肝移植术后两种极端糖尿病性昏迷的临床分析

目的探讨肝移植术后基于移植后糖尿病(PTDM)的高渗性非酮症高血糖昏迷(HNKHC)和酮症酸中毒(DKA)的诊治。 方法回顾性分析本院2005年1月至2013年12月完成的805例肝移植患者资料,总结2例HNKHC和DKA患者的诊治经过。2例术前均无糖尿病史,肝移植术后均服用他克莫司和雷帕鸣抗排斥,1例女性患者曾给予甲强龙冲击治疗急性排斥反应,另1例男性患者入院后将他克莫司改为环孢素。 结果例1诊断为HNKHC,例2诊断为DKA。2例经给予快速大量补液、小剂量胰岛素持续静脉滴注、纠正电解质及酸碱平衡紊乱等综合治疗,患者临床症状和体征消失,最终病愈出院。随访半年均未再发HNKHC、DKA和PTDM。 结论肝移植术后HNKHC和DKA的发病率极低,但病情凶险,预后取决于准确的诊断和及时有效的综合治疗措施。无糖尿病史的肝移植患者术后昏迷应警惕HNKHC和DKA的发生。

Clinical analysis of two extreme diabetic comas after liver transplantation

ObjectiveTo summarize the diagnosis and treatment of hyperosmolar non-ketotic hyperglycemic coma (HNKHC) and diabetic ketoacidosis (DKA) based on post-transplant diabetes mellitus (PTDM) after liver transplantation. MethodsThe data of 805 patients with liver transplantation in our hospital from January 2005 to December 2013 was reviewed retrospectively. Only 2 cases with HNKHC and DKA were found out. Both cases had no history of diabetes, and used tacrolimus and sirolimus for immunosuppression. After admission, the female had been given methylprednisolone impulse therapy for acute rejection, and tacrolimus was transformed into sirolimus for the male patient. ResultsThe female patient was diagnosed as HNKHC, and the male patient suffered from DKA. After comprehensive treatment, such as rapid rehydration, small doses of insulin continuously intravenous dripping, correcting electrolyte and acid-base balance disorders, the symptoms and signs disappeared, and the patients is eventually discharged from the hospital. There was no recurrence on HNKHC, DKA and PTDM after 6 months follow-up. ConclusionsThe morbidity of post-liver transplantation HNKHC and DKA is extremely low, but they are extremely dangerous. The prognosis depends on accurate diagnosis and effective comprehensive treatment in a timely manner.