1例糖尿病酮症酸中毒合并胰岛素Ⅳ型变态反应患者的护理

doi:10.3761/j.issn.0254-1769.2022.15.005

摘要/Abstract

摘要：

报告1例糖尿病酮症酸中毒合并胰岛素Ⅳ型变态反应患者的中西医结合护理经验。护理要点包括：积极与患者及家属沟通,采用综合措施补液和降低血糖,监测血pH值、血糖、血酮体变化;准确实施过敏试验,选择反应最轻的胰岛素与地塞米松混合,应用胰岛素泵由低浓度至高浓度阶梯式持续皮下注射,密切观察过敏反应,做好急救准备;中医治疗护理贯穿始终,清热解毒、袪风止痒,改善胰岛素过敏症状。补液治疗后,患者酸中毒得到纠正、尿酮体转为阴性,出院后采用1：5的生物合成人胰岛素+地塞米松1.5 mg,应用胰岛素泵持续皮下注射,血糖控制良好。

关键词: 糖尿病酮症酸中毒, 胰岛素过敏, Ⅳ型变态反应, 中医护理学

Abstract:

This paper summarized nursing experience of integrated traditional Chinese and western medicine on a patient with diabetic ketoacidosis complicated with Ⅳ insulin allergy. Key nursing care measures are as following：actively communicating with the patient and family members,adopting comprehensive measures to replenish fluid and reducing blood glucose,monitoring the changes of blood pH,blood glucose and blood ketone;accurately carrying out allergy test,choosing the least-reactive insulin and mixing it with dexamethasone,applying an insulin pump for continuous stepwise injection from the low to high concentration,and closely monitoring the patient’s allergic reaction,making emergency preparation;supplementing traditional Chinese medicine preparations for clearing away heat,detoxifying,removing wind,and relieving itching to improve the symptoms of insulin allergy. After fluid rehydration treatment,acidosis was corrected and ketone body in urine was negative. The patient received 1：5 biosynthetic human insulin + dexamethasone 1.5 mg via continuous subcutaneous injection with an insulin pump to control blood glucose at discharge,and blood glucose was currently well controlled.

Key words: Diabetic Ketoacidosis, Insulin Allergy, Type Ⅳ, Hypersensitivity Reactions, Traditional Chinese Medicine Nursing

刘巧艳, 尹卫, 许步慧, 姚卉, 凡姗, 雷敏, 徐萍, 钱方方, 杨玲, 步红兵. 1例糖尿病酮症酸中毒合并胰岛素Ⅳ型变态反应患者的护理[J]. 中华护理杂志, 2022, 57(15): 1825-1829.

LIU Qiaoyan, YIN Wei, XU Buhui, YAO Hui, FAN Shan, LEI Min, XU Ping, QIAN Fangfang, YANG Ling, BU Hongbing. Nursing care of a patient with diabetic ketoacidosis complicated with type Ⅳ insulin allergy[J]. Chinese Journal of Nursing, 2022, 57(15): 1825-1829.

图/表 6

图1 2020年8月3日患者腹部图注：2020年8月3日患者注射精蛋白生物合成人胰岛素注射液后腹部出现多处硬结、红斑。

Figure 1 The abdomen of the patient（2020-08-03）

图2 2020年8月10日患者腹部图注：2020年8月10日患者胰岛素泵皮下注射赖脯胰岛素48 h后腹部出现红、肿、硬结。

Figure 2 The abdomen of the patient（2020-08-10）

表1 胰岛素过敏试验结果

Table 2 Results of insulin allergy test

表2 生物合成人胰岛素与地塞米松混合液阶梯式持续皮下注射方案

Table 2 Stepwise continuous subcutaneous injection of a mixture of biosynthetic human insulin and dexamethasone

图3 2020年9月29日患者腹部图注：2020年9月29日患者持续皮下注射生物合成人胰岛素与地塞米松混合液,腹部红肿、硬结明显减轻。

Figure 3 The abdomen of the patient（2020-09-29）

图4 2020年10月23日患者腹部图注：2020年10月23日患者持续皮下注射生物合成人胰岛素与地塞米松混合液,腹部基本无红肿硬结。

Figure 4 The abdomen of the patient（2020-10-23）

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