糖尿病酮症酸中毒的心电图分析

目的探讨糖尿病酮症酸中毒患者的心电图改变。方法 42例符合WHO诊断标准的糖尿病酮症酸中毒患者,选择每例患者入院后24h内心电图分析,异常心电图均于病情稳定后复查。结果 42例心电图检查,有34例出现心电图异常,以窦性心动过速最常见。结论糖尿病酮症酸中毒患者的心电图改变以窦性心动过速最常见。     

糖尿病酮症酸中毒患者心律失常发病情况分析

目的探讨糖尿病酮症酸中毒患者心律失常的发病特点。方法收集1型或2型糖尿病（及并发酮症酸中毒）患者200例，按其是否并发酮症酸中毒，将其分为并发酮症酸中毒组和无酮症酸中毒组，应用统计学方法分析两组病例心律失常构成比的差异。结果并发DKA糖尿病组以室上性心动过速（48．3％）和房颤（30．0％）多见，无DKA糖尿病组以室性早搏（49．3％）和房性早搏（17．1％）多见。结论并发DKA糖尿病患者以室上性心动过速和房颤多见，无DKA糖尿病患者以室性早搏和房性早搏多见。     

重型乙型肝炎引起心肌损害的临床分析

目的探讨重型乙型肝炎引起心肌的损害,并对临床的症状进行分析研究。方法对收治的303例重型乙型肝炎患者采用日本NEC3300同步12导心电图机常规检查心电图,同时检测心肌酶谱,检测采用OLYMPUSAU640全自动生化分析仪。结果心电图异常、CPK升高的发生率明显高于CPK正常者,尤其是窦性心动过速;窦性心动过速合并ST_T改变及窦性心动过速合并低电压时,CPK升高的发生率显著高于CPK正常者(P<0.01或P<0.05)。结论本组对303例患者合并心电图异常的占43.2%,仅有20%的患者感到不同程度的心慌、胸闷或心前区不适,心电图异常以窦性心动过速最为多见,病情进展越快,心电图异常改变的发生率越高,特别是窦性心动过速是反映病情危重的重要指标,它的出现往往提示预后极差。     

伴有或不伴有2型糖尿病患者常规心电图变化对照研究

目的观察伴有或不伴有2型糖尿病患者十二导联心电图变化情况。方法收集230例伴有2型搪尿病患者(糖尿病组)与230例不伴有糖尿病(非糖尿病组)的常规心电图资料,分析2组之间心电图变化情况。结果糖尿病组患者心电图异常的发生率明显高于非糖尿病组患者(χ2=44.99,P0.01),糖尿病组中,女性异常率显著高于男性(χ2=9.479,P0.01)。窦性心动过缓、窦性心动过速、房早、房速、心房纤颤、室早、传导阻滞、ST-T改变,2组比较差异均有统计学意义。结论糖尿病患者容易发生心电图异常,常规心电图能够有效发现糖尿病患者心电图异常表现,对临床诊断有较大价值。     

126例糖尿病酮症和酮症酸中毒的治疗及分析

目的探讨糖尿病酮症及糖尿病酮症酸中毒的常见诱因及治疗。方法对1 2 6例糖尿病酮症及糖尿病酮症酸中毒的病例进行回顾性分析。结果引起糖尿病酮症及糖尿病酮症酸中毒的第一位诱因是感染,第二位诱因是中断胰岛素及口服降糖药,经治疗后所有患者均取得很好的疗效。结论加强糖尿病患者管理,认识并预防其诱因,降低糖尿病酮症及糖尿病酮症酸中毒的发病率,把握好治疗时机,可节约医疗成本,减轻患者的痛苦。     

以呕吐为首发症状的糖尿病酮症酸中毒2例误诊分析

糖尿病酮症酸中毒是糖尿病的一种严重急性并发症，也是内科常见急症之一。一些糖尿病患者以酮症酸中毒为首发表现而就医，易误诊。2008年1月～2009年1月，我院收治2例以呕吐为首发症状的糖尿病酮症酸中毒患者，现报道如下：     

