老年药物性低血糖临床误诊分析  

Analysis of Clinical Misdiagnosis of Drug-induced Hypoglycemia in the Elderly

作　　者：穆思聪 韩博 吴寿鹏 MU Sicong;HAN Bo;WU Shoupeng(Department of Pharmacy,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Pharmacy,the First Affiliated Hospital of Tsinghua University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京天坛医院药学部,北京100070 [2]清华大学第一附属医院药学部,北京100015

出　　处：《临床误诊误治》2023年第9期14-17,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的 探讨老年药物性低血糖的临床特点及误诊原因、防范措施。方法 回顾性分析2020年1月—2022年3月收治的曾误诊的老年药物性低血糖11例的临床资料。结果 本组年龄60~74岁;糖尿病病程2~18年;有高血压病史7例,脑梗死病史和冠心病史各2例。7例以不同程度意识障碍就诊,有单侧肢体活动不利,2例CT检查发现陈旧性脑梗死灶,初步诊断为急性脑血管意外;4例以心悸、胸闷、乏力、多汗就诊,1例伴心前区疼痛,心电图检查示ST段压低,一~二度房室传导阻滞,初步诊断为冠心病。误诊时间2~4 h。11例经综合分析病史及血糖检测结果等,均确诊为药物性低血糖,给予葡萄糖注射液等治疗症状逐渐好转并消失,随访2个月无复发。结论 老年药物性低血糖患者交感神经兴奋症状较轻微,易误诊为心脑血管疾病。提高基层医院接诊医生对药物性低血糖的重视,仔细询问降糖药物使用史、平时血糖控制情况及发病前饮食情况,及早行血糖检测,有利于避免药物性低血糖误诊。Objective To explore the clinical characteristics,causes of misdiagnosis,and preventive measures of drug-induced hypoglycemia in the elderly.Methods A retrospective analysis was conducted on 11 misdiagnosed cases of drug-induced hypoglycemia in the elderly admitted from January 2020 to March 2022.Results Patients in this study were aged 60-74 years.The course of diabetes in this group ranged from 2 to 18 years.There were 7 patients with a history of hypertension,2 patients with a history of cerebral infarction and 2 patients with a history of coronary heart disease(CHD).Seven patients presented with varying degrees of consciousness disturbance,and unilateral limb dysfunction.Two patients were found to have old cerebral infarction by CT examination,and were initially diagnosed as acute cerebrovascular accident.Four patients presented with palpitation,chest tightness,fatigue,and hyperhidrosis,and one patient was accompanied by precardiac pain.ECG examination showed ST segment depression and atrioventricular block of degreeⅠ-Ⅱ,and the preliminary diagnosis of CHD was made.The misdiagnosis lasted 2-4 h.After comprehensive analysis of medical history and blood glucose test results,all 11 cases were diagnosed as drug-induced hypoglycemia,and the symptoms gradually alleviated and disappeared after treatment with glucose injection,and no recurrence was observed at 2-month follow-up.Conclusion In the elderly patients with drug-induced hypoglycemia,the symptoms of sympathetic nervous system excitation are mild,and they are easily misdiagnosed as cardiocerebral vascular disease.Improving the attention of attending doctors in grassroots hospitals to drug-induced hypoglycemia,and carefully inquiring about past history of hypoglycemic drug use,daily blood sugar control,and diet before onset,as well as early blood sugar testing,can help avoid misdiagnosis of drug-induced hypoglycemia.

关 键 词：低血糖症 药物 老年人 糖尿病 2型 误诊 脑血管意外 冠心病 血糖 

分 类 号：R587.3[医药卫生—内分泌]