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探讨胃肠内补液用于治疗老年非酮症糖尿病高渗性昏迷(NKHDC)的临床意义。方法:选取本院收治的46例NKHDC患者,随机分为观察组与常规组。观察组24例,行胃肠内补液联合静脉补液方法;常规组22例,行单纯静脉补液方法。观察两组患者治疗前后的血生化指标与血浆渗透压的变化及术后并发症发生率。结果:观察组24h与48h血糖分别为(17.4±7.2)mmol/L与(9.8±3.4)mmol/L,显著性低于常规组的(21.8±8.3)mmol/L与(11.5±5.8)mmol/L(P<0.05);观察组24h血钾为(4.6±1.9)mmol/L,显著性低于常规组的(5.1±1.6)mmol/L(P<0.05);观察组24h血钠为(141±10)mmol/L,显著性低于常规组的(149±12)mmol/L(P<0.05);观察组24h与48h血浆渗透压分别为(314±12)mmol/L与(301±9)mmol/L,显著性低于常规组的(325±15)mmol/L与(312±13)mmol/L(P<0.05)。同时,观察组患者经治疗后无一例发生脑水肿,肺水肿,心力衰竭或低血钾等并发症;常规组患者并发症发生率占28.13%,两组比较,差异有显著性意义(P<0.05)。结论:老年非酮症糖尿病高渗性昏迷患者治疗除采用静脉补液外,加用胃肠内补液疗效更为显著,可较快恢复代谢,纠正患者高渗昏迷状态,达到治疗目的。
To investigate the clinical significance of gastrointestinal rehydration in the treatment of hyperosmolar coma (NKHDC) in elderly nonketotic diabetic patients. Methods: 46 cases of NKHDC patients admitted to our hospital were randomly divided into observation group and conventional group. The observation group of 24 patients underwent gastrointestinal rehydration combined with intravenous rehydration; conventional group of 22 patients underwent simple intravenous rehydration. The changes of blood biochemical indexes and plasma osmolality before and after treatment and the incidence of postoperative complications were observed. Results: The blood glucose in the observation group at 24 h and 48 h were (17.4 ± 7.2) mmol / L and (9.8 ± 3.4) mmol / L, respectively, significantly lower than that of the control group (21.8 ± 8.3 mmol / L and 11.5 ± 5.8 mmol / / L (P <0.05). The serum potassium level in the observation group was (4.6 ± 1.9) mmol / L for 24h, which was significantly lower than that in the conventional group (5.1 ± 1.6) mmol / L (141 ± 10) mmol / L and (149 ± 12) mmol / L, respectively (P <0.05). The plasma osmolality at 24h and 48h in the observation group was (314 ± 12) mmol / 301 ± 9 mmol / L, significantly lower than 325 ± 15 mmol / L and 312 ± 13 mmol / L (P <0.05) in the conventional group. At the same time, there was no complication of cerebral edema, pulmonary edema, heart failure or hypokalemia in the observation group after treatment. The incidence of complications in the conventional group was 28.13%, there was significant difference between the two groups (P < 0.05). Conclusion: The treatment of hyperosmolar coma of non-ketotic diabetic patients with hyperosmolar coma in addition to the use of intravenous rehydration, plus gastrointestinal rehydration more significant effect, rapid recovery of metabolism, correction of hypertonic coma in patients with state, to achieve the purpose of treatment.