Patrick A W, Collier A, Hepburn D A, Steedman D J, Clarke B F, Robertson C
Diabetic Department, Royal Infirmary, Edinburgh, Scotland.
Arch Emerg Med. 1990 Jun;7(2):73-7. doi: 10.1136/emj.7.2.73.
Hypoglycaemia remains a serious and much feared complication of insulin therapy. In this study, patients attending an accident and emergency department in hypoglycaemic coma were randomized to treatment with either intravenous dextrose (25g) or intramuscular glucagon (1mg), administered into the right thigh. Restoration of normal conscious level was slower after glucagon than dextrose (9.0 vs 3.0 min, P less than 0.01), although the average duration of hypoglycaemic coma was 120 min. Two patients in the glucagon-treated group, who failed to show satisfactory recovery after 15 min, required additional treatment with intravenous dextrose. On questioning following recovery, all except two patients reported loss of awareness of the onset of hypoglycaemia Intramuscular glucagon is valuable in the treatment of severe hypoglycaemia outwith hospital and, although the slightly slower and less predictable recovery may appear to make it a less attractive option than intravenous dextrose in the accident and emergency department, this must be balanced against the advantages of ease of administration and a lower incidence of serious adverse effects.
低血糖仍然是胰岛素治疗中一种严重且令人十分恐惧的并发症。在本研究中，因低血糖昏迷而前往急诊科就诊的患者被随机分为两组，分别接受静脉注射葡萄糖（25克）或肌肉注射胰高血糖素（1毫克）治疗，药物注射于右大腿。尽管低血糖昏迷的平均时长为120分钟，但肌肉注射胰高血糖素后恢复正常意识水平的速度比静脉注射葡萄糖要慢（9.0分钟对3.0分钟，P小于0.01）。在胰高血糖素治疗组中，有两名患者在15分钟后未表现出令人满意的恢复情况，需要额外接受静脉注射葡萄糖治疗。在恢复后接受询问时，除两名患者外，其他所有患者均表示未察觉到低血糖的发作。肌肉注射胰高血糖素在院外治疗严重低血糖方面具有重要价值，尽管其恢复速度稍慢且可预测性较低，这似乎使其在急诊科不如静脉注射葡萄糖那么有吸引力，但必须将其与给药简便以及严重不良反应发生率较低的优点相权衡。
