高血糖高渗性非酮症糖尿病昏迷1例

2018-10-24 李娜 中国基层医药

患者,男,47岁。主诉:全身乏力四肢湿冷半天。既往有抑郁症病史,长期在门诊口服奥氮平治疗。

患者信息

患者,男,47岁。主诉:全身乏力四肢湿冷半天。既往有抑郁症病史,长期在门诊口服奥氮平治疗。

此次发病前1周开始,患者每天饮用大量啤酒,很少进食主食;在发病3d前开始未进食任何水和食物,后感头晕、乏力,当时亲属未予重视,后患者症状加重,四肢乏力、全身湿冷,但意识尚清,来急诊时,患者神志清楚,体温38.3℃,血压测不出,血氧饱和度86%,心率110次/min。

急诊急查血生化示:血糖100.5 mmol/L、血钠161.5 mmol/L、血钾4.61 mmol/L、尿素氮26.7 mmol/L、肌酐419.6 μmol/L;尿常规示:尿酮体(-);动脉血气分析示:pH 7.12、PaCO2 39 mmHg、PaO2 174 mmHg、乳酸2.3 mmol/L、动脉血氧饱和度99%。

诊疗经过

入科后,患者意识模糊,血压90/60 mmHg左右,全身湿冷,心率110次/min,呼吸33次/min,血氧饱和度100%。

立即予中心静脉置管,并开通两条外周静脉,积极予0.9%氯化钠注射液及人血白蛋白、羟乙基淀粉补液扩容,并留置管补充温开水,小剂量胰岛素(0.1U·kg-1·h-1)持续泵入,1h监测血糖及电解质一次。

入科后1h查的血常规示:血红蛋白184 g/L、红细胞计数6.02×109/L,红细胞比容0.62;血生化:尿素氮28.4 mmol/L、肌酐442.9 μmol/L,葡萄糖86.0 mmol/L,血钾3.07 mmol/L,血钠163.8 mmol/L,血氯115.9 mmol/L;入科后2h监测血糖及电解质:血糖72.5 mmol/L,血钾2.71 mmol/L,血钠169.3 mmol/L,血氯123.6 mmol/L;入科后3h血糖及电解质:血糖47.0 mmol/L,血钾2.41 mmol/L,血钠171.7 mmol/L,血氯123.3 mmol/L;入科后4h血糖及电解质:血糖46.5 mmol/L,血钾2.89 mmol/L,血钠170.6 mmol/L,血氯123.2 mmol/L。

患者入科后持续3h无尿,经积极补液扩容后,有少量小便,但后患者血压偏低,需小剂量(0.1μg·kg-1·min-1)去甲肾上腺素维持。为进一步控制患者出入量,防止脑水肿,更好的调节患者的血浆渗透压及各种电解质的平衡,遂给予持续床边血液净化(CRRT)治疗,予大量白蛋白及血浆扩容。入科后6h出现发热,体温39.3℃,并出现上消化道出血及呼吸困难症状,予气管插管、呼吸机辅助呼吸、地佐辛镇痛、肠减压、兰索拉唑抑酸等治疗,患者病情逐渐稳定。

讨论

高渗性非酮症糖尿病昏迷,因为许多患者来就诊的时常常并没有出现昏迷,也称为高渗性高血糖状态(HHS),是糖尿病急性代谢紊乱的并发症之一,通常在老年的2型糖尿病患者中常见,而且病死率较糖尿病酮症酸中毒(DKA)高,预计有10%~20%的病死率。HHS的特点是高血糖、高渗透压以及严重的脱水症状。大概1/3的病例,HHS和DKA之间相互重叠,有时会同时发生。这也导致该疾病经常容易被误诊。

对于HHS,早期诊断早期治疗对患者的预后有积极作用。但由于临床表现无特异性,并且常被诱发的基础疾病掩盖,所以容易漏诊或误诊,从而延误了诊断和治疗。故对于意识障碍患者,不论既往有无糖尿病史,均因监测血糖,防止误诊漏诊。

补液是HHS治疗的首要手段。目前多主张先补等渗盐水,有利于恢复血容量,防止出现血渗透压下降过快引起的细胞水肿,尤其是脑水肿。对血压正常或偏低、血钠<150mmol/L的患者,先用等渗液补充血容量和维持血压,若血容量恢复,血压上升而血浆渗透压仍不下降时改用低渗液(0.45%氯化钠注射液)。对血压正常,血钠>150mmol/L的患者,可开始即用低渗液,如无此液,可用0.9%氯化钠注射液和5%的葡萄糖等量混合即可。补液中葡萄糖需按3g糖加1u胰岛素比例进行,可防止高氯高钠血症,又可较快降低血浆渗透压。对于休克或低血压,收缩压<80mmHg的患者,除开始补等渗液体外,应间断输血浆或白蛋白等胶体溶液。

