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目的探讨高渗性非酮症糖尿病昏迷的临床特点和诊治。方法分析我院住院的28例高渗性非酮症糖尿病昏迷患者的临床资料,入院后早期诊断,积极补液,纠正脱水及电解质紊乱,治疗诱因与并发症。结果高渗性非酮症糖尿病昏迷患者中年龄大于60岁者21例(75.00%),首诊误诊15例(53.57%),诱因包括感染3例,5例大面积脑梗死,3例脑出血应用脱水剂治疗过程中出现血容量不足,血糖控制不佳5例,应用静脉内高营养2例,急性胃肠炎2例。临床治疗后好转21例,死亡7例,病死率为25.00%。结论高渗性非酮症糖尿病昏迷好发于老年患者,诱因较多,症状易被原发病掩盖,首诊误诊率较高,临床需提高警惕,及时救治。
Objective To investigate the clinical features and diagnosis and treatment of hypertonic nonketotic diabetic coma. Methods Clinical data of 28 patients with hyperosmolar nonketotic diabetic coma hospitalized in our hospital were analyzed. Early diagnosis after admission, active rehydration, correct dehydration and electrolyte disorders, treatment incentives and complications. Results 21 cases (75.00%) were hypertonic nonketotic diabetic coma with age over 60 years old, 15 cases (53.57%) were misdiagnosed as first diagnosis, 3 were induced infection, 5 cases were cerebral infarction, 3 cases were cerebral hemorrhage Application of dehydrating agent in the treatment of insufficient blood volume, poor blood sugar control in 5 cases, the application of intravenous nutrition in 2 cases, 2 cases of acute gastroenteritis. 21 cases improved after clinical treatment, 7 died, the fatality rate was 25.00%. Conclusion Hyperosmolar nonketotic diabetic coma predisposed to elderly patients, more incentives, the symptoms easily covered by the original disease, the first diagnosis of higher misdiagnosis, clinical need to be vigilant and timely treatment.