糖尿病酮症酸中毒并发脑水肿临床分析

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。方法对重庆医科大学附属儿童医院1993—2005年住院治疗的糖尿病酮症酸中毒并发脑水肿患儿的临床特征及病因进行分析，并与未并发者进行对照比较。结果在71例酮症酸中毒患儿中，有6例临床表现符合脑水肿的诊断标准，临床确定为并发脑水肿，并发率为84%。6例均为重型酮症酸中毒。与未发生脑水肿同等程度的重型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及持续低钠血症，尿素氮水平升高。6例患儿中有5例应用碳酸氢盐治疗，用量大于未并发者。结论糖尿病儿童并发重型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。

Clinical characteristics of cerebral edema in children with diabetic ketoacidosis.

AbstractObjectiveTo explore the clinical characteristics of cerebral edema in children with diabetic ketoacidosis.MethodsThe clinical data of 71 children with diabetic ketoacidosis admitted to the hospital from 1993 to 2005 were analysed.The clinical characteristics and possible etiological factors between children with cerebral edema,and those with equal severe diabetic ketoacidosis but without cerebral edema were compared.ResultsSix cases in 71 children with diabetic ketoacidosis were identified in developed cerebral edema.The incidence of cerebral edema in the patients of this group was 84%.They all suffered severe ketoacidosis.Compared the children with equal severe diabetic ketoacidosis but without cerebral edema,6 children suffered more severe metabolic acidosis,experienced an attenuated rise in measured serum sodium concentrations or hyponatremia during therapy for diabetic ketoacidosis and had higher initial serum urea nitrogen concentrations.Five cases in 6 children with cerebral edema had been administrated bicarbonate treatment.ConclusionThe severe diabetic ketoacidosis is much more easy to develop cerebral edema.Children with diabetic ketoacidosis who have severe metabolic acidosis,a smaller increases in serum sodium concentration or hyponatremia during therapy and high serum urea nitrogen concentrations,and children who are treated with bicarbonate are at increased risk for developing cerebral edema.