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患者男,60岁,因头痛、头晕20年,胸闷痛加重3天于1990年12月11日入院。无多饮、多食、多尿史,无精神病史及家族史。BP 17.5/12kPa,发育正常,营养一般,神清、肺无异常。心界向左扩大,心率76次/分,A_2>P_2,未闻及杂音。尿常规(一),肝功能正常。血肌酐137mmol/L,尿素氮5.5mmol/L,心电图示左室肥厚劳损。入院诊断高血压病Ⅱ期,冠心病。给极化液、复方降压片、消心痛等治疗。因查血糖9.5mmol/L,加服优降糖2.5mg,每日3次。服药第3日晨6时,患者步态蹒跚赤脚行至凉台,众目下乱解小便,随后进屋乱扔东西,不认人。劝之不反应。在病友床上抓到点心乱扔并吃了3块约25g,被逼上床,查血压18/12kPa,面色正常,无汗,心率72次/分,神经系统检查正常,半小时后,精神恢复正常,言谈举止均自然。追问对发作无记忆。夜间无心慌、饥饿等不适,但梦多。医生误诊为夜游症,继用原药治疗。次日6时,又突然谵语,怒目叫骂,随便打人。由多人按在床上,肌注冬眠灵50mg,急查血糖2.4mmol/l,输葡萄糖10g后恢复正常。仍对适才举上无记忆,事先无任何不适。停用优降糖,2日后复查血糖8.9mmol/L,经访两年无类似情况发生。
Male patient, 60 years old, due to headache, dizziness 20 years, chest pain aggravated 3 days in December 11, 1990 admission. No more drink, eat more, history of polyuria, no history of mental illness and family history. BP 17.5 / 12kPa, normal development, general nutrition, God clear, no abnormal lung. Heart to the left to expand, heart rate 76 beats / min, A_2> P_2, no smell and noise. Urine (a), normal liver function. Serum creatinine 137mmol / L, urea nitrogen 5.5mmol / L, ECG showed left ventricular hypertrophy strain. Admission diagnosis of hypertension Ⅱ, coronary heart disease. To the polarizer, compound antihypertensive tablets, such as elimination of heartache treatment. Due to check blood glucose 9.5mmol / L, plus excellent hypoglycemic 2.5mg, 3 times a day. At 6:00 on the third day of treatment, the patient gait faltered barefoot to the veranda, disordered urine under the public eyes, and then entered the house to throw things, do not recognize people. Advise it does not respond. In the patient’s bed to catch the snack litter and eat three about 25g, forced to go to bed, check blood pressure 18 / 12kPa, looking normal, no sweat, heart rate 72 beats / min, normal nervous system examination, half an hour later, the spirit returned to normal , Speech and manner are natural. Ask no memory of the attack. No palpitation at night, hunger and other discomfort, but many dreams. Doctors misdiagnosed as night sickness, following the original drug treatment. 6 o’clock the next day, and suddenly sudden language, angrily scold, hit anyone. Press by many people in bed, intramuscular injection of Hope Spirit 50mg, acute check blood glucose 2.4mmol / l, lose glucose 10g returned to normal. Still just right without memory, without any prior discomfort. Disable glyburide, 2 days after the review of blood glucose 8.9mmol / L, no two years after the occurrence of similar circumstances.