糖尿病患者胸部手术围术期血糖控制50例分析

目的探讨糖尿病患者胸部手术围术期血糖的控制及其对手术的影响。方法回顾性分析50例胸部肿瘤并糖尿病患者接受胸科术治疗围术期的血糖调控情况。50例患者分别接受肺叶切除术、全肺切除术、肺楔形切除术、支气管袖形切除术、余肺切除术、食管贲门癌切除胃代食管术、纵隔肿瘤切除术及全胸骨切除术等复杂胸科手术治疗,术前、术中及术后分别控制血糖。结果50例患者入院时空腹血糖平均(9·2±1·4)mmol/L,术后第1、2、3d平均血糖分别为(11·6±1·0)mmol/L、(10·2±1·0)mmol/L、(9·5±0·7)mmol/L;并发术后感染5例次,吻合口瘘1例,肺功能不全、呼吸机支持2例,并发症发生率为16·0%,死亡率为2·0%。结论糖尿病患者经正确的围术期处理,将血糖维持至基本正常水平,可耐受复杂的胸部手术。     

69例糖尿病患者骨科手术临床病例分析

目的对糖尿病患者骨伤后进行骨科手术治疗时血糖的合理控制进行分析。方法从该院骨科病例资料中抽取2010年1月—2014年1月69例接受手术的糖尿病患者,对患者术前、术中、术后的血糖加以有效控制,并对其病情进行分析。结果69例患者中,68例伤口一期复合,愈合率98.55%,1例(1.45%)在术后内固定发生松动,但并未出现感染。结论糖尿病患者骨伤后进行骨科手术治疗时,血糖的控制在术前、术中及术后都有着至关重要的作用,通常患者手术空腹血糖低于9.0mmol/L时,是比较安全可行的。     

老年糖尿病骨折患者围术期血糖控制体会

目的指导老年糖尿病手术患者的围术期血糖控制。方法对57例老年髋部骨折合并糖尿病患者行围手术期血糖控制,观察手术效果。结果57例均获随访3个月-2a,无骨折不愈合发生。伤口延迟愈合3例,经积极换药后痊愈;并发肺部感染4例,经有效抗生素对症治疗后得到控制。所有患者均安全度过围手术期,血糖控制于6～11mmol／L。结论良好的血糖控制,合适的骨折处理术式,早期功能锻炼是治疗老年糖尿病骨折的主要方法,须将血糖控制贯穿于围手术期全过程。     

血糖浓度对糖尿病患者骨科手术的影响分析

目的分析血糖浓度对糖尿病患者骨科手术的影响。方法选取糖尿病骨科手术患者一共80例作为该文研究内容中的选取对象,收取时间(2015年2月—2016年2月),按照患者手术前血糖浓度分为观察组一组(40例血糖浓度在9 mmol/L以内患者)、对照组一组(40例血糖浓度在9 mmol/L以上患者),将两组糖尿病骨科手术患者的手术效果进行对比。结果观察组糖尿病骨科手术患者的平均伤口愈合时间(12.01±1.15)d与对照组患者差异有统计学意义(P0.05);观察组糖尿病骨科手术患者的并发症发生率5.00%低于对照组并发症发生率22.50%(P0.05);观察组术前术后血糖浓度和对照组差异有统计学意义(P0.05)。结论糖尿病患者进行骨科手术,应对手术方式和麻醉慎重考虑,患者血糖浓度在9 mmol/L以内,能显著降低术后并发症,缩短平均伤口愈合时间,而在患者围手术期间应对患者实施血糖控制,能降低术后感染情况,改善糖尿病骨科手术患者的预后,值得进一步推广及运用。     

糖尿病并冠心病患者冠状动脉旁路移植围术期特点

目的 :研究糖尿病 (DM )并冠心病 (CHD)患者冠状动脉旁路移植术 (CABG)前后临床特征。方法 :回顾性分析我科 2 0 0 0年 1月～ 2 0 0 2年 12月 118例患者 ,其中DM并CHD(DM组 ) 2 2例 ,同期非DM并CHD(对照组 ) 96例的术前准备、手术类型及术后并发症。结果 :DM组平均年龄 (5 9.8± 9.3)岁 ,女性 7例 (31.8% ,P<0 .0 5 ) ;体外循环阻断时间 (92 .0± 4 0 .9)min ,冠状动脉病变远端细小 8例 (36 .4 % ,P <0 .0 5 ) ;术前血糖 (6 .4±1.1)mmol/L ,术中血糖 (16 .1± 2 .3)mmol/L ,术后当天初测血糖 (17.5± 4 .4 )mmol/L ,予静脉推注胰岛素 ,次晨空腹血糖 (11.6± 2 .8)mmol/L ;术后并发肺部感染 7例 ,伤口愈合不良 5例 ,口腔溃疡 5例 ,6个月内复发心绞痛 3例 ,与对照组比较 ,均P <0 .0 5。结论 :DM并CHD患者行CABG病情复杂 ,围术期处理应采取综合疗法     

