精密输液器预防左氧氟沙星所致静脉损伤的效果观察

目的探讨精密输液器预防左氧氟沙星所致静脉损伤的应用效果。方法将110例在我科静脉滴注左氧氟沙星的患者随机分成两组,观察组60例,使用精密过滤输液器;对照组50例,使用普通输液器。观察、比较2组患者的静脉损伤发生率。结果观察组静脉损伤发生率为5％,对照组静脉损伤发生率为28％,观察组效果明显优于对照组（P〈0．05）,比较差异具有统计学意义。结论使用精密过滤输液器能有效预防输注左氧氟沙星所致静脉损伤的发生,防止静脉损伤进一步加重,有利于减轻患者的疼痛。     

结肠透析配合中药保留灌肠在慢性肾衰竭病人护理中的应用

[目的]探讨结肠透析联合中药保留灌肠治疗早中期慢性肾衰竭病人的疗效。[方法]将慢性肾衰竭病人78例分为两组,治疗组48例,对照组30例。治疗组采用结肠途径治疗机联合中药保留灌肠治疗,对照组采用同样中药液,常规保留灌肠。[结果]两组病人治疗后恶心、呕吐、胃纳差、乏力等症状明显减轻或消失,治疗组明显优于对照组;两组病人治疗后血肌酐(Scr)、尿素氮(BUN)较治疗前降低,但治疗组比对照组改善明显。[结论]结肠透析联合中药保留灌肠治疗早中期慢性肾衰竭,治疗效果优于传统灌肠法。     

代谢综合征在缺血性卒中患者心脑血管事件发生中的作用

Objective To explore the association between metabolic syndrome (MS) and risk of cardiovascular disease events (CVD) in patients with ischemic stroke. Method A total of 1087 patients with ischemic stroke were enrolled from 5 community-based medical centres and underwent baseline evaluation on risk factors of stroke during the period of Jar. 2003 to Dec. 2006. After baseline survey, all patients were followed up until Dec 31, 2008 and new CVD events were recorded. MS was defined using CDS criteria. Proportional hazard models were used to assess the HRus and 95% CI of CVD events associated with MS and other components. Results The prevalence of MS was 40. 4% at baseline. During an average follow-up of 3.5 years, 178 patients developed new CVD events. After adjusted for age, gender, smoking,drinking, marriage status, education level, hospitalization, recurrence of stroke, stroke duration,depression, cognition impairment and ADL, MS remains the independent predictor for the risk of CVD events. Compared with patients with non-MS, the risk of CVD events increased by 44% (HR:1.44, 95%CI:1.06-1.95 ). The risk of CVD also increased with the number of MS components. Compared with patients with 1 or less than 1 components of MS, the risk of CVD events increased by 30% (HR:1. 30,95%CI:0.83-2.04) in those with 2 components and by 69% ( HR: 1.69,95% CI: 1.11-2.56) in those with 3or more components of MS. Hypertension and hyperglycemia and impaired fasting glucose also served as independent risk factors for CVD event ( all P ＜ 0. 001 ) . Conclusions MS was independently associated with increased risk of CVD events in patients with ischemic stroke. There was a dose-response relationship between the numbers of MS components and the risk of CVD event.     

老年2型糖尿病患者动态血糖监测分析

目的 探讨老年2型糖尿病患者的动态血糖波动特点.方法 对老年2型糖尿病患者(老年组)92例和中青年2型糖尿病患者(中青年组)58例进行动态血糖监测,对比分析两组患者血糖谱特征及老年不同糖化血红蛋白(HbA1c)水平糖尿病患者的血糖谱特征.结果 (1)老年组与中青年组比较,血糖波动系数(BGFC)增大[(2.68±1.00)mmol/L对(2.12±0.74) mmol/L,t=-3.691,P＜0.001];餐后血糖漂移幅度(PPGE)增大,早餐后分别为 ( 5.96±2.47) mmol/L对(5.11±2.44) mmol/L(t=-2.058,P＜0.05),晚餐后分别为(5.17±2.15) mmol/L对 (4.16±2.28) mmol/L(t=-2.730,P＜0.01);餐后血糖达峰时间延长,早餐后(112.5±29.7) min对(97.0±27.2) min(t=-3.225,P＜0.01),中餐后(140.0±39.7)min对 (118.1±42.6) min(t=-3.195,P＜0.01);低血糖发生频率增加(26.3%对5.5%,P＜0.05);最大血糖漂移幅度(LAGE)增大,分别为(9.66±2.48) mmol/L对(8.40±3.13) mmol/L(t=-2.720,P＜0.01);(2)老年组患者随HbA1c下降,低血糖发生率增加(P＜0.05);随 HbA1c升高,血糖波动幅度增大;(3)HbA1c与空腹血糖(FBG)、日平均血糖(MBG)、高血糖时间比(PT7.8、PT11.1)、最低血糖(LBG)、最高血糖(HBG)、BGFC、PPGE、LAGE均正相关(r=0.899～0.289,均P＜0.001);逐步回归分析显示,MBG、FBG、PT7.8与HbA1c独立相关(校正的R2=0.807,P＜0.05).结论 老年2型糖尿病患者血糖波动幅度大,易发生餐后高血糖和夜间低血糖,动态血糖监测能较详细地显示患者的血糖水平及波动特征.

