低血糖意识障碍的相关危险因素分析

刘冬梅; 张艳; 胡华斌; 黄璞; 严俊; 余中华; 邓武权; 胡志安; 姚忠祥; 陆德宾

doi:10.16016/j.1000-5404.202102144

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低血糖意识障碍的相关危险因素分析

临床医学 | 更新时间：2026-01-09

- 低血糖意识障碍的相关危险因素分析
- High-risk factors for disorders of consciousness of hypoglycemia
- 第三军医大学学报 2021年43卷第17期页码：1679-1683
- 作者机构：
- 作者简介：
- 基金信息：
  
  国家自然科学基金创新研究群体项目(31921003)
- DOI：10.16016/j.1000-5404.202102144
  中图分类号：
- 收稿：2021-02-25，
  
  纸质出版：2021-09-15
- 稿件说明：
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刘冬梅, 张艳, 胡华斌, 等. 低血糖意识障碍的相关危险因素分析[J]. 第三军医大学学报, 2021,43(17):1679-1683.

Dongmei LIU, Yan ZHANG, Huabin HU, et al. High-risk factors for disorders of consciousness of hypoglycemia[J]. Journal of Third Military Medical University, 2021, 43(17): 1679-1683.
刘冬梅, 张艳, 胡华斌, 等. 低血糖意识障碍的相关危险因素分析[J]. 第三军医大学学报, 2021,43(17):1679-1683. DOI： 10.16016/j.1000-5404.202102144.

Dongmei LIU, Yan ZHANG, Huabin HU, et al. High-risk factors for disorders of consciousness of hypoglycemia[J]. Journal of Third Military Medical University, 2021, 43(17): 1679-1683. DOI： 10.16016/j.1000-5404.202102144.

摘要

目的

探讨低血糖患者出现意识障碍的高危因素及诱因。

方法

选择2010－2020年在中国科学院大学重庆仁济医院和重庆市急救医疗中心接受低血糖治疗住院患者108例为研究对象，分析患者性别、年龄、注射胰岛素或服用磺脲类药物、饮酒等高危因素与低血糖之间的关系；并按照患者入院时有无意识障碍分为意识障碍组(

=72)与无意识障碍组（

=36），比较两组间的糖尿病占比、血糖水平、低血糖持续时间、合并症（糖尿病、高血压、慢性阻塞性肺病、冠心病、肾病、脑卒中后遗症、肿瘤）等差异，结合CT和脑电图分析低血糖所致意识障碍的发病诱因及升糖治疗后的转归。

结果

108例低血糖患者以老年人为主（＞60岁者占89.80%），糖尿病患者多（70.40%）。72例（66.70%）合并意识障碍，其中54.17%有口服磺脲类降糖药物，为意识障碍主要诱因。与无意识障碍组比较，意识障碍组血糖水平明显降低(

0.001)，低血糖持续时间明显较长(

=0.047)，但糖尿病仅合并高血压患者明显较少(

=0.006)，而糖尿病合并高血压再合并1种以上其他合并症（慢性阻塞性肺炎、冠心病、肾病、脑卒中后遗症、肿瘤等）的占比明显较多(

=0.034)；两组间年龄、性别、血肌酐水平差异无统计学意义。另外，两组患者CT图像及意识恢复后脑电图并未见特异性改变和明显差异，经升糖治疗后均无明显后遗症，好转率高。

结论

低血糖意识障碍的主要诱因是口服磺脲类药物，而主要高危因素包括低血糖严重程度、低血糖持续时间及具有多种合并症，但糖尿病仅合并高血压患者在发生低血糖时相对不易出现意识障碍。

Abstract

Objective

To explore the high risk factors and causes of disorders of consciousness (DOC) in hypoglycemia patients.

