低血糖意识障碍的相关危险因素分析  

High-risk factors for disorders of consciousness of hypoglycemia

作　　者：刘冬梅 张艳 胡华斌 黄璞 严俊 余中华 邓武权[3] 胡志安[4] 姚忠祥[4] 陆德宾 LIU Dongmei;ZHANG Yan;HU Huabin;HUANG Pu;YAN Jun;YU Zhonghua;DENG Wuquan;HU Zhi’an;YAO Zhongxiang;LU Debin(Department of Endocrinology,Chongqing Renji Hospital(the Fifth People’s Hospital),University of Chinese Academy of Sciences,Chongqing,400062;Department of Neurology,Qijiang People’s Hospital,Chongqing,401420;Department of Endocrinology,Chongqing Emergency Medical Center(Chongqing Fourth People’s Hospital),Chongqing,400014;Department of Physiology,Institute of Brain and Intelligence,College of Basic Medical Sciences,Army Medical University(Third Military Medical University),Chongqing,400038,China)

机构地区：[1]中国科学院大学重庆仁济医院(重庆市第五人民医院)内分泌科,重庆400062 [2]綦江区人民医院神经内科,重庆401420 [3]重庆市急救医疗中心(重庆市第四人民医院)内分泌科,重庆400014 [4]陆军军医大学(第三军医大学)基础医学院生理学教研室,重庆400038

出　　处：《第三军医大学学报》2021年第17期1679-1683,共5页Journal of Third Military Medical University

基　　金：国家自然科学基金创新研究群体项目(31921003)。

摘　　要：目的探讨低血糖患者出现意识障碍的高危因素及诱因。方法选择2010-2020年在中国科学院大学重庆仁济医院和重庆市急救医疗中心接受低血糖治疗住院患者108例为研究对象,分析患者性别、年龄、注射胰岛素或服用磺脲类药物、饮酒等高危因素与低血糖之间的关系;并按照患者入院时有无意识障碍分为意识障碍组(n=72)与无意识障碍组(n=36),比较两组间的糖尿病占比、血糖水平、低血糖持续时间、合并症(糖尿病、高血压、慢性阻塞性肺病、冠心病、肾病、脑卒中后遗症、肿瘤)等差异,结合CT和脑电图分析低血糖所致意识障碍的发病诱因及升糖治疗后的转归。结果108例低血糖患者以老年人为主(>60岁者占89.80%),糖尿病患者多(70.40%)。72例(66.70%)合并意识障碍,其中54.17%有口服磺脲类降糖药物,为意识障碍主要诱因。与无意识障碍组比较,意识障碍组血糖水平明显降低(P<0.001),低血糖持续时间明显较长(P=0.047),但糖尿病仅合并高血压患者明显较少(P=0.006),而糖尿病合并高血压再合并1种以上其他合并症(慢性阻塞性肺炎、冠心病、肾病、脑卒中后遗症、肿瘤等)的占比明显较多(P=0.034);两组间年龄、性别、血肌酐水平差异无统计学意义。另外,两组患者CT图像及意识恢复后脑电图并未见特异性改变和明显差异,经升糖治疗后均无明显后遗症,好转率高。结论低血糖意识障碍的主要诱因是口服磺脲类药物,而主要高危因素包括低血糖严重程度、低血糖持续时间及具有多种合并症,但糖尿病仅合并高血压患者在发生低血糖时相对不易出现意识障碍。Objective To explore the high risk factors and causes of disorders of consciousness(DOC)in hypoglycemia patients.Methods A total of 108 patients receiving hypoglycemia treatment in Chongqing Renji Hospital and Chongqing Emergency Medical Center from January 2010 to December 2020 were enrolled in this study.The relationships of sex,age,insulin injection or administration of sulfonylurea drugs and alcohol consumption with hypoglycemia were analyzed.According to being conscious or not,the patients were divided into DOC group(n=72)and non-DOC group(n=36).The differences of being diabetes mellitus or not,blood glucose level,hypoglycemia duration,and complications(diabetes,hypertension,chronic obstructive pulmonary disease,coronary heart diseases,nephropathy,sequelae of stroke and tumors)were compared between the 2 groups.The causes of DOC by hypoglycemia and outcome after glucose raising treatment were analyzed in combination with CT images and results of electroencephalography(EEG).Results The 108 hypoglycemia patients were majorly old aged(89.8%,over 60 years old)and had diabetes mellitus(70.4%).Seventy-two of them(66.7%)were complicated with DOC,and about 54.17%of them took sulfonylurea hypoglycemic drugs,which was the main inducement of hypoglycemic DOC.Compared with the non-DOC group,the blood glucose level was obviously reduced and the duration of hypoglycemia was notably longer in the DOC group,but the ratio of patients with diabetes mellitus combined with hypertension were significantly less,while the ratio of patients with the 2 above diseases with hypertension and another one or more complications simultaneously(such as chronic obstructive pulmonary inflammation,coronary heart diseases,kidney disease,stroke sequelae,and tumor,etc.)were significantly larger.There were no significant differences in age,sex and serum creatinine between the 2 groups.In addition,no statistical differences were seen in CT images and EEGs after recovery from DOC.After the treatment of glucose,no obvious sequelaes occurred and the i

关 键 词：低血糖 意识障碍 危险因素 

分 类 号：R181.32[医药卫生—流行病学] R587.3[医药卫生—公共卫生与预防医学]