2型糖尿病合并左冠状动脉主干狭窄患者介入治疗的循证护理

目的 探讨左冠状动脉主干（LMCA）狭窄的2型糖尿病（T2DM）患者接受介入治疗的循证护理措施及其对预后结局的改善效果。方法 选取2012年6月-2013年5月在南华大学附属第一医院心血管内科住院的T2DM合并LMCA狭窄患者28例为研究组,实施介入治疗及循证护理。收集2011年6月-2012年5月在该科住院的T2DM合并LMCA狭窄患者28例为对照组,仅施以介入治疗及常规护理。比较两组介入治疗后穿刺点出血量、冠心病监护病房（CCU）入住时间、室性期前收缩（VPC）发生率及收缩压（SBP）、舒张压（DBP）、左室射血分数（LVEF）、心脏指数（CI）、随机血糖（RBG）水平的差异;比较两组随访6个月时主要不良心血管事件（MACE）发生率、血糖达标率、生活质量综合评分（QOL）及并发症发生率的差异。结果 研究组的穿刺点出血量、CCU入住时间、VPC发生率及RBG水平均较对照组降低,而SBP、DBP、LVEF及CI较对照组增加,差异有统计学意义（P＜0.05）。随访6个月时,研究组患者MACE发生率、并发症发生率较对照组降低,血糖达标率、QOL升高,差异有统计学意义（P＜0.05）。结论 应用循证护理措施对于接受介入手术的LMCA合并T2DM患者疗效显著,并可改善预后结局。     

老年2型糖尿病患者随访2年认知功能进展及相关因素研究

目的探讨老年2型糖尿病（T2DM）患者随访2年期间认知功能进展及相关因素。方法选取193例老年T2DM患者进行随访2年,期间失访4例,获得随访的189例患者根据糖尿病病程、用药方法及血糖控制情况分组比较随访前后各项临床指标[收缩压（SBP）、舒张压（DBP）、空腹血糖（FPG）、糖化血红蛋白（HbA1C）、TC、LDL、HDL、TG]、认知功能量表测评结果的差值。结果新诊断、＜1年、1~5年、＞5年的4组患者随访前后发生认知障碍的比例比较,差异均有统计学意义（均P＜0.05）,随着病程延长,发生认知障碍的比例明显增加;除HbA1C外,4组患者随访前后其余7项临床指标差值比较,差异均无统计学意义（均P＞0.05）。采用降糖药物或胰岛素治疗的两组患者随访前发生认知障碍的比例比较,差异无统计学意义（P＞0.05）,随访2年后比较差异有统计学意义（P＜0.05）;随访前后临床指标差值比较,差异均无统计学意义（均P＞0.05）。血糖控制或控制不良的两组患者随访前后发生认知障碍的比例比较,差异均有统计学意义（均P＜0.05）,其中控制不良组高于血糖控制组;除FPG外,随访前后其余7项临床指标差值比较,差异均无统计学意义（均P＞0.05）。结论随访2年期间,包含胰岛素治疗、血糖控制良好等有利于避免或减少老年T2DM患者出现认知障碍。     

快速健步走运动对老年2型糖尿病患者身体活动能力的影响

目的：探讨快速健步走运动对老年2型糖尿病（T2DM）患者糖代谢及身体活动能力各项指标的影响。方法将T2DM患者80例随机分为运动组及对照组,每组40例。对运动组患者进行为期16周的快速健步走运动训练,将运动前后糖代谢及身体活动能力各项指标进行对比。结果运动组运动前后体适能项目VO2max 、2 min原地踏步、6 min行走、30 s臂屈伸运动、抓背伸展运动、坐椅体前伸运动等6项测试指标比较差异有统计学意义（P＜0.05）;而坐站走、30 s连续坐椅站立测试2项指标值比较差异有统计学意义（P＜0.01）。对照组患者不进行运动训练,体适能各项指标无显著改善（P＞0.05）;运动组患者餐后2 h血糖下降明显（P＜0.05）,糖化血红蛋白、空腹尿糖阳性率、餐后2 h尿糖阳性率比较差异有统计学意义（P＜0.01）,空腹血糖、空腹胰岛素和餐后2 h胰岛素测试水平无显著变化（P＞0.05）。下肢肌力测试比较,运动组患者踝关节屈伸肌力量均有不同程度增长。结论快速健步走运动训练方案有利于改善T2DM患者糖代谢及活动能力。     

