儿童糖尿病酮症酸中毒并发脑水肿的危险因素分析及护理对策

目的 收集糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)及DKA并脑水肿患儿的临床资料,分析DKA患儿合并脑水肿的危险因素,并针对危险因素总结护理对策。 方法 收集宁波市妇女儿童医院2014年7月—2019年2月间收治的189例无脑水肿的DKA患儿和27例合并脑水肿的DKA患儿资料。对2组年龄、血糖、pH值、血钠上升缓慢、持续低钠血症、血尿素氮升高及碳酸氢盐浓度等情况进行统计,并采用单因素和logistic回归分析确定儿童DKA并发脑水肿的危险因素。 结果 单因素分析结果显示2组在年龄、血糖、pH值、血钠上升缓慢、持续低钠血症、血尿素氮升高及碳酸氢盐浓度等方面比较,差异有统计学意义(均P<0.05)。Logistic分析结果显示:年龄≤6岁(OR=3.456,P=0.002)、血糖>20 mmol/L(OR=3.331,P=0.001)、pH值≤7.35(OR=3.543,P=0.004)、血钠上升缓慢(OR=2.543,P=0.004)、持续低钠血症(OR=2.112,P=0.019)、血尿素氮升高(OR=2.400,P=0.021)、碳酸氢盐浓度>10 mmol/L(OR=2.732,P=0.048)是DKA患儿合并脑水肿的危险因素。 结论 年龄≤6岁、血糖>20 mmol/L、pH值≤7.35、血钠上升缓慢、持续低钠血症、血尿素氮升高及碳酸氢盐浓度>10 mmol/L是儿童DKA并发脑水肿的危险因素,临床中要重视这些危险因素,做好预防性治疗和护理,预防脑水肿的发生。 

Analysis of risk factors and nursing strategies for children with diabetic ketoacidosis complicated with cerebral edema

Objective To count the clinical data of diabetic ketoacidosis(DKA)children and DKA with cerebral edema, analyze the risk factors of DKA with cerebral edema, and summarize the nursing countermeasures. Methods The data of 189 cases of DKA without cerebral edema and 27 cases of DKA with cerebral edema were collected in Ningbo Women and Children Hospital from July 2014 to February 2019. The age, blood glucose, pH value, blood sodium slow rising, persistent hyponatremia, blood urea nitrogen elevating, and bicarbonate concentration were counted, and single factor and logistic regression analysis were used to determine the risk factor of DKA with cerebral edema. Results Univariate analysis showed that the difference between two groups was significant on age, blood glucose, pH value, blood sodium slow rising, persistent hyponatremia, blood urea nitrogen elevating, and bicarbonate concentration. Logistic analysis showed that age≤6 years(OR=3.456, P=0.002), blood glucose>20 mmol/L(OR=3.331, P=0.001), pH≤7.35(OR=3.543, P=0.004), blood sodium slow rising(OR=2.543, P=0.004), persistent hyponatremia(OR=2.112, P=0.019), blood urea nitrogen elevating(OR=2.400, P=0.021), and bicarbonate concentration>10 mmol/L(OR=2.732, P=0.048) were risks factors of DKA with cerebral edema. Conclusion Age≤6 years, blood glucose>20 mmol/L, pH value≤7.35, blood sodium slow rising, persistent hyponatremia, blood urea nitrogen elevating, and bicarbonate concentration>10 mmol/L were risks factors of DKA with cerebral edema. The risk factors should be emphasized in clinical practice, and sexual treatment and nursing should be done to prevent the occurrence of cerebral edema.