关键词: 糖尿病酮症酸中毒, 钠-葡萄糖共转运蛋白2抑制剂, 恩格列净, 冠心病

Abstract: Objective To investigate the clinical manifestations,risk factors,treatment strategies and clinical prevention feasibility of diabetic ketoacidosis (DKA) after coronary artery bypass transplantation (CABG).Methods Clinical data of 9 patients with ketoacidosis after CABG surgery treated and treated by CICU in the Intensive Care Unit of Cardiac Surgery in Nanjing Gulou Hospital from January 2022 to January 2024 were retrospectively analyzed,and the diagnosis and treatment process and short-term postoperative follow-up were conducted to evaluate the causes of ketoacidosis in order to obtain clinical characteristics.To provide early warning information for follow-up diagnosis and treatment,and to evaluate the effect of perioperative corrective treatment strategy on the short-term prognosis of patients.Results The median duration of DKA in the 9 patients was 2.6 days after surgery,and the clinically suggestive symptoms were tachyarrhythmia (8/9),hypotension (4/9),polyuria (6/9),intractable hyperglycemia (3/9),and derangation (5/9).Analysis of concomitant manifestations or risk factors were mainly the perioperative use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) (9/9),age> 60 years old.The main diagnosis was based on abnormal blood ketone and urine ketone.Blood gas analysis suggested metabolic acidosis,and BE showed serious negative performance.After early diagnosis,8 patients took the volumetric surplus strategy,and the average correction time was 5.6 days.One patient was slow to correct and eventually died from other types of severe complications.Conclusion Perioperative use of SGLT2-i drugs in CHD patients with heart failure and type 2 diabetes is a high risk factor for DKA.The strategy of early diagnosis and parallel capacity surplus is an important way to correct DKA.

Key words: diabetic ketoacidosis, sodium-glucose cotransporter 2 inhibitor, empagliflozin, coronary artery disease