糖尿病酮症酸中毒48例诱因分析体会

目的总结糖尿病酮症酸中毒的发病诱因,提高对本病的诊治水平。方法回顾性分析笔者所在医院2004年5月～2010年12月住院的48例糖尿病酮症酸中毒患者的临床资料,对患者发病诱因进行分析。结果糖尿病酮症酸中毒均有一定的诱发原因,通过及时有效的诊断及治疗,是完全可以逆转的内科急症。结论糖尿病酮症酸中毒是糖尿病最常见的急性并发症,一旦发现,应在纠正发病诱因的基础下立即抢救,正确补液及迅速使用胰岛素,纠正糖和脂肪代谢紊乱,是抢救糖尿病酮症酸中毒成功的关键措施。     

尘肺并发肺心病患者异常心电图探讨

目的 探讨心电图检查在尘肺并发肺心病患者的诊断、治疗及病情观察中的临床价值.方法 对在我院住院治疗的42例尘肺并发肺心病患者异常心电图进行统计、分析、动态观察其变化.结果 尘肺并发肺心病患者心电图改变依次以电轴右偏、高度顺钟向转位、肺型P波、ST-T段改变、窦性心动过速为主,随治疗病情好转,心电图呈现动态变化.结论 心电图检查能对尘肺并发肺心病患者的诊断、疗效观察及病情分析提供重要依据.     

急性脑出血致脑心综合症的心电图改变

目的探讨急性脑出血致脑心综合症心电图变化情况及临床意义。方法观察116例急性脑出血患者的心电图变化。结果急性脑出血后心电图改变类型最常见st-t改变。出血部位以基底节最常见,其次为脑叶、小脑及脑干、脑室出血最常见。伴有高血压、糖尿病的高龄患者,尤其是神经功能严重障碍患者,更容易出现心电图的异常变化。结论急性脑出血患者应加强心脏功能的监护,检测心电图,使可逆性心肌损害得到恢复。     

糖尿病酮症酸中毒患者的临床护理

糖尿病酮症酸中毒( DKA)是糖尿病常见急性并发症之一,病情严重、死亡率高,发病机制是糖尿病患者体内胰岛素缺乏,引起了以高血糖、高血酮症和代谢性酸中毒为主要病变的综合征.我科自2010年6月～2011年5月收治了糖尿病酮症酸中毒患者31例,经过抢救治疗和精心护理,均治愈出院.现将护理体会总结如下.     

The spectrum of brittle diabetes.

A group of 42 severely brittle insulin dependent diabetic patients were studied, and compared with a similar number of 'stable' diabetic patients. Brittle diabetics were predominantly female (86% v 45%, P < 0.01), were of younger age (mean +/- SD 27.9 +/- 12.8 years v 40.1 +/- 13.6 years, P < 0.001), and of shorter duration of diabetes (13.7 +/- 9.4 years v 19.6 +/- 11.2 years, P < 0.01). Control as measured by glycosylated haemoglobin (HbA1) was poorer (13.7 +/- 3.1% v 10.1 +/- 1.5%, P < 0.001), and daily insulin dose higher (98 +/- 81 u v 47 +/- 14 u, P < 0.001). There was no difference in diabetic complication rates, but psychosocial disturbances (74% v 17%) and factitious instability (40% v 2%) were highly significantly more common amongst brittle patients. Examination of patterns of admission revealed most brittle diabetics to have hyperglycaemic problems (70%), mainly due to recurrent ketoacidosis (52%). Recurrent hypoglycaemia accounted for 12% of the group, and only 5/42 patients (12%) had mixed forms of instability. Brittle diabetes is thus characterized by young age and female sex, and usually manifests itself as recurrent ketoacidosis or other forms of hyperglycaemic instability. Psychosocial problems and factitious metabolic decompensation are common.     

Diabetic ketoacidosis in childhood

Diabetic ketoacidosis is the most serious acute complication of insulin-dependent diabetes mellitus and the most frequent reason for hospital admission of diabetic children. The most frequent cause of death of these patients is also the diabetic ketoacidosis. The mortality rate of the disease has not changed since the seventies (1-2%). In this work, the data of 89 patients with diabetic ketoacidosis were analyzed. These patients were admitted to the 1. Department of Pediatrics of the Semmelweis University of Medicine between 1992-1997. The data (metabolic parameters, the causes of ketoacidosis and the length of hospital stay) of previously known diabetic children was compared with the data of previously unknown diabetic children. Our patients were divided in 2 groups: serious (n = 11), and mild-to-moderate (n = 48) acidosis. Their laboratory findings, their intravenous infusion-, and insulin demand and the length of their hospital stay were compared. The state of consciousness at their hospitalisation and the concomitant complications were also examined. Significant difference was found only in the duration of intravenous insulin administration (with the exception of pH and BE, of course). There was no relationship between the seriousness of the disease and the duration of hospital treatment. It is noteworthy that even the previously known diabetic children with the shortest hospitalization spent more than 7 days at the department.     