Methods

A total of 108 patients receiving hypoglycemia treatment in Chongqing Renji Hospital and Chongqing Emergency Medical Center from January 2010 to December 2020 were enrolled in this study. The relationships of sex

age

insulin injection or administration of sulfonylurea drugs and alcohol consumption with hypoglycemia were analyzed. According to being conscious or not

the patients were divided into DOC group (

=72) and non-DOC group (

=36). The differences of being diabetes mellitus or not

blood glucose level

hypoglycemia duration

and complications (diabetes

hypertension

chronic obstructive pulmonary disease

coronary heart diseases

nephropathy

sequelae of stroke and tumors) were compared between the 2 groups. The causes of DOC by hypoglycemia and outcome after glucose raising treatment were analyzed in combination with CT i

mages and results of electroencephalography (EEG).

Results

The 108 hypoglycemia patients were majorly old aged (89.8%

over 60 years old) and had diabetes mellitus (70.4%). Seventy-two of them (66.7%) were complicated with DOC

and about 54.17% of them took sulfonylurea hypoglycemic drugs

which was the main inducement of hypoglycemic DOC. Compared with the non-DOC group

the blood glucose level was obviously reduced and the duration of hypoglycemia was notably longer in the DOC group

but the ratio of patients with diabetes mellitus combined with hypertension were significantly less

while the ratio of patients with the 2 above diseases with hypertension and another one or more complications simultaneously (such as chronic obstructive pulmonary inflammation

coronary heart diseases

kidney disease

stroke sequelae

and tumor

etc

.) were significantly larger. There were no significant differences in age

sex and serum creatinine between the 2 groups. In addition

no statistical differences were seen in CT images and EEGs after recovery from DOC. After the treatment of glucose

no obvious sequelaes occurred and the improvement rate was quite high.

Conclusion

The main inducement of hypoglycemic DOC is oral administration of sulfonylurea

and the main high-risk factors are the severity of hypoglycemia

duration of hypoglycemia and having 3 or more complications. The patients with both diabetes mellitus and hypertension are relatively not so easy to develop hypoglycemic DOC.

关键词

Keywords

references

ALSAHLI M GERICH J E Hypoglycemia in patients with diabetes and renal disease J Clin Med 2015 4 5 948 964 10.3390/jcm4050948 ALSAHLI M, GERICH J E. Hypoglycemia in patients with diabetes and renal disease[J]. J Clin Med, 2015, 4(5): 948-964. DOI: 10.3390/jcm4050948.

International Hypoglycaemia study group Hypoglycaemia, cardiovascular disease, and mortality in diabetes: epidemiology, pathogenesis, and management Lancet Diabetes Endocrinol 2019 7 5 385 396 10.1016/S2213-8587(18)30315-2 International Hypoglycaemia study group. Hypoglycaemia, cardiovascular disease, and mortality in diabetes: epidemiology, pathogenesis, and management[J]. Lancet Diabetes Endocrinol, 2019, 7(5): 385-396. DOI: 10.1016/S2213-8587(18)30315-2.

宋锡欣林继红庞亚楠老年糖尿病性低血糖症59例误诊分析医学理论与实践 2020 33 21 3559 3560 10.19381/j.issn.1001-7585.2020.21.020 宋锡欣, 林继红, 庞亚楠, 等. 老年糖尿病性低血糖症59例误诊分析[J]. 医学理论与实践, 2020, 33(21): 3559-3560. DOI: 10.19381/j.issn.1001-7585.2020.21.020.

何江弘谢秋幼徐如祥《欧洲昏迷和意识障碍诊断指南》(2020版)解读中华神经创伤外科电子杂志 2020 6 3 135 140 10.3877/cma.j.issn.2095-9141.2020.03.002 何江弘, 谢秋幼, 徐如祥. 《欧洲昏迷和意识障碍诊断指南》(2020版)解读[J]. 中华神经创伤外科电子杂志, 2020, 6(3): 135-140. DOI: 10.3877/cma.j.issn.2095-9141.2020.03.002.

中华医学会糖尿病学分会中国2型糖尿病防治指南(2017年版) 中华糖尿病杂志 2018 10 1 72 74 10.19538/j.nk2018040108 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版)[J]. 中华糖尿病杂志, 2018, 10(1): 72-74. DOI: 10.19538/j.nk2018040108.

