老年糖尿病患者低血糖脑病20例临床分析

目的分析老年糖尿病患者低血糖脑病的病因、临床表现、治疗及预后特点。方法对近5年来本院收治的60岁以上确诊为低血糖脑病20例患者的病因、临床表现、治疗及预后特点进行回顾性分析。结果老年糖尿病患者发生低血糖的病因与进食突然减少,用药过量,药物协同作用,老年人生理机能减退,及伴心肝肾功能不全相关。临床表现初期有交感神经兴奋4例,脑功能障碍症状多样,误诊率50%。治疗静脉推注高渗糖,病人意识清醒或好转后,3例病人即停用葡萄糖,2例再次昏迷,复查血糖仍低。17例继续以5%葡萄糖静滴,血糖控制在5.6～8.3mmol/L之间,持续2～3天。预后15例完全康复,5例低血糖时间>6小时的遗留后遗症。结论老年糖尿病患者是低血糖脑病的易发人群,病因多样,临床症状多数类似脑血管病,易误诊。经治疗病人清醒或好转,仍需继续监测血糖及补充葡萄糖2～3天。及早诊断治疗(低血糖时间<6小时),大部分预后良好。

The Clinical Analysis of Hygoglycemic Encephalopathy in Elderly Diabetic Patients

Objective To investigate the etiology, clinical manifestation, therapeutic feature, prognosis of hypoglycemic encephalopathy in elderly diabetic patients. Methods By analyzing the clinical data of patients with HLE retrospectively in 5 year, to know the etiology, clinical manifestation, therapeutic feature, prognosis of this disease. Results The etiology of hypoglycemic in elderly diabetic was correlated with the in take of food suddenly reduce, over administration, drug synergism, decreseence of physiological functions, cardia, hepatic and renal inadequacy. Clinical manifestation There were 4 eases with the symptoms of sympathetic nerves excitation in earlier period and kinds of brain functional disorder symptoms. The misdiagnesis rate reached to 50%. Treatmerit After intravenous injection of glucose in high concentration, the conscious state of the patients could be improved, then 3 cases were took out of service glucose immediately, 2 case of them lost consciousness again, blood sugar levelof which was still low. Blood sugar level of 17 cases still with supplying 5% glucose was eontroled between 5.6-8.3mmol/L for 2-3 days; Prognosis 15 eases get recovery, 5 eases with the duration of hypoglycemia over 6 hours remained sequelae. Conclusions It was easy for elderly diabetic patients to get HLE. There were kinds of etiological factors and the clinical symptoms of HLE were similar to cerebrovascular disease, so misdiagnosis rate was very high. It was necessary to continue supplying glucose and checking blood sugar level, and control the blood sugar level between 5.6-8.3mmol/L for 2-3 days after the conscious state improved. If diagnosed and get management at an early stage, the prognosis of most of patients was eusemia