糖尿病酮症酸中毒合并高脂血症、急性胰腺炎8例临床.docVIP

　　糖尿病酮症酸中毒合并高脂血症、急性胰腺炎8例临床 【摘要】 　　目的：了解糖尿病酮症酸中毒（DKA）合并高脂血症（HL）、急性胰腺炎（AP）的特点，以提高诊治水平。方法：分析我院诊治的8例DKA合并HL、AP的临床资料，总结其特点。结果：除DKA临床特点外，均为中青年，均腹痛，入院均有HL。其中甘油三脂（TG）≥11.3 mmol/L7例（6.54～29 mmol/L），未服降脂药，治疗后TG均下降( 2.12～6.13 mmol/L)，入院时血淀粉酶(Ams)超正常值3倍2例，入院后3例，尿Ams则分别为2例和4例，3例血和尿Ams一直正常，5例B超正常，8例胰腺CT均有AP改变，治疗以禁食、纠正DKA为基础结合胃肠减压、质子泵抑制剂、6例生长抑素持续静滴。结论：(1)高脂血症可能是DKA并发AP的原因之一。(2)腹痛者,需警惕DKA、AP并存，应常规及动态测定血、尿Ams、TG。(3)TG≥11.3 mmol/L者，即使血、尿Ams正常，B超阴性，仍需胰腺CT检查。(4)DKA伴AP时，除诊治DKA外，还应积极治疗AP，早期用生长抑素能缩短治愈时间。(5)胰岛素泵（CSII）治疗DKA者血糖达标、尿酮转阴时间明显缩短。 【关键词】 糖尿病酮症酸中毒;高脂血症;甘油三酯；急性胰腺炎 ［ABSTRACT］ Objective: To understand the character of diabetic ketoacidosis (DKA) pliacted ia (HL) or acute pancreatitis (AP).Methods: Clinic data of 8 DKA cases merized .Results: Besides clinic features of DKA, all cases iddle aged patients inal pain and HL. 7 cases had three acids glyceride (TG) ≥11.3 mmol/L ent ( 2.12～6.13 mmol/L). The blood amylase (Ams) level and urine Ams of 2 cases es of normal level at admission,in blood Ams 3 cases and in urine Ams 4 cases al after admission. 3 cases had normal level of both blood Ams and urine Ams, and 5 cases had normal B utrasound imaging. Pancrea CT of 8 cases shop inhibitor, 6 of had continuous intravenous drip atostatin.Conclusion: HP maybe one cause for DKA plicated inal pain, conventional dynamic test of blood Ams, urine Ams and TG should be employed to determine the plication occurrence of DKA and AP. Pancrea CT is necessary for patients ore than11.3mmol/L even if they had normal blood Ams, urine Ams and negative B ultrasound imaging. For patients ent of AP should be applied besides therapy for DKA.Application of somatostatin can shorten the treatment time, and insulin pump (CSII) can promote the blood sugar to be normal and urine ketone to be negative. ［KEY ia; Three acids glyceride; Acute pancreatitis 糖尿病酮症酸中毒（DKA）和急性胰腺炎（AP）均为内科急症，当DKA以消化道症状为突出表现时，两者极易混肴，DKA基础上并发AP时，临床表现重叠，使病情更凶险，尤其TG ≥11.3 mmol/L时，可发生高脂血症（HL）性AP［1］，极易漏诊、误诊。现分析我院8例DKA合并HL、AP的资料，以提高临床医师诊治水平。 　　1 资料