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高渗性昏迷是中风严重的并发症,主要表现为意识障碍程度加重,血压下降,而尿量不减少或增多,血液浓缩,尿比重增高,血糖、尿素氮及血清钠、钾、氯增高.本病并发症病情危重,治疗困难,预后差,又容易漏诊、误诊.本文就其发生率、发病因素及防治问题作一分析.1 临床资料1.1 一般资料 我院从1991年10月～1994年12月住院患者中通过头颅CT证实确诊为急性脑血管病428例,其中并发高渗性昏迷13例,男5例,女8例,年龄40～70岁.基底节出血4例,脑叶出血3例,丘脑出血2例,缺血性中风4例.有糖尿病史3例,既往糖尿病史不明确者4例,否认糖尿病史6例.中风并高渗性昏迷发生时间11例在发病后3～14天,2例在中风后21天.1.2 诱发因素 主要为应用大剂量脱水剂、糖皮质激素或者中途中断降糖类药物.2例首先在外院治疗使用大剂量脱水剂,而又补液不足,肾前性肾功能衰竭,入院时即已是高渗性昏迷.
Hyperosmolar coma is a serious complication of stroke, mainly manifested as aggravating degree of disturbance of consciousness, blood pressure, and urine output does not reduce or increase, blood concentration, increased proportion of urine, blood glucose, blood urea nitrogen and serum sodium, potassium and chlorine increased. Complications of the disease in critical condition, the treatment is difficult, the prognosis is poor, but also easy to missed diagnosis, misdiagnosis.This article on its incidence, risk factors and prevention and treatment of an analysis.1 Clinical data 1.1 General Information Our hospital from October 1991 to 1994 In December, 428 cases of acute cerebrovascular disease confirmed by head CT were diagnosed in hospitalized patients in December, of which 13 cases were hyperosmolar coma, 5 were males and 8 were females, aged from 40 to 70. Hemorrhage in basal ganglia was observed in 4 cases, 3 cases, 2 cases of thalamic hemorrhage, 4 cases of ischemic stroke .There were 3 cases of history of diabetes, 4 cases of previous history of diabetes mellitus, 6 cases of history of diabetes.Conclusion: 11 cases of stroke and hypertonic coma occur after onset ~ 14 days and 2 cases 21 days after stroke.1.2 The predisposing factors were mainly the application of high-dose dehydrating agents, glucocorticoids or half-way hypoglycemic agents.Of the two cases, the high-dose dehydrating agent , Prerenal renal failure, admission is already high Coma.