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目的 :探讨糖尿病继发药物性低血糖症的发病机制及鉴别诊断。方法 :回顾分析 1981～ 2 0 0 2年 10月收治的糖尿病继发药物性低血糖 5 8例。结果 :5 8例患者确诊低血糖症时血糖值 0 .5 6～ 2 .86mmol/L ,平均 1.36mmol/L。其中以昏迷就诊者 35例占 6 0 .3% ,以谵语、幻视、幻听、定向及行为障碍等精神症状就诊者 4例 ,以偏瘫、抽搐就诊者 2例。以突发失明就诊者 1例。以憋气 ,呼吸困难 ,不能平卧等症状就诊而误诊为心衰者16例占 2 7.6 % ,并详细分析以昏迷就诊的 35例病人 ,昏迷前具饥饿、心悸、手抖、出汗精神症状者 16例占昏迷病人 4 5 .7% ,以昏迷就诊而前驱症状不详者 19例占昏迷病人 5 4 .3%。结论 :临床医生应了解糖尿病继发低血糖症的病理生理、发病机制、病程演变及各种非特异临床表现。及时诊治 ,尽量减少低血糖所致脑部后遗症及心衰的发生。
Objective: To investigate the pathogenesis and differential diagnosis of drug-induced hypoglycemia secondary to diabetes. Methods: Fifty-eight cases of secondary hypoglycemia with diabetes mellitus were admitted to our hospital from October 1981 to October 2002. Results: Fifty-eight patients were diagnosed with hypoglycemia when blood glucose was 0.56 ~ 2.86mmol / L, with an average of 1.36mmol / L. Among them, 35 cases were treated with coma, accounting for 60.3%. Four cases were treated with psychiatric symptoms such as rhetoric, hallucination, hallucination, orientation disorder and behavioral disorders, and two patients were treated with hemiplegia and convulsions. One case of sudden blindness treatment. 16 cases were misdiagnosed as heart failure with breathlessness, dyspnea, and supine symptoms. Thirty-six patients were misdiagnosed as heart failure, and 35 patients who were treated with coma were analyzed in detail. Before the coma, they had hunger, heart palpitations, hand trembling and sweating mental symptoms 16 cases accounted for 47.7% of patients who were unconscious, and those who were unconscious and whose precursor symptoms were unknown accounted for 54.4% of patients who were unconscious. Conclusion: Clinicians should understand the pathophysiology, pathogenesis, course of disease and various nonspecific clinical manifestations of secondary hypoglycemia. Timely diagnosis and treatment, to minimize hypoglycemia caused by brain sequelae and heart failure.