Bull Sarah V, Douglas Ivor S, Foster Mark, Albert Richard K
University of Colorado Health Sciences Center, Denver, CO, USA.
Crit Care Med. 2007 Jan;35(1):41-6. doi: 10.1097/01.CCM.0000249825.18677.D2.
To determine the effect of a mandatory protocol for treating diabetic ketoacidosis.
Chart review of patients treated before and after protocol implementation.
University-affiliated U.S. public teaching hospital.
A total of 241 consecutive nonpregnant patients >18 yrs old admitted to a medical intensive care unit for diabetic ketoacidosis between January 2000 and January 2005.
Implementation of a mandatory treatment protocol in May 2003.
Intensive care unit and hospital lengths of stay, time to correction of anion gap and ketone clearance, and hypoglycemic episodes.
Before protocol implementation, the mean +/- sd intensive care unit and hospital lengths of stay were 44 +/- 28 hrs and 91 +/- 73 hrs, respectively. After implementation, intensive care unit and hospital lengths of stay decreased 23% and 30%, to 34 +/- 18 hrs and 64 +/- 41 hrs, respectively (both p < .007). Time to anion gap closure and ketone clearance also decreased (both p < .05). No difference in the number of hypoglycemic episodes was observed.
Implementing a mandatory protocol for treating adult patients with diabetic ketoacidosis decreases intensive care and hospital lengths of stay and time to anion gap closure and ketone clearance, without increasing the rate of hypoglycemia.
确定糖尿病酮症酸中毒强制治疗方案的效果。
对方案实施前后治疗的患者进行病历回顾。
美国大学附属的公立教学医院。
2000年1月至2005年1月期间，共有241例年龄>18岁的非妊娠患者因糖尿病酮症酸中毒入住医疗重症监护病房。
2003年5月实施强制治疗方案。
重症监护病房住院时间、医院住院时间、阴离子间隙纠正时间、酮体清除时间及低血糖发作次数。
在方案实施前，重症监护病房平均住院时间及标准差为44±28小时，医院平均住院时间及标准差为91±73小时。实施后，重症监护病房住院时间和医院住院时间分别减少了23%和30%，降至34±18小时和64±41小时（均p<.007）。阴离子间隙闭合时间和酮体清除时间也缩短了（均p<.05）。低血糖发作次数无差异。
对成年糖尿病酮症酸中毒患者实施强制治疗方案可缩短重症监护病房住院时间、医院住院时间、阴离子间隙闭合时间和酮体清除时间，且不增加低血糖发生率。
