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目的观察适合中国人饮食习惯的生酮饮食方案治疗小儿药物难治性癫癎启动期血糖的动态变化。方法2004年10月至2006年12月深圳儿童医院对难治性癫癎住院患儿启动生酮饮食治疗,用毛细血管微量血法动态监测血糖变化。禁食48h或禁食已达到酮症状态后开始全量生酮饮食:脂肪与碳水化合物加上蛋白质的质量比为4∶1。使用适合中国人饮食习惯的配餐软件辅助配餐。对文献报道的有关并发症进行监测。结果禁食开始后(26.7±16.4)h达到酮症状态。96h内低血糖阳性例次检出率3.7%(16/427)。毛细血管微量血糖法检测低血糖发生率30.0%(9/30),症状性低血糖发生率10.0%(3/30)。对低血糖患者给予牛奶10~20mL口服,患者很快恢复,没有出现严重低血糖症。拒食、呕吐可能加重低血糖。结论用适合中国人饮食习惯的生酮饮食治疗小儿药物难治性癫癎启动期,特别是禁食期间血糖波动,需要密切监测,及时处理低血糖。生酮饮食启动期是安全的。
Objective To observe the dynamic changes of blood glucose in the initiation of refractory epilepsy in pediatric patients with ketogenic diet regimen suitable for Chinese diet. Methods From October 2004 to December 2006, children with refractory epilepsy were enrolled in Shenzhen Children’s Hospital to initiate ketogenic diet. Blood glucose was monitored dynamically by micro-capillary capillary method. Fasting 48h or fasting has reached the state of ketosis full ketogenic diet began: fat and carbohydrates plus protein mass ratio of 4: 1. Use catering software suitable for Chinese dietary aids. The literature reports on the complications to be monitored. Results After the start of fasting (26.7 ± 16.4) h reached ketosis status. 96h hypoglycemia positive cases the detection rate was 3.7% (16/427). The incidence of hypoglycemia was 30.0% (9/30) and the incidence of symptomatic hypoglycemia was 10.0% (3/30). Hypoglycemia patients given oral 10 ~ 20mL, the patient recovered quickly, there was no serious hypoglycemia. Antifeeding, vomiting may aggravate hypoglycemia. Conclusions The ketogenic diet, which is suitable for Chinese diet, should be used to treat the onset of refractory epilepsy in children, especially during the fasting period. Close monitoring and prompt treatment of hypoglycemia are needed. Ketogenic diet start-up period is safe.