血浆护骨素水平与内皮祖细胞在老年2型糖尿病患者血管病变中的关系探讨

目的 探讨老年2型糖尿病（T2DM）患者血浆护骨素（OPG）水平与外周血内皮祖细胞（endothelial progenitor cells,EPCs）含量的相关性,并分析在老年T2DM血管病变中的作用.方法 （1）采用流式细胞仪测定20例初诊T2DM患者、20例血糖控制良好（HbA1c ＜7％） T2DM患者（A组）、20例血糖控制中等（HbA1c7％～11％） T2DM患者（B组）、20例血糖控制较差（HbA1c＞1 1％） T2DM患者（C组）及10例糖耐量正常的健康对照者外周血中EPCs的含量; （2）采用酶联免疫分析法检测上述患者的血浆OPG水平.结果 （1）EPCs在T2DM组低于健康对照组,OPG在T2DM组高于健康对照组,且均有统计学差异（P＜0.05）; （2）C组血浆EPCs的水平低于B组及A组,B组低于A组,且有统计学差异（P＜0.05）;C组血浆OPG的水平高于B组及A组（P＜0.01）,B组血浆OPG的水平高于A组,差异有统计学意义（P＜0.05）; （3）单因素分析结果显示,糖尿病患者外周血中OPG水平与EPCs含量呈负相关（r=-0.354,P＜0.05）;多元回归分析结果显示,FPG、OPG、EPCs为血管病变的影响因素（P＜0.05）.结论 老年T2DM患者中空腹血清OPG水平与EPCs存在一定关系,二者可能在老年T2DM血管病变发生发展中发挥一定作用.     

2型糖尿病家系一级亲属代谢综合征相关代谢指标情况分析

目的 分析比较2型糖尿病（T2DM）家系一级亲属同胞的代谢综合征（MS）相关代谢指标情况.方法 研究组（41个T2DM家系一级亲属同胞）及对照组按CDS2004年建议标准分别进一步分为：不伴MS组、伴MS组.分析比较研究组和对照组伴MS和不伴MS者空腹血糖（FPG）、餐后2h血糖（2hPG）、糖化血红蛋白（HbA1e）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、体重指数（BMI）、腰围、收缩压（SBP）、舒张压（DBP）等MS相关代谢指标情况.结果 2型糖尿病家系一级亲属同胞在发生MS后其MS相关代谢指标的异常程度较非T2DM家系一级亲属同胞发生MS者更严重（P＜0.05）.即使在未患MS的T2DM家系一级亲属同胞与对照组比较,MS相关代谢指标也存在统计学意义（P＜0.05）.结论 T2DM家系一级亲属同胞MS相关代谢指标存在早期紊乱倾向.2型糖尿病家系一级亲属同胞应早期随访、监测,干预体质量指数、血糖、血脂、血压等代谢指标.     

中西医结合综合干预社区老年糖尿病患者44例

目的?观察社区老年糖尿病中西医结合综合干预疗效,探索符合我国国情的社区糖尿病管理模式,提高糖尿病治疗效果。方法?将受试者随机分成2组,对照组（46例）予西医综合治疗措施;试验组（44例）在此基础上加用中成药。观察2组患者血压、血糖、糖化血红蛋白及生存质量积分等变化。结果?干预后,2组空腹血糖较干预前均有所下降（P＜0.05）,2组间比较,空腹血糖下降具有显著统计学差异（P＜0.01）;餐后血糖治疗前后无明显差异（P>0.05）;2组糖化血红蛋白均有下降（P＜0.05）,试验组优于对照组（P＜0.05）。2组治疗前后收缩压、舒张压差异无统计学意义（P>0.05）,试验组优于对照组（P＜0.01）。在生存质量方面,2组患者治疗后精力（VT）、精神健康(MH)及心理健康综合评分明显改善（P＜0.05）,2组比较,P＞0.05。结论?糖尿病在社区开展综合管理,是较为理想的慢病管理模式,中西医结合综合管理疗效更优。      

面罩联合插管在急诊抢救老年心肺复苏患者的疗效分析

目的：分析面罩联合插管在急诊抢救老年心肺复苏患者的疗效。方法回顾性分析80例老年心跳骤停患者临床资料,根据不同治疗方案分为研究组与对照组,各40例。对照组予面罩治疗,研究组面罩联合插管治疗,比较研究组与对照组治疗有效率、检测指标水平、自主循环恢复情况、复苏成功率及存活率。结果研究组治疗有效率60.00%比对照组37.50%高,差异具有统计学意义（P＜0.05）;治疗后,研究组MAP与SpO2改善情况显著优于对照组（P＜0.05）;研究组自主循环恢复率、CPR成功率及存活率均比对照组高,差异均具统计学意义（P＜0.05）。结论对心跳骤停老年患者于心肺复苏早期予以面罩联合插管,有助于其自主循环恢复,并提高CPR成功率与成活率,值得临床推广及应用。     