该患者长期口服奥氮平等抗精神病药物,本身就可以抑制胰岛素分泌、升高血糖;另外此次饮用大量酒精而未进食水和食物,引起脱水,也可导致血糖升高。

该患者血糖异常增高,导致患者的血浆渗透压也异常增高。虽然患者既往无糖尿病史,但是根据患者的糖化血红蛋白高达21.3%,患者近来血糖一直偏高,自己未发现。根据患者小剂量胰岛素治疗情况,患者对胰岛素敏感,平均1h血糖下降达12~14mmol/L。对于此类患者,在救治初期,是否可以直接补液扩容,而不需要处理血糖,防止血糖下降过快,因为本身通过扩容就可以达到稀释血糖的作用。该患者就诊时血糖异常增高、血肌酐水平异常增高,这均是死亡的独立危险因素。故在遇到此类血糖异常增高的患者,胰岛素治疗可能不需要太积极,而且需根据患者对胰岛素治疗的反应及时调整胰岛素的输注速度。

原始出处:

李娜. 高血糖高渗性非酮症糖尿病昏迷一例[J]. 中国基层医药, 2018(2).

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (7)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=2086194, encodeId=84e4208619482, content=<a href='/topic/show?id=23ba1024e08c' target=_blank style='color:#2F92EE;'>#高渗性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102470, encryptionId=23ba1024e08c, topicName=高渗性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=docwu2019, createdTime=Fri Feb 08 21:17:00 CST 2019, time=2019-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1804296, encodeId=574d180429684, content=<a href='/topic/show?id=9521e673371' target=_blank style='color:#2F92EE;'>#糖尿病昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76733, encryptionId=9521e673371, topicName=糖尿病昏迷)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Fri Dec 28 14:17:00 CST 2018, time=2018-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1641199, encodeId=17f9164119953, content=<a href='/topic/show?id=8d739553475' target=_blank style='color:#2F92EE;'>#酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95534, encryptionId=8d739553475, topicName=酮症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=790822763597, createdName=ms705947299214030, createdTime=Wed Sep 04 11:17:00 CST 2019, time=2019-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1819725, encodeId=81051819e2538, content=<a href='/topic/show?id=06b499e326c' target=_blank style='color:#2F92EE;'>#非酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99732, encryptionId=06b499e326c, topicName=非酮症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=362b271, createdName=zexyw01, createdTime=Wed Dec 19 17:17:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1261166, encodeId=e127126116611, content=<a href='/topic/show?id=30c6102e2607' target=_blank style='color:#2F92EE;'>#高血糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102726, encryptionId=30c6102e2607, topicName=高血糖)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Fri Oct 26 10:17:00 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429491, encodeId=ad6414294919e, content=<a href='/topic/show?id=26d559642f9' target=_blank style='color:#2F92EE;'>#昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59642, encryptionId=26d559642f9, topicName=昏迷)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=81fb4200032, createdName=wgx307, createdTime=Fri Oct 26 10:17:00 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1041949, encodeId=0968104194969, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Wed Oct 24 22:17:00 CST 2018, time=2018-10-24, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=2086194, encodeId=84e4208619482, content=<a href='/topic/show?id=23ba1024e08c' target=_blank style='color:#2F92EE;'>#高渗性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102470, encryptionId=23ba1024e08c, topicName=高渗性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=docwu2019, createdTime=Fri Feb 08 21:17:00 CST 2019, time=2019-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1804296, encodeId=574d180429684, content=<a href='/topic/show?id=9521e673371' target=_blank style='color:#2F92EE;'>#糖尿病昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76733, encryptionId=9521e673371, topicName=糖尿病昏迷)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Fri Dec 28 14:17:00 CST 2018, time=2018-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1641199, encodeId=17f9164119953, content=<a href='/topic/show?id=8d739553475' target=_blank style='color:#2F92EE;'>#酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95534, encryptionId=8d739553475, topicName=酮症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=790822763597, createdName=ms705947299214030, createdTime=Wed Sep 04 11:17:00 CST 2019, time=2019-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1819725, encodeId=81051819e2538, content=<a href='/topic/show?id=06b499e326c' target=_blank style='color:#2F92EE;'>#非酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99732, encryptionId=06b499e326c, topicName=非酮症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=362b271, createdName=zexyw01, createdTime=Wed Dec 19 17:17:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1261166, encodeId=e127126116611, content=<a href='/topic/show?id=30c6102e2607' target=_blank style='color:#2F92EE;'>#高血糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102726, encryptionId=30c6102e2607, topicName=高血糖)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Fri Oct 26 10:17:00 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429491, encodeId=ad6414294919e, content=<a href='/topic/show?id=26d559642f9' target=_blank style='color:#2F92EE;'>#昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59642, encryptionId=26d559642f9, topicName=昏迷)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=81fb4200032, createdName=wgx307, createdTime=Fri Oct 26 10:17:00 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1041949, encodeId=0968104194969, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Wed Oct 24 22:17:00 CST 2018, time=2018-10-24, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=2086194, encodeId=84e4208619482, content=<a href='/topic/show?id=23ba1024e08c' target=_blank style='color:#2F92EE;'>#高渗性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102470, encryptionId=23ba1024e08c, topicName=高渗性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=docwu2019, createdTime=Fri Feb 08 21:17:00 CST 2019, time=2019-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1804296, encodeId=574d180429684, content=<a href='/topic/show?id=9521e673371' target=_blank