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本文比较丁胰岛素大剂量静注、小剂量肌注和连续输注三种方法治疗严重糖尿病酮症酸中毒。 36例严重糖尿病酮症酸中毒患者都用小剂量胰岛素治疗,18例肌注,18例连续静滴。对照组25例酮症酸中毒用大剂量静注胰岛素治疗。所有患者入院时碳酸氢盐<10毫当量/升,血糖>500毫克％。肌注组入院时立即肌注胰岛素20单位,以后每小时10单位。连续静滴组每小时8单位。大剂量静注组每2～3小时100单位。当血糖<250毫克％时,胰岛素输注改为皮下注射。连续静滴组则直至酸中毒被纠正。治疗头24小时输液共6～8升,先输等渗盐水,高血糖纠正后则改输5％葡萄糖。单用生理盐水治疗或小量碳酸氢盐(<250毫当量)的患者每升输液补钾30毫当量,用大量碳酸氢盐(>250毫当量)的患者每升输液补钾40毫当量。
This article compares the high-dose intravenous insulin bolus, low-dose intramuscular injection and continuous infusion of three methods for the treatment of severe diabetic ketoacidosis. Thirty-six patients with severe diabetic ketoacidosis were treated with low-dose insulin, 18 with intramuscular injection and 18 with continuous intravenous infusion. Control group, 25 cases of ketoacidosis with high-dose intravenous insulin therapy. All patients admitted to hospital bicarbonate <10 milliequivalents / l, blood glucose> 500 mg%. Intramuscular injection immediately after intramuscular insulin 20 units, after 10 units per hour. Continuous intravenous drip group of 8 units per hour. High-dose intravenous infusion of 100 units every 2 to 3 hours. Insulin infusion was changed subcutaneously when blood glucose <250 mg%. Continuous intravenous drip until acidosis was corrected. The treatment of the first 24 hours a total of 6 ~ 8 liters infusion, the first loss of isotonic saline, hyperglycemia after the change to lose 5% glucose. Patients treated with saline alone or in small amounts of bicarbonate (<250 milliequivalents) received 30 milliliters of potassium per liter of infusion and 40 milliequivalents of potassium per liter of infusion in patients with large amounts of bicarbonate (> 250 milliequivalents).