目的 探討烏司他丁聯(lián)合血液透析治療糖尿病酮癥酸中毒的療效觀察。方法 選取2013年3月-2015年3月棗陽市第一人民醫(yī)院收治的糖尿病酮癥酸中毒患者60例，隨機(jī)分為對(duì)照組和治療組，每組各30例。對(duì)照組給予連續(xù)性血液透析治療，采用Seldinger技術(shù)行股動(dòng)脈或頸動(dòng)脈穿刺，低分子肝素抗凝，置換液流量為2～3 L/h，超濾速度為50～300 mL/h，持續(xù)治療6～12 h，隔日1次。治療組在對(duì)照組基礎(chǔ)上靜脈滴注烏司他丁注射液，20萬單位加入10%葡萄糖溶液250 mL，持續(xù)12 h，1次/d。兩組患者均持續(xù)治療14 d。觀察兩組的臨床療效，比較兩組的尿酮體轉(zhuǎn)陰時(shí)間、pH值恢復(fù)時(shí)間、空腹血糖、糖化血紅蛋白、二氧化碳結(jié)合力（CO₂CP）、血乳酸（Lac）、酸堿度（pH）的情況。結(jié)果 治療后，對(duì)照組和治療組患者的總有效率分別為73.33%、93.33%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組CO₂CP和pH值明顯上升，Lac明顯下降，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；且治療組CO₂CP和Lac的改善程度明顯優(yōu)于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，治療組尿酮體轉(zhuǎn)陰時(shí)間和pH值恢復(fù)時(shí)間明顯短于對(duì)照組，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組空腹血糖和糖化血紅蛋白明顯下降，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；且治療組這些觀察指標(biāo)的改善程度明顯優(yōu)于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 烏司他丁聯(lián)合血液透析治療糖尿病酮癥酸中毒具有較好的臨床療效，可改善臨床癥狀，減輕酸中毒，降低血糖水平，具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To explore the clinical effect of ulinastatin combined with hemodialysis in treatment of diabetic ketoacidosis. Methods Patients (60 cases) with diabetic ketoacidosis in Zaoyang First People's Hospital from March 2013 to March 2015 were randomly divided into control and treatment groups, and each group had 30 cases. Patients in the control group were given continuous hemodialysis, using Seldinger technology for femoral artery or carotid artery puncture, anticoagulation with low molecular weight heparin, replacement fluid flow rate was 2-3 L/h, ultrafiltration rate was 50-300 mL/h, continuous treatment for 6-12 h, once every other day. Patients in the treatment group were iv administered with Ulinastatin Injection on the basis of the control group, 2×10⁵ U added into 10% glucose solution 250 mL, continuous iv for 12 h, once daily. Patients in two groups were treated for 14 d. After treatment, the clinical efficacies were evaluated, and turning-to-negative time of urinary keton, pH recovery time, fasting blood glucose, glycosylated hemoglobin, CO₂CP, Lac, and pH in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 73.33% and 93.33%, respectively, and there was difference between two groups (P<0.05). After treatment, CO₂CP and pH in two groups were significantly increased, but the Lac in two groups was significantly decreased, and the difference was statistically significant in the same group (P<0.05). And CO₂CP and Lac in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). After treatment, turning-to-negative time of urinary keton and pH recovery time in the treatment group were significantly shorter than those in the control group, and there was difference between two groups (P<0.05). After treatment, fasting blood glucose and glycosylated hemoglobin in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). Conclusion Ulinastatin combined with hemodialysis has clinical curative effect in treatment of diabetic ketoacidosis, can improve clinical symptoms, relieve acidosis, decrease blood glucose levels, which has a certain clinical application value.