血液透析中低血糖的临床观察

目的探讨血液透析（HD）治疗中低血糖的发生情况，防止血液透析中低血糖的发生。方法50例维挣胜血液透析患者，其中糖尿病25例、非糖尿病25例，均采用标准碳酸氢盐无糖透析液进行血液透析。患者于正常饮食后开始HD治疗，HD期间不进食，分别于透析0、1、2、3、4h检测血糖。结果共有15例患者。HD期间血糖低于4．0mmol／L，其中糖尿病11／25例（44％）；非糖尿病4／25例（16％），差异有显著性（P=0．031）；7例无任何自觉症状；糖尿病患者中，HD前应用胰岛素者发生低血糖7／9例（77．8％），未使用者发生低血糖4／16（25％）例，差异有显著性（P=0．017）。结论HD过程中糖尿病患者容易出现低血糖并且不易觉察，糖尿病透析前应用胰岛素者在HD过程中更易发生低血糖。对于HD过程中不宜进食的糖尿病患者HD前应停用胰岛素治疗。

Clinical observation to hypoglycemia in hemodialysis

Objective To assess the influenee of hemodialysis on plasma glucose. Methods 50 pa-ticnts with chronic renal failure ineluded 25 diabetic patients and 25 non diabetic patients were hemodialyzed u-sing standard glueose-free dialysis fluid. They ate prior to dialysis and were asked not to eat during hemodialysis. Blood glucose of 0 h, 1 h,2 h,3 h,4 h, were measured at regular intervals during dialysis. Results Plasma glu-cose fell below 4.0 mmol/L(72 mg/dl) in 15 of 50 patients include 11of the 25 diabetic patients and 4 of the 25 nondiabetic patients. The difference was significant There were 7 patients showed no symptom of hypoglycemia. 7 of the 9 diabetic patients oeeured hypoglycemia who were on insulin before hemodialysis,while 4 of the 16 dia-betic patients did who were not on insulin. The difference was significant. Conclusion Patients undergoing be-modialysis may become hypoglyeemie and not be aware of it. Diabetic patients who are on insulin before hemodi-alysis are prone to occulting hypoglycemia. Diabetic patients who can not eat during dialysis should not use insu-lin before hemodialysis.