急诊重度低血糖昏迷误诊的原因及急救护理体会

目的 探讨急诊重度低血糖昏迷误诊发生的原因,及其针对性的急救护理措施.方法 回顾性分析我院79例发生重度低血糖昏迷患者误诊的临床资料,并将患者分为干预组（n=40）和对照组（n=39）,干预组患者在康复出院后给予针对性护理干预措施,比较两组1年后的低血糖昏迷发生情况.结果 本院79例患者,临床表现为失语、意识障碍而全部误诊为急性脑血管意外,其中52例患者原有糖尿病史,因未相应减量而致患者低血糖昏迷.27例患者发病前原无糖尿病史,临床表现症状类似脑血管意外,致低血糖昏迷的原因是给予不适当静滴能量合剂.院后给予相关针对性护理干预后,观察组患者低血糖昏迷再发生率明显降低,达2.5％,糖化血红蛋白控制率明显升高,达90％,与对照组比较差异均有统计学意义（P＜0.05）.结论 低血糖昏迷多是以急性起病为表现,易误诊为急性脑血管意外,提高对低血糖的认识和诊断,及早诊断,及时治疗,加强康复后的指导和护理干预,及时调整对患者降糖药物的治疗,可显著降低低血糖昏迷的发生率.

The reason of misdiagnosis of severe hypoglycemia coma and first-aid nursing experience

Objective Study causes of misdiagnoses about emergency severe hypoglycemic comal to establish corresponding emergency care. Methods Retrospective analysis of 79 cases of severe hypoglycemic coma patients with the clinical data of misdiagnosis and nursing methods, all patients were divided into intervention group （ n = 40） and control group （ n = 39 ） , intervention group after discharge were given targeted nursing intervention measures, then to compare the situation of hypo- glycemic coma occurred in two groups of 1 years later. Results The clinical symptoms of aphasia and disturbance of con- sciousness of 79 patients in our hospital were all misdiagnosed as acute eerebrovaseular. 52 cases with old history of diabetes re- sult in hypoglyeemie coma because they didn＇t correspondingly reduced the dose of medicine. Clinical symptoms of 27 cases that without old history of diabetes were similar to cerebrovascular, whose cause of hypoglycemia coma was improper intravenous drip of energy mixture. By conducting nursing intervention after discharge, incidence of hypoglyeemic coma was significantly lower in intervention group, at 2. 5% , glycated hemoglobin obviously was controlled, at 90% , there were statistically significant differ- ence between two groups （P 〈 0. 05 ） . Conclusion Hypoglycemic coma is acute onset that more easily misdiagnosed as a- cute cerebrovascular accident, therefore, the improvement of understanding and diagnosis about hypoglycemia, enhancement of detection and timely adjustment of oral glucose-lowering drugs have important impact on misdiagnosis of hypoglycemic coma.