埃塞俄比亚奥罗米亚阿达玛医院医学院病房成年患者糖尿病酮症酸中毒治疗结果及相关因素分析

Dagim Assefa Kassaye, Worku Dugassa Girsha, Godana Jarso Guto, Haji Aman Deybasso
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引用次数: 2

摘要

糖尿病酮症酸中毒(DKA)是糖尿病最严重的急性并发症之一。发展中国家以及误诊和误治患者的死亡率仍然很高。因此,有针对性的早期诊断和有效的治疗方案对于挽救患者的生命至关重要。本研究的目的是评估埃塞俄比亚奥罗米亚地区Adama医院医学院急诊科和病房成年患者的糖尿病酮症酸中毒治疗结果和相关因素。采用简单随机抽样的方法对357例成人糖尿病酮症酸中毒患者进行横断面研究。使用医疗登记清单收集数据。使用SPSS version 20和EPI-info version 7统计软件包进行数据录入和分析。65.30%的患者曾发生2次及2次以上糖尿病酮症酸中毒,复发的主要原因为感染性疾病(69.50%)和胰岛素停用(14.80%)。从糖尿病酮症酸中毒患者的治疗结果来看,大多数患者(84.90%)出院后病情好转。糖尿病酮症酸中毒患者在24小时内补液6升以上的治疗效果比补液不足3升的治疗效果好2倍(AOR=2.41(1.58 ~ 10.02))。同样,前24小时胰岛素剂量大于60国际单位的患者治疗效果比小于40国际单位的患者好10倍(AOR=10.68(3.88- 20.64))。此外,补充钾的DKA患者的治疗结果改善是未补充钾患者的5倍(AOR= 5.30(2.11-13.32))。即使在安道玛医院医学院急诊室和病房治疗的糖尿病酮症酸中毒患者多数出院情况有所好转,但仍需鼓励早期治疗感染、补充充足液体和在患病期间调整胰岛素剂量。
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Diabetic Ketoacidosis Treatment Outcome and Associated Factors Among Adult Patients Admitted to Medical Wards of Adama Hospital Medical College, Oromia, Ethiopia
Diabetic Ketoacidosis (DKA) is one of the most serious acute complications of diabetes mellitus. The mortality rate remains high in developing countries and among misdiagnosed and treated patients. Therefore targeting early diagnosis and effective treatment programs is vital to save the life of patients. The aim of the study is to assess diabetic ketoacidosis treatment outcome and associated factors among adult patients at Adama Hospital Medical College emergency department and medical wards, Oromia region, Ethiopia. Cross sectional study based on record review of 357 adult diabetic ketoacidosis patients was selected using simple random sampling. Data was collected using checklist from medical registrations. The data was entered and analyzed using SPSS version 20 and EPI-info version 7 statistical packages. Majority of the patients (65.30%) had two or more episodes of diabetic ketoacidosis and the main reasons for recurrent diabetic ketoacidosis were infectious illness (69.50%) and insulin discontinuation (14.80%). Regarding treatment outcomes of diabetic ketoacidosis patients, majority of them (84.90%) discharged with improved. Those diabetic ketoacidosis patients treated with more than six liters fluid replacement in the 1st 24 hours had better treatment outcome by two times as compared to less than three liters fluid replacement (AOR=2.41 (1.58-10.02). Similarly, those patients who got more than sixty international unit insulin doses in the 1st 24hrs had better treatment outcome by ten times (AOR=10.68 (3.88- 20.64)) when compared to less than forty international unit insulin administration. In addition, DKA patients who got supplemental potassium showed five times treatment outcome improvement (AOR= 5.30 (2.11-13.32) than for those potassium replacement was not done. Even if majority of diabetic ketoacidosis patients treated at Adama Hospital Medical College emergency room and medical wards were discharged with improvement, early treatment of infection, ample fluid replacement and insulin dose adjustment during illness need to be encouraged.
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