格列美脲治疗新发老年2型糖尿病有效性和安全性的观察

目的探讨格列美脲治疗新发老年2型糖尿病（T2DM）的有效性及安全性。方法 92例新发老年T2DM患者随机分为格列美脲组和对照组;前组给予格列美脲1～4mg降糖治疗,对照组给予瑞格列奈3～6mg,疗程均为12周。比较治疗前后患者血糖指标变化情况。结果空腹血糖、餐后2h血糖、糖化血红蛋白水平均较治疗前差异有统计学意义（P〈0.05）。格列美脲组低血糖发生率明显低于瑞格列奈组（P〈0.01）,且格列美脲组无漏服现象。结论格列美脲治疗新发老年T2DM疗效可靠,安全性、依从性高。     

维生素D对老年2型糖尿病患者胰岛素抵抗影响的研究

目的：探讨维生素D对老年2型糖尿病（T2DM）患者胰岛素抵抗的影响,为该类患者的临床治疗提供可参考依据。方法共纳入160例该院诊断为T2DM的老年患者作为研究对象,采用随机数字法平均分为观察组与对照组,两组患者均给予常规降糖治疗,观察组同时加用骨化三醇（0.5μg/d ,12周）。所有患者均于治疗前及治疗后空腹抽取静脉血检测血糖相关指标及血清25羟基维生素D3[25-（OH）D3]水平。结果治疗后体质量指数（BMI）、空腹血糖（FBG）、糖化血红蛋白（HbA1c）、胰岛素（Fins）、25-（OH）D3及胰岛素抵抗指数（IRI）均较治疗前有明显改善,差异有统计学意义（P＜0.05）;且治疗后观察组BMI、FBG、HbA1c、Fins、25-（OH）D3及IRI较对照组改善更明显,差异有统计学意义（P＜0.05）。不同血清25-（OH）D3水平患者补充维生素D后IRI均有明显改善,差异有统计学意义（P＜0.05）;血清25-（OH）D3水平低于25 nmol/L的患者同时伴有BMI、FBG、HbA1c、Fins、25-（OH）D3水平的明显改善,差异有统计学意义（P＜0.05）。血清25-（OH）D3与BMI、FBG、HbA1c、Fins及IRI存在正相关关系（P＜0.05）。结论老年T2DM患者在常规降糖治疗的基础上,补充维生素D可以更好地改善胰岛素抵抗状况,促进患者血糖的平稳。     

超声心动图对中青年2型糖尿病患者左心室功能的评价

【摘要】目的 应用超声心动图评价中青年2型糖尿病（T2DM）患者的左心室功能。 方法 纳入34～49岁的2型糖尿病患者73例。根据HbA1c水平分为T2DMⅠ组（HbA1c＜7%）40例和T2DMⅡ组（HbA1c＞7%）33例,另纳入正常对照组35例。常规测量心腔大小、左心室射血分数（LVEF）和二尖瓣前向血流舒张早期、舒张晚期峰值流速比值（E/A）。应用超声心动图脉冲多普勒和组织多普勒（TDI）技术分析上述3组人群左心室E/e’ 和Tei指数;应用二维斑点追踪技术（2D STI）分析左心室整体长轴应变（GLS）。 结果 传统指标LVEF和E/A在评价中青年T2DM患者左心室收缩功能和舒张功能方面,3组间比较差异无统计学意义（P＜0.05）。左心室舒张功能指标E/e’：T2DM Ⅰ组与T2DM Ⅱ组均较正常对照组增加（P＜0.01）,T2DM Ⅱ组较T2DM Ⅰ组受损更严重（P＜0.05）。左心室收缩功能指标 GLS：T2DM Ⅰ组与正常对照组差异无统计学意义（P＞0.05）,T2DMⅡ组较T2DM Ⅰ和正常对照组均减低（P＜0.05）。左心室整体功能指标Tei指数：T2DM Ⅰ组与正常对照组无差异（P＞0.05）,T2DMⅡ组较T2DMⅠ和正常对照组均增高（P＜0.05）。结论 超声心动图指标E/e’、Tei指数和GLS可早期检出血糖控制不佳中青年T2DM患者亚临床左心室功能减低,左心室舒张功能受损先于收缩功能。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.