常武地区农村老年患者低血糖昏迷的发病原因分析及护理宣教策略
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摘要
目的分析常武地区农村老年患者低血糖昏迷的原因并探讨有效应对策略。方法回顾性分析2015年1月至2018年10月江苏大学附属武进医院内分泌科收治的40例老年农村低血糖昏迷患者的临床资料,其中男性18例,女性22例;年龄60～97岁,平均年龄(75. 68±8. 30)岁。统计并分类计数患者的发病原因,并根据常见病因制定对应的护理宣教策略。结果引起农村老年人低血糖昏迷的主要原因有使用降糖药(包括口服降糖药和皮下注射胰岛素)后未及时进食或进食过少[13例(32. 50%)]、能量摄入不足[5例(12. 50%)]、误服降糖药[5例(12. 50%)]、自行更换降糖药[5例(12. 50%)]、降糖药物剂量过大[5例(12. 50%)]、活动量增加[1例(2. 50%)]以及其他不明原因[6例(15. 00%)]。过度饮酒也在一定程度上影响了低血糖的发生。结论尽管引起患者低血糖昏迷的原因有多种,但加强糖尿病患者低血糖风险的宣教,尤其是指导患者正确使用降糖药后要及时进食,加强糖尿病患者的安全管理等可减少低血糖的发生。
Objective To analyze the causes of elderly patients with hypoglycemia and coma in rural areas and to explore effective coping strategies. Methods The causes of 40 elderly patients with hypoglycemia in rural areas from January 2015 to October 2018 were retrospectively analyzed and summarized. Among them,18 males and 22 females were aged 60-97 years with an average age of 75. 68 ±8. 30 years. To analyze the correlation factors of hypoglycemia coma in elderly patients. Result The main cause of hypoglycemia and coma in rural elderly patients was that they did not eat or eat too much after using hypoglycemic drugs including oral hypoglycemic agents and subcutaneous insulin( 32. 50%),insufficient energy intake( 12. 50%), misadministration of hypoglycemic agents( 12. 50%), self-replacement of hypoglycemic agents( 12. 50%),overdose of hypoglycemic agents( 12. 50%),increased activity( 2. 50%)and other unknown reasons( 15. 00%). In addition,excessive drinking also affects the occurrence of hypoglycemia to a certain extent. Conclusion Although there are many reasons for hypoglycemia and coma in patients,the promotion of hypoglycemia risk in diabetic patients,especially to guide patients to eat hypoglycemic drugs in a timely manner,to strengthen the safety management of diabetes patients can reduce the occurrence of hypoglycemia.
Objective To analyze the causes of elderly patients with hypoglycemia and coma in rural areas and to explore effective coping strategies. Methods The causes of 40 elderly patients with hypoglycemia in rural areas from January 2015 to October 2018 were retrospectively analyzed and summarized. Among them,18 males and 22 females were aged 60-97 years with an average age of 75. 68 ±8. 30 years. To analyze the correlation factors of hypoglycemia coma in elderly patients. Result The main cause of hypoglycemia and coma in rural elderly patients was that they did not eat or eat too much after using hypoglycemic drugs including oral hypoglycemic agents and subcutaneous insulin( 32. 50%),insufficient energy intake( 12. 50%), misadministration of hypoglycemic agents( 12. 50%), self-replacement of hypoglycemic agents( 12. 50%),overdose of hypoglycemic agents( 12. 50%),increased activity( 2. 50%)and other unknown reasons( 15. 00%). In addition,excessive drinking also affects the occurrence of hypoglycemia to a certain extent. Conclusion Although there are many reasons for hypoglycemia and coma in patients,the promotion of hypoglycemia risk in diabetic patients,especially to guide patients to eat hypoglycemic drugs in a timely manner,to strengthen the safety management of diabetes patients can reduce the occurrence of hypoglycemia.
引文
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2 Geller AI,Shehab N,Lovegrove MC,et al.National estimates of insulin-related hypoglycemia and errors leading to emergency department visits and hospitalizations[J].JAMA Intern Med,2014,174(5):678-686.
3中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017版)[J].中华糖尿病杂志,2018,10(1):4-67.
4马蓝.对老年糖尿病实施个体化健康教育及护理干预效果分析[J].医学信息(上旬刊),2008,21(9):1620-1621.
5石四梅.沟通对农村老年患者健康行为的影响[J].疾病监测与控制杂志年,2011,5(11):701-702.
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7吴丽琴,徐勤容,陈育群,等.膳食结构调整在老年糖尿病患者饮食干预中的应用评价[J].护理与康复,2014,13(11):1077-1079.
8王玉芳.2型糖尿病患者低血糖发生原因分析及护理对策探讨[J].当代临床医刊,2017,30(5):3425.
9张莉.研究分析糖尿病合并高血压药物治疗的合理应用和不良反应[J].中国医药指南,2018,16(26):186-187.
10潘虹,孔迪.老年2型糖尿病低血糖症39例临床分析[J].中华全科医学,2012,10(4):567-568.
11余显霞,熊雪松,戚忠林,等.住院期间老2型糖尿病患者低血糖原因分析及对策[J].现代生物医学进展,2014,14(30):5899-5902.
12王占辉,王爱红,朱平,等.反复低血糖对2型糖尿病患者心功能影响的研究[J].中国糖尿病杂志,2014,22(11):1004-1008.
2 Geller AI,Shehab N,Lovegrove MC,et al.National estimates of insulin-related hypoglycemia and errors leading to emergency department visits and hospitalizations[J].JAMA Intern Med,2014,174(5):678-686.
3中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017版)[J].中华糖尿病杂志,2018,10(1):4-67.
4马蓝.对老年糖尿病实施个体化健康教育及护理干预效果分析[J].医学信息(上旬刊),2008,21(9):1620-1621.
5石四梅.沟通对农村老年患者健康行为的影响[J].疾病监测与控制杂志年,2011,5(11):701-702.
6高欣.糖尿病低血糖患者昏迷的急诊救治措施研究[J].糖尿病新世界,2018,3(5):179-180.
7吴丽琴,徐勤容,陈育群,等.膳食结构调整在老年糖尿病患者饮食干预中的应用评价[J].护理与康复,2014,13(11):1077-1079.
8王玉芳.2型糖尿病患者低血糖发生原因分析及护理对策探讨[J].当代临床医刊,2017,30(5):3425.
9张莉.研究分析糖尿病合并高血压药物治疗的合理应用和不良反应[J].中国医药指南,2018,16(26):186-187.
10潘虹,孔迪.老年2型糖尿病低血糖症39例临床分析[J].中华全科医学,2012,10(4):567-568.
11余显霞,熊雪松,戚忠林,等.住院期间老2型糖尿病患者低血糖原因分析及对策[J].现代生物医学进展,2014,14(30):5899-5902.
12王占辉,王爱红,朱平,等.反复低血糖对2型糖尿病患者心功能影响的研究[J].中国糖尿病杂志,2014,22(11):1004-1008.