重温糖尿病酸性 (DKA) 流体管理:应该使用正常盐水吗?
Noelle Messina1, Zackary Anderson1, Lauren Saravis1
1Graduate Medical Education Internal Medicine Residency, Naples Comprehensive Health (NCH) Healthcare System, Naples, USA.
Cureus
|February 21, 2025
概括
在糖尿病酸性症 (DKA) 治疗中,大量的正常盐水 (NS) 与更长的重症监护室 (ICU) 停留和增加的代谢性酸性有关. 均衡的晶体可能为DKA患者提供更好的结果.
科学领域:
- 内分泌学 在内分泌学.
- 关键护理医学 关键护理医学
- 腎臟病學 (nephrology) 是一種醫學專業.
背景情况:
- 糖尿病酸症 (DKA) 是一种严重的糖尿病并发症,需要密集护理.
- 液体复苏是DKA管理的关键,传统上使用正常盐水 (NS).
- 人们担心大量的NS可能会导致高酸性和不良结果.
研究的目的:
- 评估DKA患者的大容量NS复苏是否与长时间的ICU停留时间 (LOS) 相相关.
- 评估DKA后NS体积和增加胰岛素输液持续时间之间的关联.
- 为了确定高的NS体积是否会增加DKA解析后非离子间隙代谢酸化的发生率.
主要方法:
- 对109名DKA患者进行了回顾性,单中心的观察性研究.
- 根据NS体积分类的患者接受:0L,1L,2L和≥3L.
- 统计分析 (ANOVA,t测试,奇方) 比较了ICU的LOS,整体的LOS,胰岛素持续时间和酸发生率.
主要成果:
- 接受2L (p=0.0249) 和≥3L (p=0.00065) NS的患者比0L组的ICU LOS显著长.
- ≥3L的NS体积与显著更长的胰岛素输注持续时间有关 (p=0.0101).
- 接收≥2LNS显著增加非阴离子酸性酸性发生率 (p=0.0000).
结论:
- 在DKA中大量的NS复苏与长时间的ICU停留,延长的胰岛素使用以及更高的非阴离子间隙代谢酸性化率有关.
- 研究结果表明,像乳酸Ringer等平衡晶体可能是DKA复苏的首选.
- 建议进行进一步的前性研究,以确认这些结果并完善DKA流体管理协议.
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