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目的:分析低血糖症误诊为脑卒中的原因,提出预防低血糖症误诊的措施。方法:20例就诊于本院急救中心及神经内科的患者,回顾性分析其临床表现及病因,并对所有患者进行快速血糖测定、头颅CT检查,住院患者进行头颅MRI检查。结果:20例患者中糖尿病患者15例;3例为误服格列本脲;1例确诊为胰腺肿瘤;1例为肝脏肿瘤。结论:误诊原因与低血糖症的病因复杂,临床表现与脑卒中有相似之处等客观因素有关;亦与临床医师对低血糖症的认识不足、未进行有效的鉴别诊断,部分特殊病因的低血糖症患者家属不能提供重要的病史等主管因素有关。只要对低血糖症提高足够的警惕,及时作快速血糖测定,误诊是可以避免的。
Objective: To analyze the causes of misdiagnosis of hypoglycemia as stroke and to propose measures to prevent misdiagnosis of hypoglycemia. Methods: Twenty patients were referred to emergency department and neurology department of our hospital. The clinical manifestations and etiology of the patients were retrospectively analyzed. All patients underwent rapid blood glucose measurement, skull CT examination and in-hospital MRI examination. Results: Twenty patients had diabetes mellitus in 15 patients; three patients were taking glibenclamide orally; one was diagnosed as pancreatic tumor; and one was liver tumor. Conclusions: The cause of misdiagnosis and hypoglycemia are complex, the clinical manifestations are related to the objective factors such as the similarities of stroke. They also have not enough understanding of hypoglycemia with clinicians, no effective differential diagnosis, and some special causes are low Family members of patients with glycemia can not provide important medical history and other relevant factors. As long as the vigilance to improve hypoglycemia, timely and rapid blood glucose determination, misdiagnosis can be avoided.