颅脑损伤合并非酮性高血糖高渗性昏迷

Brain injury accompanied by nonketotic hyperglycemic hyperosmotic coma

目的探讨颅脑损伤并发非酮性高血糖高渗性昏迷病人的诊断、治疗及预后.方法对1997年7月～2002年1月期间收治的17例中、重型颅脑损伤合并非酮性高血糖高渗性昏迷的病人进行回顾性分析.结果17例颅脑损伤合并非酮性高血糖高渗性昏迷的病人,除1例之外,其余均在静滴胰岛素及胃内注水治疗后2 d内,高血糖、高血渗得到控制.17例非酮性高血糖高渗性昏迷病例占同期中、重型颅脑损伤病人的1.76%.死亡3例,死亡率17.6%.结论对非酮性高血糖高渗性昏迷,静滴胰岛素极其有效,救治的关键是及早发现并采取有效的治疗措施.治疗中连续性监测血糖、血清渗透压、电解质、严密的病情监护,及时有效调整胰岛素用量至关重要.

Objective To explore the diagnosis, treatment and prognosis of patients with brain injury accompanied by nonketotic hyperglycemic hyperosmotic coma. Methods 17 cases with brain injury accompanied by nonketotic hyperglycemic and hyperosmotic coma were retrospectively analyzed. Results Among the 17 cases, the hyperglycemia and hyperosmotic state were controlled by injecting insulin and feeding water nasally for 2 days in 16 cases. 3 cases died, death rate accounting for 17.6 %. Conclusion Insulin is a relatively ideal drug to treat patients with nonketotic hyperglycemic hyperosmolar coma. The key to save the patients is confirmative diagnosis and timely treatment. Monitoring of blood sugar, blood serum osmotic pressure and electrolyte as well as timely adjustment of insulin dosage is necessary.