Singh R K, Perros P, Frier B M
Department of Diabetes, Royal Infirmary of Edinburgh, UK.
Diabet Med. 1997 Jun;14(6):482-6. doi: 10.1002/(SICI)1096-9136(199706)14:6<482::AID-DIA371>3.0.CO;2-A.
A study was undertaken in order to examine the quality of management of diabetic ketoacidosis (DKA) in a teaching hospital and to assess whether the introduction of clinical guidelines contributed to a satisfactory outcome. Data on presentation and management of 71 cases of DKA admitted in one calendar year (1994) were collected and analysed. Comparing the data to standards set in guidelines, inadequacies of clinical management were identified including delay in initiation of intravenous fluid replacement (greater than 30 min) and intravenous insulin (greater than 60 min) in 70% and 69% of cases, respectively; under-replacement with intravenous fluid in the first 24 h (less than 6.5 l) in 70% of cases, and insufficient intravenous potassium replacement (less than 70 mmol) in the first 24 h in 70% of cases. Suboptimal management of DKA may have contributed towards death in one of the three fatalities, and to morbidity in other patients. In 22.5% of cases (group 1) in whom the guidelines were alleged to have been followed, intravenous fluid, potassium, and insulin had been administered earlier and in larger quantities compared to the remaining cases (group 2). However, in most cases in group 1 the standards set by the guidelines were unfulfilled and the incidence of hypokalaemia, hypoglycaemia, and duration of in-patient stay did not differ from group 2. The treatment of DKA by non-specialist general medical staff in a large teaching hospital was frequently inadequate and was associated with significant mortality and morbidity. The introduction of guidelines had moderately influenced the process of managing DKA but not the outcome, probably because of the low rate of their implementation by junior doctors.
为了检查一家教学医院糖尿病酮症酸中毒（DKA）的管理质量，并评估临床指南的引入是否有助于取得满意的结果，开展了一项研究。收集并分析了1994年一整年收治的71例DKA患者的就诊及管理数据。将这些数据与指南中设定的标准进行比较，发现临床管理存在不足，包括分别有70%和69%的病例静脉补液（超过30分钟）和静脉注射胰岛素（超过60分钟）起始延迟；70%的病例在最初24小时内静脉补液不足（少于6.5升），70%的病例在最初24小时内静脉补钾不足（少于70毫摩尔）。DKA管理欠佳可能是导致3例死亡病例中1例死亡及其他患者发病的原因。在据称遵循了指南的22.5%的病例（第1组）中，与其余病例（第2组）相比，静脉补液、补钾和胰岛素的使用更早且剂量更大。然而，第1组中的大多数病例未达到指南设定的标准，低钾血症、低血糖症的发生率以及住院时间与第2组并无差异。在一家大型教学医院，非专科普通医务人员对DKA的治疗常常不足，且与显著的死亡率和发病率相关。指南的引入对DKA的管理过程产生了适度影响，但对结果没有影响，这可能是因为初级医生对其执行率较低。