Abstract：

Objective To investigate the characteristics of the blood glucose fluctuation in elderly patients with type 2 diabetes mellitus (T2DM). Methods The 92 elderly patients with T2DM (the elderly group) and 58 young and middle-aged patients with T2DM (the non-elderly group) were monitored using the continuous glucose monitoring system(CGMS). The characteristics of glucose profiles of the two different age groups, and of the different glycosylated hemoglobin (HbA1c) level groups in the elderly were comparatively analyzed. Results (1)There was no significant difference in HbA1c level between the elderly group and the non-elderly group. Compared with the non-elderly group, the elderly group showed the increases in blood glucose fluctuant coefficient [BGFC, (2.68±1.00) mmol/L vs. (2.12±0.74) mmol/L, t=-3.691, P＜0.001], in postprandial glucose excursion (PPGE) of breakfast and supper [(5.96±2.47) mmol/L vs. (5.11±2.44) mmol/L, t=-2.058, P＜0.05; (5.17±2.15) mmol/L vs. (4.16±2.28) mmol/L, t=-2.730, P＜0.01], in the time to postprandial glucose peak of breakfast and lunch [(112.5±29.7) min vs. (97.0±27.2) min, t=-3.225, P＜0.01; (140.0±39.7) min vs. (118.1±42.6) min, t=-3.195, P＜0.01], in the frequency of hypoglycemia (26.3% vs. 5.5%, P＜0.05), and showed the largest amplitude of glycemic excursions [LAGE, (9.66±2.48) mmol/L vs.(8.40±3.13) mmol/L, t=-2.720, P＜0.01]. (2)In the elderly, along with decreased HbA1c, the incidence of hypoglycaemia increased (P＜0.05); And along with increased HbA1c, the amplitude of blood glucose fluctuation increased. There were significant differences in BGFC, PPGE of breakfast and lunch, and LAGE among different HbA1c level groups (P＜0.01, P＜0.05, P＜0.05, P＜0.001). (3)HbA1c was positively correlated with FBG, mean blood glucose (MBG), percentage of time at glycemia (PT7.8, PT11.1), the lowest blood glucose (LBG), the highest blood glucose (HBG), BGFC, PPGE and LAGE (r=0.899-0.289, all P＜0.001). Multiple stepwise regression analysis indicated that MBG, FBG and PT7.8 was the independent influential factor of HbA1c (adjusted R2=0.807, P＜0.05). Conclusions The elderly patients with T2DM are at a particularly high risk for postprandial hyperglycemia and nocturnal hypoglycemic episodes, CGMS could show glucose fluctuation characters of T2DM patients diurnally, and provide a clinical basis for reasonable therapy.     

不同代谢综合征诊断标准与中老年人心脑血管病患病率分析

目的 探讨不同代谢综合征(MS)诊断标准与中老年人心脑血管病( CCVD)患病的关系.方法 于2009年在北京城区、近郊区平原和远郊山区对55岁及以上中老年人进行调查和检查,共1458名中老年人完成问卷调查和实验室检查.分别采用世界卫生组织(WHO)定义、美国国家胆固醇教育计划成人治疗组第3次报告( NCEP-ATPⅢ)修订定义、国际糖尿病联盟(IDF)定义和中华医学会糖尿病分会(CDS)定义计算MS患病率,分析MS患病与CCVD患病的关系.结果 无论采用何种定义,MS患者CCVD、脑卒中、冠心病患病危险均明显高于非MS者,WHO定义、NCEP-ATPⅢ修订定义、IDF定义和CDS定义的MS者CCVD危险均明显增加,其中WHO定义和CDS定义的MS与CCVD患病的关联程度最高,这2种定义的MS患者CCVD患病的危险分别是非MS者的2.14倍(OR=2.14,95％CI:1.59～2.87)和1.91倍(OR=1.91,95％CI:1.43～2.55),而NCEP-ATPⅢ修订定义和IDF定义的MS患者CCVD患病的危险分别是非MS者的1.68倍(OR=1.68,95％CI:1.32～2.15)和1.64倍(OR=1.64,95％CI:1.26～2.13).采用Logistic回归模型控制年龄、性别、地区、吸烟和饮酒史后,上述4种定义所计算的OR值分别是1.91、1.88、1.67、1.80.分别分析上述4种MS定义与脑卒中和冠心病患病的危险,结果依然显示WHO定义和CDS定义的MS与这2种疾病的关联程度最高.结论 采用WHO定义和CDS定义的MS是反映55岁及以上中老年人CCVD患病危险的最佳指标.     

