高血压脑出血手术后合并糖尿病非酮症高渗性昏迷的临床抢救措施

Clinical rescue measures for hypertensive cerebral hemorrhage complicated with diabetic nonketotic hyperosmotic coma after operation

目的探讨高血压脑出血术后合并糖尿病非酮症高渗性昏迷(HNDC)患者的临床抢救措施。方法选取2017年9月至2018年12月于上海市浦东新区人民医院急诊科行高血压脑出血手术的患者46例,术后所有患者均合并HNDC,均及时给予患者停止脱水药物的使用,胃肠内补液、胰岛素、补钾和控制血压水平等针对性的抢救措施,分析患者抢救前后的血糖、血钾、血钠和血浆渗透压指标水平,并分析患者的预后情况。结果抢救15 d后,46例患者中,死亡1例,能够生活自理者29例,部分生活自理者12例,植物状态生存者4例;术后患者的血钠、血钾、血糖、血浆渗透压水平明显高于术前,差异均有统计学意义(P<0.05);抢救后患者的血钠、血钾水平明显低于术前,血糖、血浆渗透压水平明显高于术前,差异均有显著统计学意义(P<0.01)。结论高血压脑出血患者术后极易并发HNDC,且临床预后较差,临床应尽早确诊,及时采取纠正水电解质紊乱和酸碱平衡紊乱,合理使用胰岛素的针对性抢救措施能够有效提高抢救成功率,患者的预后较好。

Objective To explore the clinical rescue measures for patients with hypertensive intracerebral hemorrhage complicated with diabetic nonketotic hyperosmotic coma(HNDC).Methods Forty-six patients with hypertensive intracerebral hemorrhage were selected from September 2017 to December 2018 in the Department of Emergency,Shanghai Pudong New District People's Hospital.All patients were treated with HNDC and were given timely rescue measures(such as stopping the use of dehydration drugs,gastrointestinal fluid infusion,insulin,potassium infusion,and controlling blood pressure level).The levels of blood sugar,potassium,sodium,and osmotic pressure before and after rescue were analyzed,and the prognosis of the patients was analyzed.Results After 15 days of rescue,1 patient died,29 were able to take care of themselves,12 can partially taken care of themselves,and 4 were in vegetative state.The levels of serum sodium,potassium,blood sugar,and plasma osmotic pressure were significantly higher in patients after operation than those before operation(P<0.05).Potassium levels were significantly lower than those before operation,and blood sugar and plasma osmotic pressure levels were significantly higher than those before operation(P<0.01).Conclusion The patients with hypertensive intracerebral hemorrhage are prone to HNDC after operation,and the clinical prognosis is poor.Clinical diagnosis should be made as soon as possible,and water and electrolyte disorders and acid-base balance disorders should be corrected in time.Proper use of insulin can effectively improve the success rate of rescue,and the prognosis of patients is good.