微量泵在糖尿病酮症酸中毒中的临床应用

目的:探索微量注射泵与静脉滴注治疗糖尿病酮症酸中毒的临床疗效.方法:选取2017年9月~2019年11月在本院治疗的糖尿病酮症酸中毒患者72例为观察对象,分为两组.微量注射泵组(实验组)38例患者,采用微量注射泵注射胰岛素方案治疗;静脉滴注组(对照组)34例患者,采取静脉滴注胰岛素方案治疗.比较两组患者的临床疗效以及各项指标的变化情况.结果:①经过治疗发现微量注射泵组患者的总有效率对比静脉滴注组具有明显优势,P<0.05.②经过治疗发现微量注射泵组患者血酮转阴时间短、住院时间少、血糖达标时间短及维持胰岛素量小对比静脉滴注组具有明显优势,P<0.05.结论:采用微量注射泵的方式注射胰岛素治疗糖尿病酮症酸中毒效果确切,对比临床疗效及各项指标等方面有明显的优势.     

25 years experiences on diabetic ketoacidotic patients

INTRODUCTION: In the past 25 years the authors regularly assessed the clinical characteristics of patients with diabetic ketoacidosis who were admitted to their diabetes unit. AIM: The aim was to examine the possible changes in the incidence, causes, treatment and mortality of diabetic metabolic disorders. METHODS: Retrospective analysis of the data obtained by the assessment of case histories. RESULTS: Between 1981 and 2005, 288 patients were admitted with 364 ketoacidotic episodes. The mean age of the patients was 42 +/-16.9 -- 53.2 +/- 12.6 years. Approximately 60% of them had type 1 diabetes and the proportion of the male patients was almost the same. The mean duration of diabetes was 7.8 +/- 8.1 -- 10 +/- 7.1 years. The ratio of manifest comas was approximately 10%. Among the precipitating factors the dominance of infections decreased (from 77.3% to 50.4%). During the treatment the aim of the authors was to supply fluids and electrolytes properly and to administer insulin for a prolonged period of time and in a dose as small as possible. The dose of the insulin bolus significantly decreased in the last period (8.29 +/- 4.31 U; p < 0.05). In the observed period 43 patients died (14.93% of the patients), the mortality rate decreased to 7.2% during the last period. CONCLUSIONS: Despite the intensive education, care and treatment of diabetic patients, the number of hospitalizations due to diabetic ketoacidosis has not decreased. In order to prevent ketoacidotic episodes proper team work is needed in the management of diabetic patients.     

Diabetic ketoacidosis presenting as acute abdomen

Three patients, two women aged 21 and 67 and a man aged 43 years, presented at the emergency department with diabetic ketoacidosis and abdominal symptoms mimicking an acute abdominal condition. In two of them laparotomy was performed which proved to be negative. Abdominal symptoms resolved after correction of metabolic, fluid and electrolyte disturbances. Symptoms indicating a possible diagnosis of acute abdomen have to be regarded as being compatible with diabetic ketoacidosis per se. However, a potential acute abdominal problem prompting surgical intervention should not be overlooked; it may have been the precipitating factor for diabetic ketoacidosis.     

