糖尿病酮症酸中毒并发急性ST段抬高型心肌梗死4例临床分析

目的探讨糖尿病酮症酸中毒(DKA)合并急性ST段抬高型心肌梗死(STEMI)的临床特点及救治方法。方法回顾性分析4例DKA合并急性STEMI患者临床特点及救治过程,总结救治经验。结果DKA并发急性STEMI患者女性多于男性,患者均为高血糖(>29 mmol/L),酸中毒严重(pH<7.1),酮症阳性(尿酮体+++)。4例患者中,1例为男性,3例为女性。1例女性因心源性休克死亡。2例急诊冠脉造影提示冠脉血栓形成,其中1例支架治疗,1例冠脉未见明显狭窄;1例择期造影显示冠脉内无血栓,右冠状动脉仅约30%狭窄,未予支架治疗。3例患者均顺利出院。结论尽快就医,及时补液降糖纠酸治疗,快速开通闭塞冠脉血管,可能是DKA合并急性STEMI患者救治成功的关键。

Clinical analysis of 4 cases of diabetic ketoacidosis complicated with acute ST-elevation myocardial infarction

Objective To explore the clinical characteristics and treatment of diabetic ketoacidosis(DKA)complicated with acute ST-elevation myocardial infarction(STEMI).Methods The clinical characteristics and treatment process of 4 patients with DKA complicated with acute STEMI were analyzed retrospectively,and the treatment experience was summarized.Results In DKA patients complicated with acute STEMI,female were more than male;the examination of all patients showed hyperglycemia(>29 mmol/L),severe acidosis(pH<7.1)and ketosis positive(urine ketone body+++).Among the 4 patients,1 case was male and 3 case was female.One female died of cardiogenic shock.Two cases were diagnosed as coronary thrombosis by emergency coronary angiography,1 case was treated with stent,and the other had no obvious coronary stenosis;1 case showed no thrombus in the coronary artery and only about 30%stenosis of the right coronary artery by selective angiography,then no stent treatment was given.Three patients were discharged successfully.Conclusion The key to the successful treatment of DKA patients with acute STEMI may be to seek medical treatment as soon as possible,timely rehydration,hypoglycemic and acid rectifying therapy,and rapid opening of occluded coronary arteries.