易加朝陈明理段小嬿 25例疑似短暂性脑缺血发作的低血糖症患者脑血管病变分析解放军预防医学杂志 2018 36 4 559 10.13704/j.cnki.jyyx.2018.04.044 易加朝, 陈明理, 段小嬿. 25例疑似短暂性脑缺血发作的低血糖症患者脑血管病变分析[J]. 解放军预防医学杂志, 2018, 36(4): 559. DOI: 10.13704/j.cnki.jyyx.2018.04.044.

DAVIS T M E BRUCE D G FINN J Temporal changes in the incidence and predictors of severe hypoglycaemia in type 2 diabetes: the fremantle diabetes study Diabetes Obes Metab 2019 21 3 648 657 10.1111/dom.13568 DAVIS T M E, BRUCE D G, FINN J, et al . Temporal changes in the incidence and predictors of severe hypoglycaemia in type 2 diabetes: the fremantle diabetes study[J ] . Diabetes Obes Metab, 2019, 21(3): 648-657. DOI: 10.1111/dom.13568.

秦连柱李鹍肖明生老年糖尿病并发低血糖症32例临床分析实用临床医学(江西) 2015 16 1 24 https://www.cnki.com.cn/Article/CJFDTOTAL-DDYI201122011.htm 秦连柱, 李鹍, 肖明生. 老年糖尿病并发低血糖症32例临床分析[J]. 实用临床医学(江西), 2015, 16(1): 24.

杨鸥孔俭重视老年糖尿病患者低血糖的发生中华老年病研究电子杂志 2020 7 1 19 21 https://www.cnki.com.cn/Article/CJFDTOTAL-LNBY202001005.htm 杨鸥, 孔俭. 重视老年糖尿病患者低血糖的发生[J]. 中华老年病研究电子杂志, 2020, 7(1): 19-21.

曹晓孚纪立伟彭净老年患者使用磺脲类药物安全性评价中国糖尿病杂志 2017 25 5 99 102 https://www.cnki.com.cn/Article/CJFDTOTAL-ZGTL201705023.htm 曹晓孚, 纪立伟, 彭净, 等. 老年患者使用磺脲类药物安全性评价[J]. 中国糖尿病杂志, 2017, 25 (5): 99-102.

ZHANG C TAN Z R TIAN F F Impaired consciousness and decreased glucose concentration of CSF as prognostic factors in immunocompetent patients with cryptococcal meningitis BMC Infect Dis 2020 20 1 69 10.1186/s12879-020-4794-5 ZHANG C, TAN Z R, TIAN F F. Impaired consciousness and decreased glucose concentration of CSF as prognostic factors in immunocompetent patients with cryptococcal meningitis[J]. BMC Infect Dis, 2020, 20(1): 69. DOI: 10.1186/s12879-020-4794-5.

余爱勇赵迎春赵玉武血糖升高速度对糖尿病模型大鼠低血糖性脑损伤的影响临床神经病学杂志 2018 31 2 126 129 https://www.cnki.com.cn/Article/CJFDTOTAL-LCSJ201802019.htm 余爱勇, 赵迎春, 赵玉武, 等. 血糖升高速度对糖尿病模型大鼠低血糖性脑损伤的影响[J]. 临床神经病学杂志, 2018, 31(2): 126-129.

王静 48例低血糖症临床分析并文献回顾中国医师杂志 2018 20 5 779 781 10.3760/cma.j.issn.1008-1372.2018.05.045 王静. 48例低血糖症临床分析并文献回顾[J]. 中国医师杂志, 2018, 20(5): 779-781.

武银铃蔡祥增赵玉国低血糖脑病21例临床分析实用糖尿病杂志 2017 13 1 53 54 https://www.cnki.com.cn/Article/CJFDTOTAL-LNSY201701036.htm 武银铃, 蔡祥增, 赵玉国, 等. 低血糖脑病21例临床分析[J]. 实用糖尿病杂志, 2017, 13(1): 53-54.

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