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頁籤選單縮合
題名 | Hyperglycemic Hyperosmolar Non-ketotic Syndrome in Hemodialysis Patients=血液透析病人之非酮酸性高血糖高滲透性症候群 |
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作者 | 王堯輝; 李建德; 許國泰; 陳靖博; | 書刊名 | 長庚醫學 |
卷期 | 22:3 1999.09[民88.09] |
頁次 | 頁453-459 |
分類號 | 415.668 |
關鍵詞 | 非酮酸性高血糖高滲透性症候群; 末期腎病; 糖尿病; 血液透析; Hyperglycemic hyperosmolar non-ketotic syndrome; HHNK; Endstage renal disease; ESRD; Diabetes mellitus; Hemodialysis; |
語文 | 英文(English) |
中文摘要 | 背景:非酮酸性高血糖高滲透性症候群是糖尿病人偶而可見的急性併發症,治療 的過程中需要大量液體補充。對於長期血液透析的病人,體液不易經由泌尿道喪失,同時在 透析中葡萄糖及尿素會被洗出。在本文中,我們試圖探討長期血液透析的病人發生非酮酸性 高血糖高滲透性症候群時,其疾病誘發因子、臨床過程、治療方式及預後。 方法:本研究包含8個長期血液透析的病人及8個因急性腎衰竭而接受血液透析的病人, 分析及比較其發生非酮酸性高血糖高滲透性症候群時的血糖濃度、滲透壓、尿素、肌肝酸、 鈉、鉀,同時包括兩組病人的年齡、疾病誘發因子、臨床過程、治療方式及預後。 結果:兩組病人的血糖濃度、滲透壓、尿素、肌肝酸、鈉、鉀及病人的年齡無明顯差異。 停用降血糖藥物是長期血液透析的病人的主要疾病誘發因子,而感染是因急性腎衰竭而接受 血液透析的病人的主要疾病誘發因子。同時長期血液透析的病人比因急性腎衰竭而接受血液 透析的病人需要較少量液體補充,及較少的併發症。在長期血液透析的病人中,沒有病人死 亡,然而因急性腎衰竭而接受血液透析的病人中有6個病人死亡。 結論:長期血液透析的病人比因急性腎衰竭而接受血液透析的病人有較少的併發症,同 時沒有長期血液透析的病人死亡。主要有3個原因:包括長期規則地接受醫療照顧、較適量 液體補充及接受規則血液透析。 |
英文摘要 | Background: Hyperglycemic hyperosmolar non-ketotic syndrome (HHNK) is an emergency complication of diabetes mellitus. The conventional treatment modality often includes massive fluid supplementation. In maintenance hemodialysis patients, dehydration via the renal route may not occur, and fluid management is rather complicated. In this study, we investigated the precipitating factors, treatment modalities, clinical course and prognosis of HHNK patients who received maintenance hemodialysis. Methods: From January 1988 through August 1998, 16 disbetic patients who had developed HHNK were enrolled. Eight of them were end stage renal disease (ESRD) patients on maintenance hemodialysis, and another group included 8 acute renal failure (ARF) diabetes mellitus patients who received their first hemodialysis during the HHNK episode. We retrospectively reviewed their medical charts and recorded each patient's age, treatment modalities, especially fluid supplemention, predisposing factors, and biochemical data during the HHNK episode. Complications and the final outcome were also recorded. Results: There were no significant differences in biochemical data and patients' ages between the two groups (p>0.05). The major predisposing factor for the ARF patients was infection, but irregular use of or discontinuing oral hypoglycemic agents (OHA) or insulin was the major predisposing factor for the ESRD patients. Less fluid supplementation was given in the ESRD group as compared to the ARF group and no deaths occurred in the ESRD group of patients. However, 6 patients expired in the ARF group of patients. Conclusion: Regular medical care, early diagnosis and recognition, and easier management of fluid administration explain the rather smooth course and better prognosis in the ESRD group of patients. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。