脑外科重症患者并发高渗高糖非酮症昏迷的观察及护理分析(1)
摘 要：目的 探讨脑外科重症并发高渗性高血糖非酮症昏迷护理方法。方法 动态观察病情变化及急救护理，早期发现早治疗，及时采用输液和胃管补液相结合治疗，控制血糖及感染和治疗并发症。结果 采取上述治疗及护理后， 11例患者中有7例患者在第10～18 d高血糖高渗状态得到纠正，继续以上治疗方案最终各项指标均正常，治愈出院；2例放弃治疗自动出院；2例肺部感染合并多器官衰竭死亡。结论 早期发现及时治疗，积极治疗原发病和并发症，得到及时有效的救治和护理，是提高抢救成功率的关键。
关键词：脑外科重症；高渗高糖非酮症昏迷；急救护理
中图分类号：R473.6 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.01.063
文章编号：1006-1959(2018)01-0160-03
Observation and Nursing Care of Patients with Severe Brain Surgery Complicated with Hyperosmolar Hyperketose and Nonketotic Coma
, 百拇医药
GUI Shu-zhen，YANG Xiao-lan，WAN Cheng-xian
(Department of Cerebral Surgery，Intensive Care Unit，Jiangxi Provincial People's Hospital，Nanchang 330006，Jiangxi，China)
Abstract：Objective To investigate the non-ketotic coma nursing of hypertensive hyperglycemia in patients with severe brain surgery.Methods The changes of the disease and emergency nursing were observed dynamically.Early detection and early treatment were found.The combination of infusion and gastric tube rehydration was used in time to control blood sugar，infection and treatment of complications.Results After taking the above treatment and nursing care， 7 out of 11 patients were corrected in hyperglycemia state on the 10th to 18th d.All the above indexes were normal after the above treatment and were cured and discharged； 2 patients gave up the treatment and discharged automatically；2 cases of pulmonary infection with multiple organ failure died.Conclusion Early detection and timely treatment，active treatment of primary disease and complications.Timely and effective treatment and nursing is the key to improve the success rate.
, 百拇医药
Key words：Severe department of cerebral surgery；Hyperosmolar hyperglycemic nonketotic coma；Emergency nursing
腦外科重症并发高渗性高血糖非酮症昏迷(Hyperosmolar hyperglycemic nonketotic coma，HHNC)是一种严重的并发症，临床发生容易被原症状隐匿，并且患者本身大部分无糖尿病史，不容易被发现。所以，临床中很难及时发现，一旦发生病死率极高[1]。常见病情急促，死亡率可达到50%～70%[2]。早期发现及时治疗，是提高抢救成功的关健，现将我科监护室从2015年10月～2017年1月收治的发生高渗性非酮症糖尿病昏迷患者11例，现报道如下。
1资料与方法
1.1一般资料 我科监护室从2015年10月～2017年1月收治的患者中共发生高渗性非酮症糖尿病昏迷患者11例，男性8例，女性3例，年龄42～76岁，平均年龄(55.2±7.5)岁。重症颅脑损伤6例，颅内动脉瘤2例，高血压脑出血3例。患者无糖尿病史，入院后均使用大剂量脱水剂，分别于伤后或术后1～12 d出现不同程度脱水，发生HHNC并发症。
, 百拇医药
1.2诊断标准 内科HHNC的诊断标准[3]：①血糖≥33.3 mmol/L；②血渗透压≥350 mmol/L；③尿糖3～4+，酮体阴性或弱阳性；④有不同程度的意识障碍。本组HHNC的诊断标准：血糖和生化指标符合下列①或②项，同时符合第③项情况可诊断HHNC[4]。
1.3方法 确诊HHNC后，停用利尿剂、脱水剂、激素及含糖容液，遵嘱快速补充晶体及胶体液和胰岛素静脉微量泵入，监测血糖，静脉输入总量1/3，给予液体总量2/3经胃管补充。用温开水(纯净水)以100～200 ml/h的速度持续胃管内滴注[5]，根据血容量、血糖、血生化指标来调节量和速度。
1.4结果 7例治愈，2例放弃治疗自动出院，2例肺部感染合并多器官衰竭死亡。, 百拇医药(桂淑珍 杨晓兰 万承贤)
关键词：脑外科重症；高渗高糖非酮症昏迷；急救护理
中图分类号：R473.6 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.01.063
文章编号：1006-1959(2018)01-0160-03
Observation and Nursing Care of Patients with Severe Brain Surgery Complicated with Hyperosmolar Hyperketose and Nonketotic Coma
, 百拇医药
GUI Shu-zhen，YANG Xiao-lan，WAN Cheng-xian
(Department of Cerebral Surgery，Intensive Care Unit，Jiangxi Provincial People's Hospital，Nanchang 330006，Jiangxi，China)
Abstract：Objective To investigate the non-ketotic coma nursing of hypertensive hyperglycemia in patients with severe brain surgery.Methods The changes of the disease and emergency nursing were observed dynamically.Early detection and early treatment were found.The combination of infusion and gastric tube rehydration was used in time to control blood sugar，infection and treatment of complications.Results After taking the above treatment and nursing care， 7 out of 11 patients were corrected in hyperglycemia state on the 10th to 18th d.All the above indexes were normal after the above treatment and were cured and discharged； 2 patients gave up the treatment and discharged automatically；2 cases of pulmonary infection with multiple organ failure died.Conclusion Early detection and timely treatment，active treatment of primary disease and complications.Timely and effective treatment and nursing is the key to improve the success rate.
, 百拇医药
Key words：Severe department of cerebral surgery；Hyperosmolar hyperglycemic nonketotic coma；Emergency nursing
腦外科重症并发高渗性高血糖非酮症昏迷(Hyperosmolar hyperglycemic nonketotic coma，HHNC)是一种严重的并发症，临床发生容易被原症状隐匿，并且患者本身大部分无糖尿病史，不容易被发现。所以，临床中很难及时发现，一旦发生病死率极高[1]。常见病情急促，死亡率可达到50%～70%[2]。早期发现及时治疗，是提高抢救成功的关健，现将我科监护室从2015年10月～2017年1月收治的发生高渗性非酮症糖尿病昏迷患者11例，现报道如下。
1资料与方法
1.1一般资料 我科监护室从2015年10月～2017年1月收治的患者中共发生高渗性非酮症糖尿病昏迷患者11例，男性8例，女性3例，年龄42～76岁，平均年龄(55.2±7.5)岁。重症颅脑损伤6例，颅内动脉瘤2例，高血压脑出血3例。患者无糖尿病史，入院后均使用大剂量脱水剂，分别于伤后或术后1～12 d出现不同程度脱水，发生HHNC并发症。
, 百拇医药
1.2诊断标准 内科HHNC的诊断标准[3]：①血糖≥33.3 mmol/L；②血渗透压≥350 mmol/L；③尿糖3～4+，酮体阴性或弱阳性；④有不同程度的意识障碍。本组HHNC的诊断标准：血糖和生化指标符合下列①或②项，同时符合第③项情况可诊断HHNC[4]。
1.3方法 确诊HHNC后，停用利尿剂、脱水剂、激素及含糖容液，遵嘱快速补充晶体及胶体液和胰岛素静脉微量泵入，监测血糖，静脉输入总量1/3，给予液体总量2/3经胃管补充。用温开水(纯净水)以100～200 ml/h的速度持续胃管内滴注[5]，根据血容量、血糖、血生化指标来调节量和速度。
1.4结果 7例治愈，2例放弃治疗自动出院，2例肺部感染合并多器官衰竭死亡。, 百拇医药(桂淑珍 杨晓兰 万承贤)