重型颅脑损伤并发非酮症高渗性糖尿病昏迷18例诊治的的体会.docVIP

重型颅脑损伤并发非酮症高渗性糖尿病昏迷18例诊治的的体会 　　【摘要】 目的:探讨重型颅脑损伤并发非酮症高渗性糖尿病昏迷的危险因素及其治疗方法。方法:以重型颅脑损伤患者并发非酮症高渗性糖尿病昏迷18例为研究对象，对其发生时间，危险因素及其治疗等临床资料进行统计分析。结果:伤后半年时根据GOS分级标准：恢复良好4例;中残3例;重残2例;植物生存1例;死亡8例。表明该并发症死亡率高(本组为44.44%)。结论:本病主要是丘脑下部损害和较长时间大剂量脱水药物使用引起。救治的关键是及早发现并尽快抢救休克、纠正脱水、纠正高渗状态，注意控制血糖是治疗关键，静滴胰岛素极其有效。 　　【关键词】 脑损伤 ；非酮症高渗性； 糖尿病昏迷 治疗 　　 Nonketonic Hyperosmotic Diabetic Coma Secondary to Severe Cerebral Trauma: 　　 An Analysis on Emergency Care for 18 Cases 　　 Liangxingze. Hemingfa.yonglijun. 　　Department of Neurosurgery, General Hospital, guangyuan628000, China 　　【Abstract】 ObjectiveTo study the risk factors of nonketonic hyperosmotic diabetic coma (NHDC) secondary to severe cerebral trauma, as well as its therapeutic methods. MethodsA total of 33 cases of NHDC secondary to severe cerebral trauma were enrolled into the study. The clinical data about its risk factors and emergency care were analyzed. ResultsAfter half an year, there were four cases with good recovery, three with medium disability, two with severe disability, and one with vegetative survival according to GOS classification; the other 8 patints died, which indicated a high mortality (44.44%). ConclusionNHDC secondary to severe cerebral trauma is caused by the injury in hypothalamus and by the long?term administration of dehydrating agents. The key to treatment is to find and cope with shock, dehydration and hyperosmolality, especially to control blood sugar level with insulin. 　　【Key words】cerebral injury; nonketonic hyperosmotic diabetic coma; risk factor; therapy 　　【中图分类号】R749.1+2 　　【文献标识码】B 　　【文章编号】1007-8231（2011）10-1601-02 　　重型颅脑损伤并发非酮症高渗性糖尿病昏迷(nonketotic hyperosm olar diabetic coma，NHDC)临床并非少见，是严重危及生命的神经外科重症，死亡率极高，如延误治疗，可在24~48 h 内死亡。目前对单纯非酮症高渗性糖尿病昏迷的救治报道较多，但对重型颅脑损伤并发非酮症高渗性糖尿病昏迷的临床诊断、病因及治疗等报道较少。现将2006年1月―2011年1月我科收治的540例重型颅脑损伤患者在治疗中所并发非酮症高渗性糖尿病昏迷18例(3.3%)进行分析，以对重型颅脑损伤并发非酮症高渗性糖尿病昏迷有较全面的认识。 　　 1资料与方法 　　 1.1一般资料 　　 本组18例，其中男13例，女5例;年龄26~65岁，平均(45±2.8)岁;车祸伤8例，高处摔伤6例，打击伤4例。GCS评分均≤8分。重型颅脑损伤均经CT和(或)MRI确诊，其中原发