以急性脑血管病首发的低血糖脑病32例临床分析

Clinical analysis of 32 hypo-glycemia encephalopathy patients with acute cerebrovascular disease

目的了解老年人低血糖脑病的临床特点,分析误诊原因,吸取教训,以提高诊治水平。方法对32例老年人低血糖脑病的临床资料作回顾性分析。结果初诊误诊12例,误诊率37.5%,被误诊为急性脑血管病8例,精神病1例,昏迷待查3例,诊断明确后即静脉注射50%GS 40~100mL,15~30min后神志清楚,6~8h后局部神经体征消失,继之用5%或10%GS静滴,以维持血糖稳定24~48h,经5~7h监测血糖稳定后予以出院。结论以急性脑血管病首发的低血糖脑病,常见于老年糖尿病患者的用药过程中,临床医生应拓宽知识面,提高警惕,及时检测血糖,并迅速处理。

Objective To study the clinical features of hypoglycemia encephalopathy in elderly people,and to analyze the reasons of misdiagnosis and improve how to diagnose and treat.Methods Retrospective analysis was done on clinical data of 32 elderly hypoglycemia encephalopathy patients received and cured from March 2007 to March 2013.Results 12 cases were misdiagnosed at the first time,misdiagnosis rate was 37.5%,including 8cases of acutecerebrovascular disease,1case of mental disease,3cases of coma to be checked,who received intravenous 50% glucose injection about 40-100 mL after correct diagnosing,then became clear in consciousness after15-30 minutes,and local neurological symptoms disappeared after 6-8hours,5%or 10% glucose injection were continued to keep glucostasis for 24-48 hours,discharged after glucostasis for 5-7hours.Conclusion Hypoglycemia encephalopathy initials with acute cerebrovascular disease are commonly seen in medication process of elderly diabetic,clinicians should broaden scope of knowledge,raise vigilance and detect blood glucose,then dispose in time.