乌司他丁联合血液透析治疗糖尿病酮症酸中毒的疗效观察

目的探讨乌司他丁联合血液透析治疗糖尿病酮症酸中毒的疗效观察。方法选取2013年3月—2015年3月枣阳市第一人民医院收治的糖尿病酮症酸中毒患者60例,随机分为对照组和治疗组,每组各30例。对照组给予连续性血液透析治疗,采用Seldinger技术行股动脉或颈动脉穿刺,低分子肝素抗凝,置换液流量为2~3 L/h,超滤速度为50~300 m L/h,持续治疗6~12 h,隔日1次。治疗组在对照组基础上静脉滴注乌司他丁注射液,20万单位加入10%葡萄糖溶液250 m L,持续12 h,1次/d。两组患者均持续治疗14 d。观察两组的临床疗效,比较两组的尿酮体转阴时间、p H值恢复时间、空腹血糖、糖化血红蛋白、二氧化碳结合力(CO_2CP)、血乳酸(Lac)、酸碱度(p H)的情况。结果治疗后,对照组和治疗组患者的总有效率分别为73.33%、93.33%,两组比较差异有统计学意义(P0.05)。治疗后,两组CO_2CP和p H值明显上升,Lac明显下降,同组治疗前后比较差异有统计学意义(P0.05);且治疗组CO_2CP和Lac的改善程度明显优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组尿酮体转阴时间和p H值恢复时间明显短于对照组,两组比较差异有统计学意义(P0.05)。治疗后,两组空腹血糖和糖化血红蛋白明显下降,同组治疗前后比较差异有统计学意义(P0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P0.05)。结论乌司他丁联合血液透析治疗糖尿病酮症酸中毒具有较好的临床疗效,可改善临床症状,减轻酸中毒,降低血糖水平,具有一定的临床推广应用价值。

Clinical observation of ulinastatin combined with hemodialysis in treatment of diabetic ketoacidosis

Objective To explore the clinical effect of ulinastatin combined with hemodialysis in treatment of diabetic ketoacidosis. Methods Patients (60 cases) with diabetic ketoacidosis in Zaoyang First People''s Hospital from March 2013 to March 2015 were randomly divided into control and treatment groups, and each group had 30 cases. Patients in the control group were given continuous hemodialysis, using Seldinger technology for femoral artery or carotid artery puncture, anticoagulation with low molecular weight heparin, replacement fluid flow rate was 2-3 L/h, ultrafiltration rate was 50-300 mL/h, continuous treatment for 6-12 h, once every other day. Patients in the treatment group were iv administered with Ulinastatin Injection on the basis of the control group, 2×10⁵ U added into 10% glucose solution 250 mL, continuous iv for 12 h, once daily. Patients in two groups were treated for 14 d. After treatment, the clinical efficacies were evaluated, and turning-to-negative time of urinary keton, pH recovery time, fasting blood glucose, glycosylated hemoglobin, CO₂CP, Lac, and pH in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 73.33% and 93.33%, respectively, and there was difference between two groups (P<0.05). After treatment, CO₂CP and pH in two groups were significantly increased, but the Lac in two groups was significantly decreased, and the difference was statistically significant in the same group (P<0.05). And CO₂CP and Lac in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). After treatment, turning-to-negative time of urinary keton and pH recovery time in the treatment group were significantly shorter than those in the control group, and there was difference between two groups (P<0.05). After treatment, fasting blood glucose and glycosylated hemoglobin in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). Conclusion Ulinastatin combined with hemodialysis has clinical curative effect in treatment of diabetic ketoacidosis, can improve clinical symptoms, relieve acidosis, decrease blood glucose levels, which has a certain clinical application value.