类似急性脑血管病的低血糖症22例临床分析.docVIP

类似急性脑血管病的低血糖症22例临床分析 　　doi：10.3969/j.issn.1007-614x.2014.14.11 　　摘 要 目的：提高对低血糖所致神经系统损害的认识。方法：收治22例低血糖症患者，临床表现类似急性脑血管病，对其头颅CT、MRI及临床资料进行回顾性分析。结果：22例患者头颅CT、MRI检查阴性，血糖2.8mmol/L，给予高渗糖治疗，症状、体征均消失。结论：对于糖尿病患者突发类似急性脑血管病症状时，急查头颅CT、MRI的同时，应急检血糖、尿糖、尿酮体，以提高低血糖症的早期诊断率，为治疗争取时机。 　　关键词 急性脑血管病 低血糖症 临床分析 　　Clinical analysis of 22 cases of hypoglycemia similar to acute cerebral vascular disease 　　Shang Jie，XuHong，Mao Jiuhua 　　Internal medicine of Xinqiao Town Xinqiao Hospital of Jingjiang City in Jiangsu Province，214537 　　Abstract Objective：To improve the understanding of damage in nervous system caused by hypoglycemia.Methods：We selected 22 cases of hypoglycemia patient.The clinical manifestation is similar to acute cerebral vascular disease.The head of CT，MRI and clinical data of the patients were retrospectively analyzed.Results：In 22 patients，the results of brain CT，MRI examination were negative，and the blood glucose was lower than 2.8mmol/L.After the treatment of Hypertonic glucose，symptoms and signs were disappeared.The manifestation of central nervous system of hypoglycemia were similar to the acute cerebral vascular disease，so it was easy to be misdiagnosed.Conclusion：When a person with diabetes suddenly appear similar symptom of acute cerebral vascular disease，we should give the quick check of head CT and MRI for them，at the same time，we should give the quick check of blood sugar，urine sugar，urine ketone for them in order to improve the early diagnosis rate of hypoglycemia and strive for the opportunity to treatment. 　　Key words Acute cerebral vascular disease；Hypoglycemia；Clinical analysis 　　脑血管病为内科常见急诊之一，类似急性脑血管病的低血糖症并不少见。我院内科2009年1月-2013年12月收治此类患者22例，现报告如下。 　　资料与方法 　　本组患者22例，男13例，女9例，年龄52～81岁，平均（69±4）岁。20例患者有糖尿病史，病程5～18年，目前正在服用降糖药或注射胰岛素进行治疗；1例误服降糖药物；1例因长期进食差而引起低血糖。既往有高血压病史18例，高脂血症18例，冠心病史12例，糖尿病肾病史10例，脑梗死病史5例，脑出血病史1例，病前大量饮酒1例，急性胃肠炎1例。 　　临床表现：22例均以类似急性脑血管病症状而就诊，伴有不同程度的神经系统体征。其中，10例患者出现心悸、出汗和一侧肢体瘫痪等症状，9例患者出现轻度意识障碍伴双侧肢体瘫痪，3例患者出现重度意识障碍及双侧肢体瘫痪。瘫痪肢体肌力0～1级3例，2～3级6