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中华产科急救电子杂志 ›› 2017, Vol. 06 ›› Issue (02) : 87 -91. doi: 10.3877/cma.j.issn.2095-3259.2017.02.006

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妊娠合并糖尿病并发酮症酸中毒临床处理
马孝甜1, 张眉花1,()   
  1. 1. 030012 山西省太原市妇幼保健院妇产科
  • 收稿日期:2017-01-30 出版日期:2017-05-18
  • 通信作者: 张眉花

Clinical treatment of diabetic ketoacidosis in pregnancy

Xiaotian Ma1, Meihua Zhang1()   

  • Received:2017-01-30 Published:2017-05-18
  • Corresponding author: Meihua Zhang
引用本文:

马孝甜, 张眉花. 妊娠合并糖尿病并发酮症酸中毒临床处理[J]. 中华产科急救电子杂志, 2017, 06(02): 87-91.

Xiaotian Ma, Meihua Zhang. Clinical treatment of diabetic ketoacidosis in pregnancy[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2017, 06(02): 87-91.

妊娠合并糖尿病酮症酸中毒是妊娠期严重合并症,发病率虽然并不高(1%~3%),但严重威胁孕妇及胎儿生命。本文主要对妊娠合并糖尿病酮症酸中毒的诊断和治疗和对母儿的影响及产科处理进行讨论。

Diabetic ketoacidosis (DKA) in pregnancy is a serious pregnancy complication. Although the incidence is 1%~3%, it will threaten the lives of mother and baby. This article elaborates the diagnosis and treatment, maternal-neonatal outcomes and obstetrical treatment of pregnancy associated with diabetic ketoacidosis.

表1 2009年美国糖尿病协会(ADA)DKA的分级[3]
表2 产程中根据孕妇血糖及尿酮体情况每小时小剂量短效胰岛素的持续静脉点滴剂量
[1]
Bryant SN, Herrera CL, Nelson DB et al. Diabetic ketoacidosis complicating Pregnancy[J]. J Neonatal Perinatal Med, 2017, 10(1):17-23.
[2]
Himuro H, Sugiyama T, Nishigori H, et al. A case of a woman with late-pregnancy-onset DKA who had normal glucose tolerance in the first trimester[J]. J Neonatal Perinatal Med, 2017, 10(1):17-23.
[3]
Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes[J]. J Diabetes Care, 2009, 32(7):1335-1343.
[4]
de Veciana M. Diabetes ketoacidosis in pregnancy[J]. Semin Perinatol, 2013, 37(4):267-273.
[5]
Sibai BM, Viteri OA. Diabetic ketoacidosis in pregnancy[J]. Obstet Gynecol, 2014,123(1):167-178.
[6]
Nyenwe EA, Kitabchi AE. Evidence-based management of hyperglycemic emergencies in diabetes mellitus[J]. J Diabetes Res Clin Pract, 2011,94(3):340-351.
[7]
Perel P, Roberts I, Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients[J]. Cochrane Database Syst Rev, 2013, 2:CD000567.
[8]
Yunos NM, Bellomo R, Hegarty C, et al. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults[J]. JAMA, 2012, 308(15):1566-1572.
[9]
Orbegozo Cortes D, Gamarano Barros T, Njimi H, et al. Crystalloids versus colloids: exploring differences in fluid requirements by systematic review and meta-regression[J]. Anesth Analg, 2015, 120(2):389-402.
[10]
Chua HR, Venkatesh B, Stachowski E, et al. Plasma-Lyte 148 vs 0.9% saline for fluid resuscitation in diabetic ketoacidosis[J]. J Crit Care, 2012, 27(2):138-145.
[11]
Savage M, Dhatariya K, Kilvert A, et al. Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis[J]. J Diabet Med, 2011, 28(5):508-515.
[12]
Hoffman WH, Steinhart CM, el Gammal T, et al. Cranial CT in children and adolescents with diabetic ketoacidosis[J]. J Neuroradiol, 1988, 9(4):733-739.
[13]
Sterns RH. Disorders of plasma sodium-causes, consequences, and correction[J]. J Med, 2015, 372(1):55-65.
[14]
Edge JA, Jakes RW, Roy Y, et al. The UK case-control study of cerebral oedema complicating diabetic ketoacidosis in children[J]. J Diabetologia, 2006, 49(9):2002-2009.
[15]
Nyenwe EA, Kitabchi AE. The evolution of diabetic ketoacidosis: an update of its etiology, pathogenesis and management[J]. J Metabolism, 2016, 65(4):507-521.
[16]
Dhatariya K. The use of point-of-care blood ketone monitors in the management of diabetic ketoacidosis in adults[J]. J Ann Clin Biochem, 2014, 51(Pt 5):525-527.
[17]
Palmer BF, Clegg DJ. Electrolyte and acid-base disturbances in patients with diabetes mellitus[J]. J Med, 2015, 373(6):548-559.
[18]
Sibai BM, Viteri OA. Diabetic ketoacidosis in pregnancy[J]. J Obstet Gynecol, 2014, 123(1):167-178.
[19]
Morrison FJR, Movassaghian M, Seely EW, et al. Fetal outcomes after diabetic ketoacidosis during pregnancy[J]. J Diabetes Care, 2017, 40(7):e77-e79.
[20]
Driscoll M, Alcantora IL, Hastings A, et al. Diabetic ketoacidosis in pregnancy[J]. J Obstet Gynecol, 2014, 123(5):1106.
[21]
Devlieger R, Benhalima K, Damm P, et al. Maternal obesity in Europe: where do we stand and how to move forward?:A scientific paper commissioned by the European Board and College of Obstetrics and Gynaecology (EBCOG).[J]. Obstet Gynecol Reprod Biol, 2016, 201:203-208.
[22]
Liu Y, Hong S, Xu H. Maternal Acute Necrotizing Pancreatitis and Fetal Death Associated With Diabetic Ketoacidosis[J]. J Pancreas, 2016, 45(1):e9-e10.
[23]
Má GR, D GR, Mj P, et al. Managing diabetic ketoacidosis in pregnancy[J]. J Saudi Anaesth, 2016, 10(2):238-239.
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