食管癌术后并发高血糖高渗性非酮症性昏迷的临床分析

目的:探讨食管癌患者术后并发高血糖高渗性非酮症性昏迷的病因及临床防治策略。方法:回顾性分析2009年1月至2014年12月复旦大学附属中山医院胸外科收治的食管癌术后发生高血糖高渗性非酮症性昏迷的5例患者的临床资料。结果:5例患者术前均无糖尿病,术后均采用肠内营养,其中4例发生并发症。5例患者均以脱水、精神障碍为主要临床表现,严重者出现昏迷。3例发现早,及时处理后恢复较好,平均住院时间42 d,均痊愈;2例发现较晚,1例于术后第54天治疗无效死亡,1例住院时间长达210 d。所有患者均未发展为糖尿病。结论:非糖尿病的食管癌患者术后亦可发生高血糖高渗性非酮症性昏迷,在有并发症或使用肠内高营养的患者中较易发生,术后监测血糖可避免此并发症发生;早诊早治能改善此并发症的预后。

Clinical Analysis of Hyperglycemic Hyperosmolar Nonketotic Coma after Esophagectomy

Objective: To explore the etiology, as well as the clinical prevention and treatment strategy, of hyperglycemic hyperosmolar nonketotic coma after esophagectomy. Methods: The clinical data of five patients who suffered hyperglycemic hyperosmolar nonketotic coma after esophagectomy in Department of Thoracic Surgery, Zhongshan hospital, Fudan Unviersity during January 2009 and December 2014, were retrospectively analyzed. Results: There was no case with diabetes history among the five cases before operation. All the 5 cases received enteral nutrition after operation, among which 4 cases suffered postoperative complications. The main symptoms included dehydration and psychogenia. And coma occurred in severe cases. Three cases recovered well and reach an average hospital stay of 42 days owning to early diagnosis and treatment. The other two were diagnosed too late. One case died in hospital on the 54th day after operation and the other case had been staying in hospital for 210 days. Furthermore, no patient developed diabetes. Conclusions: Hyperglycemic hyperosmolar nonketotic coma may even occur after esophagectomy in patients without diabetes, especially in the patients who suffer from complications or received enteral nutrition. Postoperative monitoring of blood glucose could prevent this complication. Early diagnosis and treatment could improve its prognosis.