持续皮下胰岛素输注联合电解质补充对儿童糖尿病酮症酸中毒的治疗价值。
完整摘要 · 中文译文
背景：小儿糖尿病酮症酸中毒（DKA）危及生命；传统静脉胰岛素治疗存在低血糖和电解质紊乱风险。我们评估了持续皮下胰岛素输注（CSII）联合电解质补充治疗DKA的疗效与安全性。 方法：将66例患者随机分为研究组（CSII+电解质补充）和对照组（静脉胰岛素输注+电解质补充）。比较两组总体疗效、pH恢复正常时间、达标血糖时间、尿酮体清除时间、尿素氮、肌酐、钾、空腹血糖（FPG）、餐后2小时血糖（2hPG）和钠水平、炎症指标、酸碱平衡指标及不良反应。 结果：研究组总体疗效更高（χ2 = 5.121），pH恢复正常时间、达标血糖时间和尿酮体清除时间更短（t = 8.023、7.712、7.438），尿素氮、肌酐、FPG、2hPG、钠、CRP、TNF-α和IL-6水平更低（t = 8.893、15.816、5.865、12.267、4.542、3.626、2.615、5.746），血清钾、CO₂CP和血液pH水平更高（t = 9.737、4.220、17.78），血乳酸水平更低（t = 6.922），不良反应发生率更低（χ2 = 4.243），与对照组相比差异均有统计学意义（均P < 0.05）。 结论：CSII联合电解质补充可通过调节血糖和电解质、减轻炎症和酸中毒、减少治疗期间不良反应，改善小儿DKA的治疗结局。 已知信息：• 小儿糖尿病酮症酸中毒（DKA）是糖尿病的一种危及生命的急性并发症。• 传统静脉胰岛素输注是标准治疗方法，但存在低血糖、低钾血症和其他电解质紊乱的风险。• 在DKA中，常规在胰岛素治疗的同时补充电解质，以纠正脱水和代谢失衡。 新增信息：• 本研究提供了临床证据，表明持续皮下胰岛素输注（CSII）联合电解质补充在小儿DKA中比传统静脉胰岛素治疗更有效。• 基于CSII的方案实现了更快的pH值恢复正常、血糖控制和尿酮体清除，并且在肾功能、炎症标志物和酸碱平衡方面有更好的改善。• CSII组的不良反应发生率也较低，提示该方法可能为管理小儿DKA提供一种更安全、更有效的替代方案。
完整摘要 · 英文原文
BACKGROUND: Pediatric diabetic ketoacidosis (DKA) is life-threatening; traditional IV insulin risks hypoglycemia and electrolyte issues. We evaluated the efficacy and safety of continuous subcutaneous insulin infusion (CSII) combined with electrolyte supplementation in DKA. METHODS: Sixty-six patients were randomly assigned to the study group (CSII + electrolyte supplementation) or control group (intravenous insulin infusion + electrolyte supplementation). Overall efficacy, time to pH normalization, target blood glucose achievement, urine ketone clearance, levels of BUN, creatinine, potassium, FPG, 2hPG and sodium, inflammatory markers, acid-base balance indicators, and adverse reactions were compared. RESULTS: Study group had higher overall efficacy (χ2 = 5.121), shorter time to pH normalization, target blood glucose achievement, and urine ketone clearance (t = 8.023, 7.712, 7.438), lower BUN, creatinine, FPG, 2hPG, sodium, CRP, TNF-α, and IL-6 levels (t = 8.893, 15.816, 5.865, 12.267, 4.542, 3.626, 2.615, 5.746), higher serum potassium, CO₂CP, and blood pH levels (t = 9.737, 4.220, 17.78), and lower blood lactate levels (t = 6.922) and adverse reaction rates (χ2 = 4.243) than the control group (all P < 0.05). CONCLUSION: CSII with electrolyte supplementation improves pediatric DKA treatment outcomes by regulating blood glucose and electrolytes, alleviating inflammation and acidosis, and reducing adverse reactions during treatment. WHAT IS KNOWN: • Pediatric diabetic ketoacidosis (DKA) is a life-threatening acute complication of diabetes mellitus. • Traditional intravenous insulin infusion is the standard treatment but carries risks of hypoglycemia, hypokalemia, and other electrolyte disturbances. • Electrolyte supplementation is routinely used alongside insulin therapy to correct dehydration and metabolic imbalances in DKA. WHAT IS NEW: • This study provides clinical evidence that continuous subcutaneous insulin infusion (CSII) combined with electrolyte supplementation is more effective than conventional intravenous insulin therapy in pediatric DKA. • CSII-based regimen achieved faster pH normalization, blood glucose control, and urine ketone clearance, with better improvements in renal function, inflammatory markers, and acid-base balance. • The CSII group also showed lower rates of adverse reactions, suggesting that this approach may offer a safer and more efficient alternative for managing pediatric DKA.