style='color:#2F92EE;'>#糖尿病昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76733, encryptionId=9521e673371, topicName=糖尿病昏迷)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Fri Dec 28 14:17:00 CST 2018, time=2018-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1641199, encodeId=17f9164119953, content=<a href='/topic/show?id=8d739553475' target=_blank style='color:#2F92EE;'>#酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95534, encryptionId=8d739553475, topicName=酮症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=790822763597, createdName=ms705947299214030, createdTime=Wed Sep 04 11:17:00 CST 2019, time=2019-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1819725, encodeId=81051819e2538, content=<a href='/topic/show?id=06b499e326c' target=_blank style='color:#2F92EE;'>#非酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99732, encryptionId=06b499e326c, topicName=非酮症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=362b271, createdName=zexyw01, createdTime=Wed Dec 19 17:17:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1261166, encodeId=e127126116611, content=<a href='/topic/show?id=30c6102e2607' target=_blank style='color:#2F92EE;'>#高血糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102726, encryptionId=30c6102e2607, topicName=高血糖)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Fri Oct 26 10:17:00 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429491, encodeId=ad6414294919e, content=<a href='/topic/show?id=26d559642f9' target=_blank style='color:#2F92EE;'>#昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59642, encryptionId=26d559642f9, topicName=昏迷)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=81fb4200032, createdName=wgx307, createdTime=Fri Oct 26 10:17:00 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1041949, encodeId=0968104194969, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Wed Oct 24 22:17:00 CST 2018, time=2018-10-24, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=2086194, encodeId=84e4208619482, content=<a href='/topic/show?id=23ba1024e08c' target=_blank style='color:#2F92EE;'>#高渗性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102470, encryptionId=23ba1024e08c, topicName=高渗性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=docwu2019, createdTime=Fri Feb 08 21:17:00 CST 2019, time=2019-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1804296, encodeId=574d180429684, content=<a href='/topic/show?id=9521e673371' target=_blank style='color:#2F92EE;'>#糖尿病昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76733, encryptionId=9521e673371, topicName=糖尿病昏迷)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Fri Dec 28 14:17:00 CST 2018, time=2018-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1641199, encodeId=17f9164119953, content=<a href='/topic/show?id=8d739553475' target=_blank style='color:#2F92EE;'>#酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95534, encryptionId=8d739553475, topicName=酮症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=790822763597, createdName=ms705947299214030, createdTime=Wed Sep 04 11:17:00 CST 2019, time=2019-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1819725, encodeId=81051819e2538, content=<a href='/topic/show?id=06b499e326c' target=_blank style='color:#2F92EE;'>#非酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99732, encryptionId=06b499e326c, topicName=非酮症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=362b271, createdName=zexyw01, createdTime=Wed Dec 19 17:17:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1261166, encodeId=e127126116611, content=<a href='/topic/show?id=30c6102e2607' target=_blank style='color:#2F92EE;'>#高血糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102726, encryptionId=30c6102e2607, topicName=高血糖)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Fri Oct 26 10:17:00 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429491, encodeId=ad6414294919e, content=<a href='/topic/show?id=26d559642f9' target=_blank style='color:#2F92EE;'>#昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59642, encryptionId=26d559642f9, topicName=昏迷)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=81fb4200032, createdName=wgx307, createdTime=Fri Oct 26 10:17:00 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1041949, encodeId=0968104194969, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Wed Oct 24 22:17:00 CST 2018, time=2018-10-24, status=1, ipAttribution=)]
    2018-12-19 zexyw01
  5. [GetPortalCommentsPageByObjectIdResponse(id=2086194, encodeId=84e4208619482, content=<a href='/topic/show?id=23ba1024e08c' target=_blank style='color:#2F92EE;'>#高渗性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102470, encryptionId=23ba1024e08c, topicName=高渗性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=docwu2019, createdTime=Fri Feb 08 21:17:00 CST 2019, time=2019-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1804296, encodeId=574d180429684, content=<a href='/topic/show?id=9521e673371' target=_blank style='color:#2F92EE;'>#糖尿病昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76733, encryptionId=9521e673371, topicName=糖尿病昏迷)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Fri Dec 28 14:17:00 CST 2018, time=2018-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1641199, encodeId=17f9164119953, content=<a href='/topic/show?id=8d739553475' target=_blank style='color:#2F92EE;'>#酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95534, encryptionId=8d739553475, topicName=酮症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=790822763597, createdName=ms705947299214030, createdTime=Wed Sep 04 11:17:00 CST 2019, time=2019-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1819725, encodeId=81051819e2538, content=<a href='/topic/show?id=06b499e326c' target=_blank style='color:#2F92EE;'>#非酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99732, encryptionId=06b499e326c, topicName=非酮症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=362b271, createdName=zexyw01, createdTime=Wed Dec 19 