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出现低血糖该怎么处理?
作者:未知 来源:39健康网 日期:[2010/12/11 11:27:08]
 一、主因

  低血糖是由多种原因引起的血糖过低而发病。正常人血糖低于2.8mmol/L(50mg/dl)时,脑细胞因缺乏能量引起交感神经过度兴奋和脑功能障碍。血糖越低,病情来得越快,持续时间越久,症状越突出,甚至可发生昏迷。急救不及时可死亡或遗留脑损伤。

  二、判断

  1.自发性:多见于饥饿时,出现肌体无力,定向力减退或消失,精神异常,抽搐,视力减退,昏迷

  2.内分泌性:岛素分泌过多。

  3.肝源性:因肝病使肝糖原合成、血糖分解障碍。

  应性:多在食后2~5小时发生。

  5.诱发性:服胰岛素、磺胺类药、降糖药、水杨酸、保泰松、氨基酸、心得安、美加明或长期服肾上腺糖皮质激素突然停药者。

  三、 急救措施:

  1.绝对卧床休息,声速补充葡萄糖是决定预后的关键。及时补糖将使症状完全缓解;而延误治疗则出现不可逆的脑损害。因此,应强调在低血糖发作的当时,立即给予任何含糖较高的物质,如饼干、果汁等。重症者应注意误使食物吸入中呛入气管引起吸入性肺炎肺不张

  2.能自己进食的低血糖患者,食应低糖,高蛋白,高脂肪,少食多餐,必要时午夜加饮糖料一次。

  3.静脉推注50%葡萄糖40-60ml是低血糖抢救最常用和有效的方法。若病情不严重,尚未造成严重脑功能损害,则症状可迅速缓解,神志可立即清醒。

  四、预防措施:

  对于低血糖症必须做到“防重于治”,并且预防低血糖发作是治疗糖尿病低血糖最佳治疗措施。在低血糖预防中应该注意做到以下几点:

  1.合理使用胰岛素和口服降糖药。药物使用过多是低血糖发生的主要原因。根据病情及时调整药物剂量,尤其是并发肾病、肝病、心脏病、肾功能不全者。掌握各种胰岛素的特点及正确的注射技术。定期轮流更换注射部位,防止产生皮下硬结,影响胰岛素吸收。

  2.生活规律,养成良好的生活习惯,戒烟戒酒,饮食定时定量,保持每日基本稳定的摄食量。积极采用分餐制,一日至少进食三餐。易出现低血糖患者或病情不稳定的患者还应在三次正餐之间增添2-3次加餐,即从三次正餐中匀出一部分食品留作加餐食用。糖尿病患者一般可在上午9:00-10:00,下午3:00-4:00及晚上睡前加一次餐。这是防止低血糖,控制高血糖,之有效的措施,值得采用。

3.运动疗法是糖尿病病人综合治疗五驾马车之一。运动可使糖尿病病人血糖降低,提高胰岛素的敏感性,改善精神面貌等。但是对于糖尿病病人来说,主张中、轻度的运动方式。剧烈运动可致低血糖发生,因此剧烈运动或体力活动增加时应及时加餐或酌情减少胰岛素用量。

  4.自我血糖监测能够明显减少低血糖的发生率。有些患者病情不稳定,常发生夜间低血糖,因此睡前应监测血糖,如果血糖偏低,可在睡前适量加餐。对于无症状地低血糖患者应加强血糖监测,及时降低胰岛素的剂量,调整饮食和运动治疗方案。

  5.作为每一个糖尿病病人外出时应随身两件宝物:一是食物,如糖果、饼干等,以备发生低血糖时急用,及时纠正低血糖,避免导致严重低血糖;二是急救卡(注明姓名、诊断、电话、用药等),它提供了糖尿病急救有关的重要信息,使发生严重低血糖时能在最短时间得到诊断和治疗。

 

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