糖尿病酮酸血症的治療與護理

Treatment and Nursing Care of Diabetic Ketoacidosis

糖尿病酮酸血症(Diabetic Ketoacidosis, DKA)為一種因胰島素缺乏而致威脅生命的急性合併症。隨著糖尿病患人數的增加，即使治療及照護的方式已有長足的進步，DKA的致死率始終維持在5～10%(Wagner et al., 1999)。除耗費龐大的醫療資源外，亦對患者及其家庭造成重大的影響。DKA患者之主要表徵在於高血糖、脫水、酸血症及鉀離子不平衡，而其治療及護理的目標也是著重在解決上述四大問題。然國內相關於DKA之護理及預防方面的文獻付之闕如，故本文藉由探討DKA的誘發因子、生理病理機轉、臨床症狀、治療方向、護理措施及預防方法，以增進護理人員對DKA的瞭解與認知，提供臨床上照顧此類病患的參考，以期能有效的預防DKA的發生或減少發病時合併症的產生，進而降低醫療成本及提昇病人生活品質。

Diabetic ketoacidosis (DKA) is a life-threatening emergency caused by deficiency of insulin. Along with the increasing population of diabetes mellitus, the 5-10% mortality rate has persisted. It costs huge medical expenses and also greatly influences the patients and their families. The major clinical presentations of DKA are hyperglycemia, dehydration, ketoacidosis, and potassium imbalance. The objective of treatment and nursing care is to resolve these four problems. The literature of nursing care and prevention of DKA is relatively rare in Taiwan. This article reviewed the precipitating factors, pathophysiology, clinical presentations, treatment guidelines, nursing interventions, and prevention of DKA. Nursing staffs can benefit from this review to better understand DKA and provide better care to these patients. Healthcare cost can also be reduced if complications of DKA are effectively prevented through better care.