2型糖尿病肝损害相关因素研究

目的本研究旨在探讨2型糖尿病肝损害的相关因素。方法回顾性分析该院239例确诊为2型糖尿病患者的临床资料,对其一般资料、肝功能损害情况进行统计分析。结果本组患者共239例,肝功能异常46例,发生率19.2%,其中ALT异常11例(23.9%),而AST以9例(19.6%),ALT及AST均异常29例(63%),AKP异常19例(41.3%),TB、TG、TC均异常升高20例(43.4%),单项TB、TG、TC升高11例(23.9%)。超声、CT或MRI诊断脂肪肝患者23例(50%)。肝功能损害组空腹血糖及血脂均明显高于无肝功能损害组,两组间经过t检验分析差异均有统计学意义,P<0.05。肝功能损害组糖尿病肾病、神经病变、视网膜病变发病率明显高于无肝功能损害组,组间有统计学差异,P<0.05;而酮症酸中毒组间比较无统计学差异,P>0.05。结论高血糖、高血脂是2型糖尿病患者肝损伤最为常见的因素,而糖尿病肾病、神经病变、视网膜病变、酮症酸中毒也易导致肝功能损害,严格控制血糖,降低血脂能极大改善2型糖尿病患者肝损害。     

Vomiting: not a benign symptom in children with diabetes

Two girls, 14 and 15 years old and known for several years with diabetes, came to the paediatric outpatients' clinic because they had been vomiting for 1-2 days. Laboratory tests revealed diabetic ketoacidosis. After administration of fluids and short-acting insulin, and sodium bicarbonate in one of the girls, the patients recovered, although one of them continued to have fluctuating glucose values. In most children, vomiting indicates benign gastro-enteritis and is therefore self-limiting. But in children with diabetes mellitus, vomiting can be more sinister because it could lead to, or be a symptom of, diabetic ketoacidosis. Even with normal blood glucose levels, severe metabolic disturbances are possible, and tests diagnosing diabetic ketoacidosis are recommended.     

Diabetes mellitus associated with atypical antipsychotic medications: new case report and review of the literature.

BACKGROUND: Since the introduction of atypical antipsychotic medications, beginning with clozapine in 1990, several case reports in the psychiatric literature have suggested that they might be associated with new onset of diabetes mellitus as well as with diabetic ketoacidosis. METHODS: We report the case of a 38-year-old patient with schizophrenia who suddenly developed diabetes mellitus and ketoacidosis 12 months after starting olanzapine. Similar cases in the literature were found through a MEDLINE-assisted search using the key words "schizophrenia," "diabetes mellitus," "ketoacidosis," and "adverse drug reaction." RESULTS: Including this case, 30 patients have been reported in the literature to have developed diabetes or have lost diabetic control after starting clozapine, olanzapine, or quetiapine. Twelve of these 30 developed diabetic ketoacidosis. Two limited quantitative studies have added evidence toward this association. CONCLUSION: Although a causal relation has not been definitively proved, the number of cases reported in the literature suggests there might be an association between atypical antipsychotic medications and diabetes mellitus. Primary care physicians who care for patients with schizophrenia should be aware of this possible association.     

The post-operative electrocardiogram and creatine kinase: implications for diagnosis of myocardial infarction after non-cardiac surgery

The objective of this study was to evaluate different approaches to the diagnosis of post-operative myocardial infarction. A total of 232 patients, mostly hypertensive and/or diabetic patients, who were undergoing elective non-cardiac surgery were evaluated pre-operatively. They were followed serially from the day of operation to discharge or the sixth post-operative day with daily clinical evaluations, electrocardiograms, creatine kinase and creatine kinase isoenzymes. In total 22% (51/232) of the patients had post-operative ECG changes in two or more leads. Only 1% developed new Q waves; most of the changes involved changes in the T or ST segments. Seventy percent of patients who had changes in their electrocardiogram were completely asymptomatic. The highest risk of ECG changes or symptoms occurred on the day of operation and the first post-operative day; evidence of post-operative infarction was infrequent after the second post-operative day. Creatine kinase levels rose an average of 250-300 IU on the first and second post-operative day (also the peak time for post-operative ECG changes), reducing its utility as an adjunct to the diagnosis of post-operative infarctions. Importantly, 52% (12/23) of the patients who had greater than or equal to 5% MB isoenzyme had neither ECG changes nor symptoms; the diagnosis of a myocardial infarction should not be made in these patients. In summary, most patients who experience ischemia or infarction post-operatively are asymptomatic. Symptoms should not be required for the diagnosis of post-operative infarction. Seemingly minor differences in criteria can produce major discrepancies in post-operative myocardial infarction rates (from 1 to 9%). The development of a final set of criteria will require further study but the diagnosis of post-operative infarction should probably be based on ECG changes, their duration and consistency, and the association of a positive MB fraction.