醒脑静注射液联合胃肠内补液治疗糖尿病高渗性非酮症昏迷的疗效分析

摘要

目的 探讨醒脑静注射液联合胃肠内补液治疗糖尿病高渗性非酮症昏迷(hyperosmolar nonketotic diabetic coma,HNDC)的临床疗效.方法 将2015年4月至2017年4月解放军第八五医院神经内分泌科收治的150例HNDC的患者,按照治疗方法分为3组,常规治疗组、胃肠内补液组和醒脑静注射液联合胃肠内补液组(联用组),每组50人.检测3组患者治疗前和治疗后24、48 h血生化指标及血浆渗透压的变化,观察HNDC患者治疗有效率、并发症发生率及病死率.结果 胃肠补液组和联用组总有效率明显高于常规治疗组,差异有统计学意义(P<0.01);与胃肠补液组比较,联用组总有效率上升,差异有统计学意义(P<0.05).3组患者24、48 h后血糖、血钠、血尿素氮、血浆渗透压水平均明显低于本组治疗前,差异有统计学意义(P<0.01);胃肠补液组和联用组24、48 h后患者的血糖、血钠、血尿素氮、血浆渗透压水平均明显低于常规治疗组对应的时间点,差异有统计学意义(P<0.05),且联用组明显低于胃肠补液组,差异有统计学意义(P<0.05).联用组患者不良反应及病死率明显低于胃肠补液组和常规治疗组,差异有统计学意义(P<0.05或P<0.01).结论 醒脑静注射液联合胃肠内补液治疗HNDC疗效优于传统常规静脉输液和单一胃肠内补液治疗,且治疗方法简单、安全,值得临床进一步推广.%Objective To investigate the clinical effect of Xingnaojing injection combined with gastroenteric fluid replacement in the treatment of hyperosmolar nonketotic diabetic coma ( HNDC) .Methods In accordance with different treatment methods , 150 HNDC patients who received medical care in the Neurological and Endocrinological Department of the hospital from April 2015 to April 2017 were divided into 3 groups, i.e.the conventional treatment group , the gastroenteric fluid replacement group and the Xingnaojing injection combined with gastroenteric fluid replacement group (or the combination group ), each consisting of 50 patients.Blood bio-chemical indexes and changes in plasma osmotic pressure were detected in the patients of the 3 groups, both before therapy and at hour 24 and hour 48 after therapy, and the therapeutic efficacy , rate of complications and mortality were also closely observed .Results To-tal effective rates of the gastroenteric fluid replacement group and the combination group were significantly higher than that of the con -ventional treatment group(P<0.01).As compared with that of the gastroenteric fluid replacement group , total effective rate of the combination group was also significantly higher(P<0.05).The levels of blood glucose, serum sodium, blood urea nitrogen and plasma osmotic pressure at hour 24 and hour 48 after treatment were all lower than those before treatment (P<0.01).The levels of blood glu-cose, serum sodium, blood urea nitrogen and plasma osmotic pressure in the patients of the gastroenteric fluid replacement group and the combination group were obviously lower than those of the conventional group at corresponding time points (P<0.05), and the a-bove-mentioned levels of the combination group were lower than those of the gastroenteric fluid replacement group (P<0.05).The rate of adverse reactions and mortality of the combination group were obviously lower than those of the gastroenteric fluid replacement group and the conventional group (P<0.05 or P<0.01).Conclusion The therapeutic efficacy of Xingnaojing injection combined with gas-troenteric fluid replacement in the treatment of hyperosmolar nonketotic diabetic coma is superior to those of the conventional fluid re -placement and single gastroenteric fluid replacement treatment , and this treatment method is simple and safe , which is worth further clinical extension .