血淀粉酶升高在糖尿病酮症酸中毒病情评估中的作用

来源 :中华急诊医学杂志 | 被引量 : 0次 | 上传用户:zhaoyouwei119
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目的:探讨血淀粉酶升高在糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)患者病情评估中的作用,以及影响糖尿病酮症酸中毒患者血淀粉酶(amylase,AMS)水平的相关因素。方法:选取郑州大学第一附属医院2011年11月至2018年8月收治的DKA患者进行回顾性研究,根据入选和排除标准最终确定249例DKA患者为研究对象,根据入院次日晨空腹抽取静脉血测得的AMS水平分为正常组(n n=176)和升高组(n n=73)。对性别、糖尿病类型、糖尿病血管并发症、死亡例数、ICU监护例数、出院后发生急性胰腺炎(acute pancreatitis,AP)次数等计数资料采用χn 2检验或Fisher检验,对年龄、pH、糖化血红蛋白(HbA1c)、二氧化碳结合力(COn 2CP)、Can 2+、尿素氮(BUN)、肌酐(Scr)等计量资料采用独立样本n t检验,比较两组患者一般资料、临床资料、院内及院外结局的差异。n 结果:AMS升高组ICU监护率为50.7%,ICU监护天数中位数为4 d,总住院天数中位数为14 d,治疗费用中位数为2.8万,均高于AMS正常组(n P0.05),糖尿病病程、既往发生DKA次数、糖尿病血管并发症发生率、HbA1c、pH、BUN、Scr,在AMS升高组均高于正常组(n P<0.01或n P<0.05)。n 结论:AMS升高的DKA患者,需要收入ICU监护病房的可能性增加,在ICU内监护天数、总住院天数及总治疗费用增加,住院期间总体病死率及出院后发生AP的可能性未增加。“,”Objective:To investigate therole of serum amylase elevation in the evaluation of diabetic ketoacidosis (DKA) patients and the related factors affecting serum amylase (AMS) levels in patients with diabetic ketoacidosis.Methods:A total of 249 patients with DKA who were admitted to the First Affiliated Hospital of Zhengzhou University from November 2011 to August 2018 were selected for this retrospective study. The patients were divided into the normal group (n n=176) and the elevated group (n n=73) according to the AMS level measured by fasting venous blood samples. The enumeration data such as sex, type of DM, diabetic vascular complications, number of deaths, number of ICU monitoring, and number of acute pancreatitis (AP) after discharge were analyzed by chi-square test or Fisher test, and the measurement data such as age, pH, HbA1c, COn 2CP, Can 2+, BUN, and Scr were analyzed by independent sample n t test to compare the difference between the two groups.n Results:The intensive care unit (ICU) monitoring rate was 50.7%, the median length of stay in ICU was 4 days, the median length of hospital stay was 14 days, and the median treatment cost was 28 000 yuan, which were higher in the elevated group than those in the normal group (n P0.05). The duration of diabetes, the number of previous DKA, the incidence of diabetic vascular complications, HbA1c, pH, BUN, and Scr in the elevated group were all higher than those in the normal group (n P<0.01 or n P<0.05).n Conclusions:DKA patients with elevated AMS are more likely to be admitted to ICU, and the length of stay in ICU, total length of hospital stay and total cost of treatment are all increased. Where as the overall mortality rate during hospitalization and the likelihood of AP after discharge are not increased.
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