围手术期的血糖护理对妇科疾病合并糖尿病手术切口感染的影响

目的探讨围手术期的血糖护理对妇科疾病合并糖尿病手术切口感染的影响。方法选取该院2013年1月—2014年10月收治的妇科手术疾病合并糖尿病患者96例,使用胰岛素等强化围术期血糖的控制,并且进行有效护理,并选取2013年前收治的妇科手术疾病合并糖尿病患者80例作为对照,观察两组患者手术前后的空腹血糖水平和手术切口感染率。结果对照组手术前空腹血糖为(11.5±1.6)mmol/L,手术后为(12.6±1.9)mmol/L,观察组手术前空腹血糖为(9.7±0.6)mmol/L,手术后为(9.9±0.8)mmol/L,观察组手术前后血糖水平均低于对照组(P0.05)。观察组切口感染率(3.1%)明显低于对照组(26.3%)。结论围手术期血糖控制到理想范围是决定病人切口是否感染的关键,临床医护人员要高度重视。     

糖尿病患者骨科手术69例临床治疗分析

目的探究69例糖尿病患者骨科手术治疗治疗方法。方法选择于2016年9月—2017年9月进入该院骨科实行手术治疗的69例糖尿病患者为研究主体对象,所有患者均实行术前、术中及术后全过程血糖控制治疗,全面分析影响手术治疗效果的风险因素,统计所有患者的平均血糖、总愈合率及内固定松动发生率各项指标。结果手术后48 h检测所有患者空腹血糖,其平均血糖为6.1～8.6 mmol/L,并且69例患者中伤口一期复合67例、其愈合率为97.10%。其中,2例患者术后出现内固定松动且无任何感染情况。同时,开展为期12个月的治疗随访,随访期间无一例患者出现伤口延期愈合或感染情况,所有患者关节恢复情况良好。结论血糖控制占据糖尿病患者实行骨科手术治疗极其重要的地位及作用,并且空腹血糖低于9.0 mmol/L是判断骨科手术是否可行的重要指标,一定程度上保证手术治疗安全性。     

血糖浓度对糖尿病患者骨科手术的影响分析

目的探讨血糖浓度对糖尿病患者行骨科手术的影响。方法选取2014年1月—2015年1月于该院骨科住院部行择期手术的糖尿病骨疾病患者100例作为研究组,根据术前血糖浓度分为正常组与对照组,另选这一时间段骨科收治的行择期手术的非糖尿病患者50例作为对照组,对研究组组患者围手术期血糖进行干预,观察手术后3组患者平均伤口愈合时间及评级、术后并发症,评价随访8个月骨折愈合情况。结果血糖正常组与对照组患者平均伤口愈合时间为13 d左右,二者相比,差异无统计学意义(P0.05);血糖非正常组患者平均伤口愈合时间为19 d左右,明显长于正常组和对照组,差异有统计学意义(P0.05)。在伤口愈合分级中,血糖正常组和对照组所有患者均为甲级愈合,而血糖非正常组有5例乙级愈合和1例丙级愈合,其愈合情况明显差于正常组和对照组,差异有统计学意义(P0.05)。结论糖尿病骨疾病患者血糖控制在9.0 mmol/L为骨科手术安全浓度,而控制在6.1 mmol/L的正常浓度之内,可有效缩短患者伤口愈合时间,提高愈合等级,大大改善患者生活质量。     

糖尿病患者骨科手术40例临床分析研究

目的探讨分析40例糖尿病患者骨科手术时的血糖安全范围,防范并发症的发生与合并症的加重。方法选取该院2013年1月—2014年1月收治的40例糖尿病患者,在接受骨科手术治疗中,利用胰岛素控制血糖范围,同时对手术、预后、并发症均有着良好的效果,在预防感染、骨不愈合上有着积极作用。结果 40例患者均没有发生感染,骨愈合情况良好,临床治疗效果较好。结论将血糖控制在9.0mmol/L以下是较为安全的,在临床治疗中,有效控制围手术期的血糖水平,是确保糖尿病患者安全接受骨科手术的重要手段,能够有效改善患者的生活质量,提高治疗效果。     

非体外循环冠状动脉搭桥手术后血糖控制水平分析

目的:探讨非体外循环下冠状动脉搭桥术后患者的血糖控制水平对手术后主要并发症的影响。方法:2年共观察患者83例,对住院准备手术的患者进行随机分组,术前将血糖控制在正常水平。实验组手术后48h内血糖控制在(4·4~7·1)mmol/L,对照组血糖控制在(7·1~11)mmol/L。观察术后呼吸机辅助呼吸时间、平均住院时间、术后7d内心房颤动的发生率、围手术期心脏事件发生率、伤口并发症情况。结果:实验组术后7d内心房颤动的发生率12%,较对照组低,差异有显著性。其余指标差异无显著性。结论:非体外循环下冠状动脉搭桥手术后血糖控制在较低水平对患者术后恢复有利。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.