causes. Cerebral oedema occurs in about 0.3-1% of all episodes of DKA, and its aetiology, pathophysiology, and ideal method of treatment are poorly understood. There is debate as to whether physicians treating DKA can prevent or predict the occurrence of cerebral oedema, and the appropriate site(s) for children with DKA to be managed. There is agreement that prevention of DKA and reduction of its incidence should be a goal in managing children with diabetes.     

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糖尿病酮症酸中毒(DKA)是糖尿病的危急并发症,也是糖尿病最常见的死亡原因,其死因大多为脑水肿。DKA是由于体内有效的胰岛素浓度绝对或相对减低所致。常合并有胰岛素抵抗或反调节激素产生过多[1]。反调节激素包括:胰高糖素、儿茶酚胺类、可的松、生长激素。绝对胰岛素缺乏常见于1型糖尿病(T1DM)初诊时、T1DM不正规治疗或使用胰岛素泵发生故障者;相对胰岛素缺乏见于各种应激、感染、创伤、胃肠疾病等的反调节激素增加。激素改变的结果是增加肝、肾葡萄糖的产生和外周对葡萄糖利用的受损,最终导致高血糖和血液高渗透性;另外增加脂解作用,…     

Hereditary spherocytosis: Guidelines for the diagnosis and management in children

Hereditary spherocytosis (HS) is the commonest inherited disorder of the erythrocyte membrane in Northern Europe and North America. It is marked by a regenerative anemia which varies widely from asymptomatic patients to severe hemolysis. In 75% of HS patients, inheritance is autosomal dominant. The diagnosis of HS is easily made when there are a family history, hemolytic anemia, reticulocytosis, spherocytes and increased hyperdense cells. Specialized testing to clarify the nature of membrane disorder is required when the film appearance is atypical without a positive family history, in the absence of a family history, in the newborn and before the splenectomy, to rule out the stomatocytosis which is contraindicated. The indication for splenectomy is dependent on the degree of anemia and its clinical manifestation.     

ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents.

Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus (TIDM). Mortality is predominantly related to the occurrence of cerebral oedema; only a minority of deaths in DKA are attributed to other causes. Cerebral oedema occurs in about 0.3-1% of all episodes of DKA, and its aetiology, pathophysiology, and ideal method of treatment are poorly understood. There is debate as to whether physicians treating DKA can prevent or predict the occurrence of cerebral oedema, and the appropriate site(s) for children with DKA to be managed. There is agreement that prevention of DKA and reduction of its incidence should be a goal in managing children with diabetes.