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重度烧伤常引起应激性高血糖,易忽视原有隐性糖尿病的存在,以致诱发糖尿病酮症酸中毒,死亡率高。近年来我们收治3例重度烧伤合并糖尿病酸中毒病人,死亡2例,痊愈1例。现报道如下:1 临床资料例1,女,59岁,因双下肢火焰烧伤2小时入院。烧伤总积37%,其中深Ⅱ度20%,Ⅲ度17%。伤后第1天查空腹血糖13.32mmol/L,尿糖(+),尿酮(-),既往无糖尿病史。考虑伤后应激性高血糖,未行处理。于伤后第5天行20%创面切削痂植皮术,术后次日患者意识模糊,呼吸深快。实验室检查:空腹血糖 24.07mmol/L,血 pH 7.358,血二氧化碳结合力 15mmol/L,尿糖(++++),尿酮体(++++)。诊断:糖尿病酮症酸中毒。予普通胰岛素加生理盐水静滴,调节胰岛素入量约6u/h,24小时后血糖仍高至18.80mmol/L,患者昏迷加深,出现心力衰竭,伤后第8天死亡。
Severe burns often cause stress hyperglycemia, easy to ignore the existence of the original hidden diabetes, resulting in diabetic ketoacidosis, high mortality. In recent years, we treated 3 patients with severe burn patients complicated with acidosis, 2 patients died, 1 patient recovered. Are reported as follows: 1 clinical data example 1, female, 59 years old, due to lower extremity flame burns 2 hours admission. Total burns 37%, of which deep Ⅱ 20%, Ⅲ 17%. Fasting blood glucose 13.32mmol / L, urine sugar (+), urinary ketone (-), the first non-diabetic history. Consider post-traumatic stress hyperglycemia, untreated. On the fifth day after injury, 20% wound crust grafting was performed. The patient had blurred consciousness and had a deep breathing on the next day after operation. Laboratory tests: fasting blood glucose 24.07mmol / L, blood pH 7.358, blood carbon dioxide binding 15mmol / L, urine sugar (+ + +), urine ketone body (++++). Diagnosis: diabetic ketoacidosis. To normal insulin plus intravenous infusion of normal saline to regulate insulin intake of about 6u / h, 24 hours after the blood glucose is still as high as 18.80mmol / L, patients coma deepened, heart failure, 8 days after injury died.