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[儿童糖尿病酮症酸中毒治疗的现代进展]

[Modern aspects of diabetic ketoacidosis treatment in children].

作者信息

Petriaĭkina E E, Lukovenkov A V, Semenova N A, Koltunov I E, Petriaĭkin A V, Varfolomeev S D

出版信息

Anesteziol Reanimatol. 2012 May-Jun(3):62-7.

Abstract

UNLABELLED

The aim of the research - the analysis of the regularities of diabetic ketoacidosis treatment in children and adolescents with type 1 diabetes mellitus, the explanation of the results obtained with the use of biological systems stability theory elements. MATHERIALS AND METHODS: The study included 90 children with type I diabetes mellitus in a state of diabetic ketoacidosis of different severity degree. With newly diagnosed type 1 diabetes mellitus - 56 children, with the "courced" diabetes - 34 children. In the evaluation of patients status was defined glucose, pH, and other indicators of acid-base status, using gas analyzer GEM Premier 3000 ("Instrumental laboratory", USA).

RESULTS

All children received treatment under the Protocol, approved by the Moscow Health Department, withdrawn from the state of diabetic ketoacidosis without any complications. In the basis of this methodology is application of glucose solutions and "small" doses of insulin from the start of infusion therapy in spite of hyperglycemia. This therapy helps to prevent cerebral edema against the background of gradually reduce the blood glucose. pH recovery was explained by the existence of a common pathophysiology process. Given the qualitative description of this process on the basis of biological systems stability theory. Were determined 3 stationary state: pH = 7.4 and pH < 6,9; and one is unstable, called "the point of no return" - pH = 6.9. The conclusions of this theory substantiate the effectiveness of ketoacidosis treatment with offered method

CONCLUSION

The offered technique for diabetic ketoacidosis treatment on the basis of the glucose solutions infusion throughout the treatment and "small" doses of insulin values pH and glucose in a safe range, even in patients with high risk of brain edema, which is confirmed by biological systems stability theory.

摘要

未标注

本研究的目的——分析1型糖尿病儿童和青少年糖尿病酮症酸中毒的治疗规律,运用生物系统稳定性理论要素解释所得结果。材料与方法:该研究纳入90例处于不同严重程度糖尿病酮症酸中毒状态的1型糖尿病儿童。其中新诊断为1型糖尿病的儿童56例,“病程较长”的糖尿病儿童34例。使用GEM Premier 3000型血气分析仪(美国“仪器实验室”)评估患者的血糖、pH值及其他酸碱状态指标。

结果

所有儿童均按照莫斯科卫生部批准的方案接受治疗,脱离糖尿病酮症酸中毒状态且无任何并发症。该方法的基础是从输液治疗开始就应用葡萄糖溶液和“小剂量”胰岛素,尽管存在高血糖。这种治疗有助于在血糖逐渐降低的背景下预防脑水肿。pH值的恢复可通过共同的病理生理过程来解释。基于生物系统稳定性理论对该过程进行了定性描述。确定了3个稳态:pH = 7.4和pH < 6.9;以及1个不稳定状态,称为“不归点”——pH = 6.9。该理论的结论证实了所提供方法治疗酮症酸中毒的有效性。

结论

所提供的糖尿病酮症酸中毒治疗技术,基于在整个治疗过程中输注葡萄糖溶液和“小剂量”胰岛素,可将pH值和血糖维持在安全范围内,即使对于有脑水肿高风险的患者也是如此,这得到了生物系统稳定性理论的证实。

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