糖尿病酮症酸中毒并发纵隔气肿、横纹肌溶解1例报告

王爱芳 吴琳瑾 金一鸣

[摘要] 该文报道1例糖尿病酮症酸中毒并发纵隔气肿、横纹肌溶解。此患者因糖尿病酮症酸中毒急诊入院，病程中出现纵隔气肿，肌痛伴肌酸激酶、肌酸激酶-MB、血淀粉酶升高，经过积极补液、小剂量胰岛素等处理后病情好转。糖尿病最常见的急性并发症，多出现高血糖、高血酮、脱水、代谢性酸中毒及水电解质紊乱等征候群，但在糖尿病酮症酸中毒的诊治过程中，也需要关注并警惕少见并发症的发生，对于重症糖尿病酮症酸中毒的诊治及预后判断有积极的作用。

[关键词] 糖尿病酮症酸中毒;纵隔气肿;横纹肌溶解;病例报告

[中图分类号] R714.253          [文献标识码] C          [文章编号] 1673-9701（2021）30-0150-03

[Abstract] A case report of diabetic ketoacidosis complicated with mediastinal emphysema and rhabdomyolysis was analyzed in this paper. This patient was admitted to hospital in emergency because of diabetic ketoacidosis. Mediastinal emphysema， myalgia with creatine kinase， creatine kinase-MB and serum amylase increased during the course of the disease. And his condition improved after being actively rehydrated and treated with a small dose of insulin. The most common acute complications of diabetes are hyperglycemia， hyper ketosis， dehydration， metabolic acidosis， water and electrolyte disturbance， etc. However， in the process of diagnosis and treatment of diabetic ketoacidosis， it is necessary to pay attention to and guard against the occurrence of rare complications， which plays a positive role in the diagnosis， treatment and prognosis judgment of severe diabetic ketoacidosis.

[Key words] Diabetic ketoacidosis; Mediastinal emphysema; Rhabdomyolysis; Case report

糖尿病酮癥酸中毒（Diabetic ketoacidosis，DKA）是糖尿病最常见的急性并发症，多由于在多种诱因下胰岛素明显缺乏，升糖激素不适当升高，出现高血糖、高血酮、脱水、代谢性酸中毒及水电解质紊乱等征候群，也系内科常见急症之一。纵隔气肿是指因各种原因空气进入纵隔胸膜内结缔组织间隙之间，可以是自发性，也可以因食管穿孔、胸部创伤、医源性因素等，可有胸闷、胸痛等症。横纹肌溶解症是指可逆或不可逆的横纹肌细胞受损后使细胞膜完整性改变，导致大量肌红蛋白、肌酸激酶和乳酸脱氢酶等进入外周血的一种临床综合征。糖尿病酮症酸中毒同时合并自发性纵隔气肿、横纹肌溶解临床上较为罕见。现将我科近期收治的1例患者报道如下。

1 病例资料

患者，男，22岁。因“口干多饮10 d，恶心呕吐伴胸闷1 d”于2020年2月28日入院。……