17:17:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1261166, encodeId=e127126116611, content=<a href='/topic/show?id=30c6102e2607' target=_blank style='color:#2F92EE;'>#高血糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102726, encryptionId=30c6102e2607, topicName=高血糖)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Fri Oct 26 10:17:00 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429491, encodeId=ad6414294919e, content=<a href='/topic/show?id=26d559642f9' target=_blank style='color:#2F92EE;'>#昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59642, encryptionId=26d559642f9, topicName=昏迷)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=81fb4200032, createdName=wgx307, createdTime=Fri Oct 26 10:17:00 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1041949, encodeId=0968104194969, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Wed Oct 24 22:17:00 CST 2018, time=2018-10-24, status=1, ipAttribution=)]
    2018-10-26 hbwxf
  6. [GetPortalCommentsPageByObjectIdResponse(id=2086194, encodeId=84e4208619482, content=<a href='/topic/show?id=23ba1024e08c' target=_blank style='color:#2F92EE;'>#高渗性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102470, encryptionId=23ba1024e08c, topicName=高渗性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=docwu2019, createdTime=Fri Feb 08 21:17:00 CST 2019, time=2019-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1804296, encodeId=574d180429684, content=<a href='/topic/show?id=9521e673371' target=_blank style='color:#2F92EE;'>#糖尿病昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76733, encryptionId=9521e673371, topicName=糖尿病昏迷)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Fri Dec 28 14:17:00 CST 2018, time=2018-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1641199, encodeId=17f9164119953, content=<a href='/topic/show?id=8d739553475' target=_blank style='color:#2F92EE;'>#酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95534, encryptionId=8d739553475, topicName=酮症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=790822763597, createdName=ms705947299214030, createdTime=Wed Sep 04 11:17:00 CST 2019, time=2019-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1819725, encodeId=81051819e2538, content=<a href='/topic/show?id=06b499e326c' target=_blank style='color:#2F92EE;'>#非酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99732, encryptionId=06b499e326c, topicName=非酮症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=362b271, createdName=zexyw01, createdTime=Wed Dec 19 17:17:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1261166, encodeId=e127126116611, content=<a href='/topic/show?id=30c6102e2607' target=_blank style='color:#2F92EE;'>#高血糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102726, encryptionId=30c6102e2607, topicName=高血糖)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Fri Oct 26 10:17:00 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429491, encodeId=ad6414294919e, content=<a href='/topic/show?id=26d559642f9' target=_blank style='color:#2F92EE;'>#昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59642, encryptionId=26d559642f9, topicName=昏迷)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=81fb4200032, createdName=wgx307, createdTime=Fri Oct 26 10:17:00 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1041949, encodeId=0968104194969, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Wed Oct 24 22:17:00 CST 2018, time=2018-10-24, status=1, ipAttribution=)]
    2018-10-26 wgx307
  7. [GetPortalCommentsPageByObjectIdResponse(id=2086194, encodeId=84e4208619482, content=<a href='/topic/show?id=23ba1024e08c' target=_blank style='color:#2F92EE;'>#高渗性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102470, encryptionId=23ba1024e08c, topicName=高渗性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=docwu2019, createdTime=Fri Feb 08 21:17:00 CST 2019, time=2019-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1804296, encodeId=574d180429684, content=<a href='/topic/show?id=9521e673371' target=_blank style='color:#2F92EE;'>#糖尿病昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76733, encryptionId=9521e673371, topicName=糖尿病昏迷)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Fri Dec 28 14:17:00 CST 2018, time=2018-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1641199, encodeId=17f9164119953, content=<a href='/topic/show?id=8d739553475' target=_blank style='color:#2F92EE;'>#酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95534, encryptionId=8d739553475, topicName=酮症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=790822763597, createdName=ms705947299214030, createdTime=Wed Sep 04 11:17:00 CST 2019, time=2019-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1819725, encodeId=81051819e2538, content=<a href='/topic/show?id=06b499e326c' target=_blank style='color:#2F92EE;'>#非酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99732, encryptionId=06b499e326c, topicName=非酮症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=362b271, createdName=zexyw01, createdTime=Wed Dec 19 17:17:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1261166, encodeId=e127126116611, content=<a href='/topic/show?id=30c6102e2607' target=_blank style='color:#2F92EE;'>#高血糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102726, encryptionId=30c6102e2607, topicName=高血糖)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Fri Oct 26 10:17:00 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429491, encodeId=ad6414294919e, content=<a href='/topic/show?id=26d559642f9' target=_blank style='color:#2F92EE;'>#昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59642, encryptionId=26d559642f9, topicName=昏迷)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=81fb4200032, createdName=wgx307, createdTime=Fri Oct 26 10:17:00 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1041949, encodeId=0968104194969, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Wed Oct 24 22:17:00 CST 2018, time=2018-10-24, status=1, ipAttribution=)]
    2018-10-24 misszhang

