以脑梗死为表现的急诊低血糖性脑病临床分析

Clinical analysis of acute cerebral infarction in patients with cerebral infarction

目的探讨以脑梗死为表现的急诊低血糖性脑病的临床特征。方法分析表现为脑梗死的急性低血糖性脑病患者12例的临床资料,观察临床症状、体征、实验室及相关辅助检查、治疗及预后。结果 12例患者中有明确糖尿病病史10例,服用消渴丸3例,自购中成药2例,应用胰岛素治疗2例,口服其他降糖药3例。临床表现昏迷5例,嗜睡3例;偏瘫6例,四肢瘫痪3例;肌力Ⅰ级2例、Ⅱ级3例、Ⅲ级5例、Ⅳ级2例;有精神症状2例。颅脑CT检查陈旧性脑梗死4例,腔隙性脑梗死3例;血糖水平0.8~2.8 mmol/L,平均(1.90±0.48)mmol/L。明确诊断后予50%葡萄糖静脉注射,然后予10%葡萄糖静脉滴注,同时进行相应治疗后症状缓解,血糖恢复正常;1例患者低血糖纠正但因高龄、肺部感染、肾功能不全死亡。结论应正确认识低血糖性脑病的神经系统表现,完善急诊相关检查鉴别诊断,并实施相应措施积极治疗。

Objective To investigate the clinical characteristics and preventive measures of acute cerebral infarction in patients with cerebral infarction.Methods 12 cases acute hypoglycemia encephalopathy in cerebral infarction patients, observe the clinical symptoms, signs, laboratory and auxiliary examination, treatment and prognosis. Results 12 patients had diabetes history 10 cases,3 cases with xiaokewan,Ownbuy Chinese medicine 2 cases,a pplication insulin therapy 2 cases, 3 cases of other oral antidiabetic drugs.The clinical manifestations were coma 5 cases, somnolence in all cases, hemiplegia 6 cases, and paralysis in extremities 3 cases, muscle class Ⅰ 2 cases, Ⅱ 3 cases,Ⅲ 5 cases, Ⅳ 2 cases;mental symptom 2 cases.craniocerebral CT examination old cerebral infarction 4 cases,lacunar cerebral infarction 3 cases;blood glucose level 0.8-2.8 mmol/L, the average （ 1.90 ± 0.48） mmol/L.Clear diagnosis 50% glucose intravenous injection, and then treated with 10% glucose intravenous drip, while the corresponding treatment of symptoms, blood glucose returned to normal, 1 cases of patients with hypoglycemia correct but because age, pulmonary infection,renal insufficiency death.Conclusian Should correctly understand the nervous system performance of hypoglycemic encephalopathy,improve the emergency related examination and differential diagnosis,and the implementation of appropriate measures to actively treat.