重型颅脑损伤伴糖尿病酮症酸中毒2例报告并文献复习

目的探讨重型颅脑损伤（sTBI）合并糖尿病酮症酸中毒(DKA)患者的临床特征、血糖管理、治疗策略及预后。方法回顾性分析2021年8月—10月郑州大学第五附属医院神经外科收治入院的2例sTBI合并DKA患者的临床资料，将其临床表现、影像和手术治疗及相关文献进行分析讨论，并对患者的预后进行随访。结果2例患者在纠正酮症酸中毒后，于急诊全麻下行开颅血肿清除术。术后以胰岛素微量泵持续输注调节血糖，血糖稳定后给予口服二甲双胍缓释片治疗。随访3个月，患者预后良好，无明显神经功能障碍。结论纠正围手术期糖尿病酮症酸中毒(DKA)是颅脑损伤患者术后预后良好的关键因素，术后良好的血糖水平管理是加速患者康复的一个重要影响因素。

Objective To investigate the clinical characteristics, blood glucose management, surgical strategy and prognosis of severe traumatic brain injury(sTBI) with diabetic ketoacidosis(DKA). Method The clinical data of 2 patients with sTBI combined with DKA admitted to Department of neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University from August to October 2021 was analyzed retrospectively. The clinical features, radiological images, operation and related literatures were analyzed and discussed, and the prognosis of patients was followed up. Results After these patients were corrected for ketoacidosis, and the traumatic intracranial hematoma was removed under general anesthesia. The blood glucose was adjusted by continuous intravenous pumping of insulin after operation, and the metformin sustained-release tablets were given when the blood glucose was stable during hospitalization. These patients had a good prognosis and had no significant neurological dysfunction after 3 months follow-up. Conclusions Correction of perioperative DKA plays a critical role in the prognosis of patients with TBI. Having a good blood glucose management after operation is an important factor to accelerate the rehabilitation of patients.