【摘要】 目的探讨重型颅脑损伤并发非酮症高渗性糖尿病昏迷的危险因素及其治疗方法。方法以重型颅脑损伤患者并发非酮症高渗性糖尿病昏迷33例为研究对象，对其发生时间，危险因素及其治疗等临床资料进行统计分析。结果伤后半年时根据GOS分级标准：恢复良好9例;中残5例;重残3例;植物生存1例;死亡15例。表明该并发症死亡率高(本组为45.45%)。结论本病主要是丘脑下部损害和较长时间大剂量脱水药物使用引起。救治的关键是及早发现并尽快抢救休克、纠正脱水、纠正高渗状态，注意控制血糖是治疗关键，静滴胰岛素极其有效。
【关键词】 脑损伤 非酮症高渗性 糖尿病昏迷 治疗
Nonketonic Hyperosmotic Diabetic Coma Secondary to Severe Cerebral Trauma: An Analysis on Emergency Care for 33 Cases
Liao Shengfang, Wang Handong, Chen Hanmin, Wang Yuchai
1. Department of Neurosurgery, PLA No.180 Hospital, Quanzhou 362000, China;
2. Department of Neurosurgery, Nanjing General Hospital of Nanjing Military Region, PLA, Nanjing 210002, China
Abstract： ObjectiveTo study the risk factors of nonketonic hyperosmotic diabetic coma (NHDC) secondary to severe cerebral trauma, as well as its therapeutic methods. MethodsA total of 33 cases of NHDC secondary to severe cerebral trauma were enrolled into the study. The clinical data about its risk factors and emergency care were analyzed. ResultsAfter half an year, there were nine cases with good recovery, five with medium disability, three with severe disability, and one with vegetative survival according to GOS classification; the other 15 patints died, which indicated a high mortality (45.45%). ConclusionNHDC secondary to severe cerebral trauma is caused by the injury in hypothalamus and by the longterm administration of dehydrating agents. The key to treatment is to find and cope with shock, dehydration and hyperosmolality, especially to control blood sugar level with insulin.
Key words： cerebral injury; nonketonic hyperosmotic diabetic coma; risk factor; therapy
重型颅脑损伤并发非酮症高渗性糖尿病昏迷(nonketotic hyperosm olar diabetic coma，NHDC)临床并非罕见，是严重危及生命的神经外科重症，死亡率极高，如延误治疗，可在24~48 h 内死亡。目前对单纯非酮症高渗性糖尿病昏迷的救治报道较多，但对重型颅脑损伤并发非酮症高渗性糖尿病昏迷的临床诊断、病因及治疗等报道较少。现将2003年1月—2007年3月我科收治的1 323例重型颅脑损伤患者在治疗中所并发非酮症高渗性糖尿病昏迷33例(2.49%)进行分析，以对重型颅脑损伤并发非酮症高渗性糖尿病昏迷有较全面的认识。
1资料与方法
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