A case of multiple difficult illnesses in a patient with extremely severe burn complicated with type 2 diabetes
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摘要: 2018年12月20日，广州市第一人民医院收治1例特重度火焰烧伤40岁男性患者，多种疑难病症同时（顽固性高血糖、顽固性高钠血症、创面进行性加深）或序贯（反复术后低血压、神经系统病变、继发性尿崩症）发生。患者入院后历经抗休克、降血糖、降血钠、削痂、分次植皮等治疗，仍于5个月后在高血糖、高血钠基本纠正、创面基本修复的情况下，因神经系统病变和继发性尿崩症而死亡。虽然上述病症未被完全明确病因，但是该团队采取针对性对症治疗措施以改善患者临床症状，维持内环境稳定及生理机能，加快创面修复进程的做法或许能为此类重症患者的治疗提供一些经验。Abstract: On December 20, 2018, a 40-year-old male patient with extremely severe flame burn was admitted to Guangzhou First People's Hospital. A variety of difficult illnesses occurred simultaneously (refractory hyperglycemia, refractory hypernatremia, and progressive wound deepening) and successively (repeatedly postoperative hypotension, nervous system diseases, and secondary diabetes insipidus). The patient underwent treatments such as anti-shock, reducing blood sugar and blood sodium, scab removing, and gradual skin grafting after admission. Although the hyperglycemia and hypernatremia were basically corrected and the wounds were basically repaired, the patient ultimately died of nervous system diseases and secondary diabetes insipidus 5 months later. Although the cause of the above illnesses can not be fully determined, the targeted treatments to improve clinical symptoms, maintain stable internal environment and physiological function, and accelerate the process of wound repair conducted by the team may provide some experience for the treatment of such severe patients.
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Key words:
- Burns /
- Hyperglycemia /
- Hypernatremia /
- Hypotension /
- Diabetes insipidus /
- Complications
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1 特重度烧伤合并2型糖尿病患者入院后2周四肢皮下组织及部分肌肉出现进行性坏死。1A.左下肢皮下组织溶解、坏死；1B.左下肢内侧局部部分肌肉坏死；1C.右上肢皮下组织溶解、坏死；1D.左上肢皮下组织溶解、坏死
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