升降出入理论的研究与应用进展

<正>气机学说是中医基本理论之一,气机指气的运动,包括升、降、出、入四种基本形式。升降出入泛指体内所有物质的运动和变化[1],是脏腑经络、阴阳气血矛盾运动的全过程[2]。历代医家对升降出入理论非常重视,参与己见,从不同侧面对其进行阐发,论     

抗抑郁治疗对老年高血压合并抑郁患者血压和生命质量的影响

目的了解抗抑郁治疗对老年高血压合并抑郁患者血压和生命质量的影响。方法 2008年8月至2011年3月对我院内科67例老年高血压合并抑郁的住院患者进行调查,在常规降压治疗的基础上随机分为对照组(氨氯地平片5mg/d)和治疗组(氨氯地平片5mg/d和西酞普兰20mg/d)两组,治疗3个月。比较两组治疗前后24h收缩压(24hSBP)、24h舒张压(24hDBP)、白昼平均收缩压(dSBP)、白昼平均舒张压(dDBP)、夜间平均收缩压(nSBP)、夜间平均舒张压(nDBP)和SF-36量表评分的变化。结果经治疗后与对照组相比,治疗组的24hSBP[(128.74±3.79)mmHgvs.(139.42±10.19)mmHg]、24hDBP[(72.10±7.65)mmHgvs.(78.64±8.03)mmHg]、dSBP[(130.81±4.50)mmHgvs.(143.39±12.32)mmHg]、dDBP[(76.03±9.46)mmHgvs.(81.53±9.20)mmHg]、nSBP[(126.94±3.69)mmHgvs.(136.53±9.03)mmHg]、nDBP[(68.52±6.89)mmHgvs.(75.44±7.57)mmHg]明显降低,差异有统计学意义(P均<0.01);生命质量除生理功能之外其余各维度均升高(生理机能70.84±9.90vs.62.31±10.16,躯体疼痛74.71±8.51vs.63.33±8.48,总体健康62.19±8.39vs.50.64±7.07,活力64.03±8.26vs.56.11±6.82,社会功能70.94±6.94vs.62.92±7.46,情感职能70.32±6.93vs.62.14±8.18,心理健康69.94±6.44vs.61.69±8.83,总分68.70±3.29vs.60.40±3.40,均P<0.01)。结论对老年高血压合并抑郁患者在降压治疗的同时要重视抗抑郁治疗。     

认知功能障碍对老年高血压患者生命质量的影响

目的了解认知功能障碍对老年高血压患者生命质量的影响。方法 132例老年高血压患者进行简明精神状态量表和SF-36量表测定,分为高血压合并认知功能障碍组61例(合并组)和高血压不合并认知功能障碍组71例(对照组),比较2组SF-36量表评分的变化。结果合并组生命质量的生理功能、生理机能、躯体疼痛、总体健康、活力、社会功能、情感职能和心理健康8个维度及总分均低于对照组,差异有统计学意义(P<0.01)。结论认知功能障碍可影响老年高血压患者生命质量,应减少认知功能障碍的发生。     

《傅青主女科》血崩辨治特色

《傅青主女科》为明末清初著名医家傅山的代表作,其理论独特,辨证详明,制方不失古人准绳,用药纯和,深受后世推崇.对血崩的治疗可归纳为：滋阴凉血、补气摄血、活血祛瘀、疏肝解郁、摄生节欲.用药特色主要为：补气药与补血药相伍,养血药与理气药相伍,活血药与理气药相伍,以气血双补,调理冲任为核心,根据寒热虚实灵活加减.     

抑郁对老年高血压患者动态血压和生活质量的影响

目的 了解抑郁对老年高血压患者动态血压和生活质量的影响.方法 选择2008年8月～2009年10月我院收治的年龄≥60岁的高血压73例,根据汉密尔顿抑郁量表(HAMD)测定,分为抑郁组28例和非抑郁组45例,比较两组动态血压和非特异性生活质量(SF-36)量表评分.结果 抑郁组全天平均收缩压、舒张压及白昼、夜间平均收缩压、舒张压均显著高于非抑郁组,差异有统计学意义(P均＜0.05).抑郁组SF-36评分总分及8个维度得分均低于非抑郁组,差异均有统计学意义(P均＜0.05).结论 抑郁严重影响老年高血压患者的血压和生活质量,临床医生应予以重视,及早识别和干预.