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1例以酮症酸中毒起病的初发2型糖尿病的护理.doc

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1例以酮症酸中毒起病的初发2型糖尿病的护理.doc
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1 2 ; 2 ; ; ; :100044, :100044, , , 2013 9 840 , 2035 , 1.43 [1] , 1 2 [2] , 1 , , , ; 2 , , 2016 9 24 1 2 , , 1 2 , 1 , , 29 , 1 , 2016 9 24 1 , 24h 4 000mL, , 4d , , , 21mmol/L, (+++) , :2 , , 15mmol/L, (+++) , pH:7.33, , , , , 12mmol/L~18mmol/L, 1d , (BMI) 30.5kg/m, 103cm, 113cm, 0.9 , , , 500g 10 , 10 , , 0 120 0 1.89ng/mL, C 120 3.02ng/mL; 11.5%; (-) , , , , , , , 2.39mmol/L~3.09mmol/L, 2 2 , , 6 1 , 3.8 mmol/L, , 1 , 2 6.2mmol/L, 13 ( ) 500mg, 3 , 2 2.1 2.39mmol/L~3.09mmol/L, 2 , , 1 , 2 , , , 2.2 , C 0 :1.89ng/mL, C 120 :3.02ng/mL 2.3 , , 2.4 , 6 1 , 3.8 mmol/L, 3 3.1 : 3.1.1 ; , , ; , , , , 3.1.2 1 , 14.7 mmol/L, (++) , 0.9% 250mL+ R 10U 0.9% 500mL+ R 12U , , , 24h 10% , , 13.9mmol/L , 3g~4g 1 U , , [2] 3.1.3 , 2 8 , 2.39 mmol/L, : (++) , , , 5% 500mL+ R 6U+15% 10mL 0.9% 250 mL+ R 10U+15% 5mL , , , 2 , 40 mL/h , 3.5mmol/L , [3] , 3.2 BMI 30.5kg/m, , , 2 , 3.2.1 179cm, 98kg, 74kg , 3 ~6 5%~10%[3] , 24kg , , 3 5kg , 1kg~2kg, [19] 3.2.2 , , 179-105=74kg, , 212.7g, 74.0g, 61.7g, 1/5, 2/5, 2/5 , 0.5 , , , , ; , , , [20] , [21] 3.2.3 : , , , , 3 20min , , 2 , 40%~50% (220- (50%~60%) 10min~30min 3 4 , 3.3 3.3.1 , 6 1 , 3.8mmol/L, , 1 , 2 6.2mmol/L, , [6] , (UKPDS) 2 , 36.5%[8] , , , [9-11] , 3.9mmol/L , 15g , 15min , , 4 2 , , 1 2 , 4.1 , [3] , , , , , , [2] 2.39mmol/L~3.09mmol/L, , Na-K-ATP , [4] , , , [5] , 4.2 2 , 2 , 4.2.1 (medical nutrition therapy, MNT) , [3] , 2 3 (HbA1c) 2%, [8] (2010 ) , [12] (glycemic index, GI) GI 50g 100%, 50g , Meta , GI , GI HbA1c 0.4%, [13] (food exchange list, FEL) , [14] , 1 , , [15], 4.2.2 , , [16] (1) : , , , (2) , 5 min~10 min , 5min 10min~30min , , 5 min~10 min, , , 3 4 , 3d 4d, , [18] 3d , 1 (3) : , 5 , , , , , , , , , [1] . [J]. : , 2014 (2) :9-11. [2] , . [M].8 . : , 2013:1. [3] . (2010 ) [M]. : , 2011:1. [4] . [J]. : .2001, 28 (1) :32-35. [5] , . [M]. : , 2010:30-34. [6] , , . 2 [J]. , 2003, 11 (1) :5-9. [7]The Diabetes Control and Complications Trial Research Group.Hypoglycemia in the diabetes control and complications trial[J].Diabetes, 1997, 46:271-286. [8]UK Prospective Diabetes Study (UKPDS) Group.Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type2diabetes (UKPDS 33) [J].Lancet, 1998, 352:837-853. [9] , , , .2 [J]. , 2005 (7) :518-519. [10] , , , . 2 [J]. , 2007, 23 (2) :229-234. [11]BrownSA, Upchurch S, Anding R, et al.Promoting weight loss in type 2diabetes[J].Diabetes Care, 1996, 19:613-624. [12] , . (2010 ) [S]. : , 2010:1. [13]Brand-Miller J, Hayne S, Petocz P, et al.Low-glycemic index diets in the management of diabetes:a meta-analysis of randomized controlled trials[J].Diabetes Care, 2003, 26 (8) :2261-2267. [14] , , , . 2 [J]. , 2009, 44 (6) :513-516. [15] , , , . [J]. , 2011, 25 (4B) :992-993. [16] , . [J]. , 2013, 33 (6) :373-377. [17] . [M]. : , 2012:1. [18]GoodyearLJ, Kahn BB.Exercise, glucose transport, and insulin sensitivity[J].Annu Rev Med, 1998, 49:235-261. [19]American Diabetes Association, Bantle JP, Wylie-Rosett J, et al.Nutrition recommendations and interventions for diabetes:aposition statement of the American Diabetes Association[J].Diabetes Care, 2008, 31 (Suppl 1) :S61-78. [20] , [J]. , 2013, 13 (7) :110-112. [21]Sperl-Hillen J, Beaton S, Fernandes O, et al.Comparative effectiveness of patient education methods for type 2diabetes:a randomized controlled trial[J].Arch Intern Med, 2011, 171 (22) :2001-2010.
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