    谢谢MedSci提供最新的资讯

    0

相关资讯

2018 ADA/EASD共识:2型糖尿病患者高血糖的管理

2018年10月,美国糖尿病学会(ADA)联合欧洲糖尿病研究协会(EASD)共同更新了2012年和2015年发布的关于2型糖尿病管理的立场声明。本文主要内容涉及2型糖尿病患者高血糖的管理。

Crit Care:对高血糖危重患儿强化降糖 获益与风险并存!

发表在《Crit Care》的一项由中国和美国科学家进行的系统评价和meta分析,考察了危重患儿强化降糖(TGC)的获益和风险。

JAMA:妊娠期血糖升高对母子的代谢危害可持续十年

据JAMA杂志一项对4697名妇女和4832名儿童进行平均11.4年随访的国际多民族队列研究发现,妊娠期血糖升高的对母亲和儿童的危害持续十多年。

Diabetic Med:葡萄糖警报系统可改善健康专业人员对不良血糖的反应,并减少非重症监护住院患者的高血糖发作次数

近日,国际杂志 《Diabetic Med》上在线发表一项关于葡萄糖警报系统可改善健康专业人员对不良血糖的反应,并减少非重症监护住院患者的高血糖发作次数的研究。研究目的是调查新型葡萄糖警报系统的效果,包括墨尔本葡萄糖警报途径和具有葡萄糖警报功能的网络血糖仪,以用于护理和医院医务人员对不良血糖的反应。 研究人员在三级医院的非重症监护病房进行在4个月(n=148或660患者-日)的前瞻性,前后

J Clin Periodontol: 绿茶对长期高血糖T1D大鼠的血管紊乱和牙周破坏的预防作用

评估绿茶对链脲佐菌素诱导的1型糖尿病(T1D)大鼠长期高血糖期间自发性牙周炎进展过程中血管调节的影响。

糖尿病患者的高血糖、高血压、高血脂,一个也不能忽视

近年来,高血糖、高血压、高血脂的患病率在我国居民中越来越高,若不及时有效地控制,会对心脏、脑、肾脏等产生严重危害。为什么有的人一样也不高,有的人却都高呢?简单地说,这“三高”是在同一块土地上长出来的三棵毒草。除先天因素(即遗传因素)外,不良生活习惯是引起三高的非常重要的原因。