血液透析中低血糖的临床观察

Clinical observation to hypoglycemia in hemodialysis

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。

Objective To assess the influence of hemodialysis on plasma glucose. Methods 50 patients with chronic renal failure included 25 diabetic patients and 25 non diabetic patients were hemodialyzed using standard glucose-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 glucose fell below 4. 0 mmol/L（ 72 mg/dl） in 15 of 50 patients include 11 of 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 occured hypoglycemia who were on insulin before hemodialysis, while 4 of the 16 diabetic patients did who were not on insulin. The difference was significant. Conclusion Patients undergoing hemodialysis may become hypoglycemic and not be aware of it. Diabetic patients who are on insulin before hemodialysis are prone to occulting hypoglycemia. Diabetic patients who can not eat during dialysis should not use insulin before hemodialysis.