以抗利尿激素分泌不当综合征为临床表现的肿瘤11例分析

抗利尿激素分泌不当综合征（SIADH）系指体内抗利尿激素（ADH）分泌异常增多或其活性超常，并不受血容量所制约，从而导致水潴留、尿排钠增多以及稀释性低钠血症等综合征。其中有相当一部分由肿瘤所致异位ADH分泌，最多见为肺燕麦细胞癌，其他肿瘤如胰腺癌、淋巴肉瘤、霍奇金病、胸腺瘤、十二指肠癌、膀胱癌、前列腺癌等。现将我院2000年1月～2006年1月收治的以抗利尿激素分泌不当综合征为表现的肿瘤11例临床资料分析如下：     

亚急性甲状腺炎100例临床治疗探讨

对我院2011年1月至2012年10月收治的100例亚急性甲状腺炎患者,给予8周糖皮质激素治疗,停药后随访2个月.停药2个月时的短期复发率34％（34/100）,其中停药时甲状腺超声异常者的复发率为52％ （30/58）,高于正常者的10％（4/42,x2=9.67,P＜0.01）;红细胞沉降率为40 ～ 100 mm/1 h和＞100 mm/1 h者的复发率分别为37％（22/60）和30％ （12/40） （P ＞0.05）.     

抢救糖尿病酮症酸中毒休克11例体会

糖尿病酮症酸中毒(DKA)是内分泌常见急症,在胰岛素问世前有极高的病死率,随着胰岛素的广泛使用及医疗条件的改善,病死率已从过去的70%下降到1%以下.但DKA休克如抢救不当仍有很高的病死率.现将我院5年来抢救DKA休克11例体会,分析报告如下.     

新诊断酮症倾向2型糖尿病患者临床特点

目的 对酮症起病的T2DM患者的临床特征进行分析,探讨酮症倾向的T2DM的发病机制.方法 收集新诊断的T2DM患者167例,其中以酮症起病T2DM患者（KPD组）76例,无酮症的T2DM者（T2DM组）91例,比较两组治疗前的BMI、随机血糖、TG、HbA1c、FC-P、胰岛β细胞功能指数（HOMA-β）、胰岛素抵抗指数（HOMA-IR）.结果 KPD组超重及肥胖患者比例、随机血糖、HbA1c、TG水平、HOMA-IR均高于T2DM组（P＜0.005或P＜0.001）,FC-P水平、HOMA-β指数低于T2DM组（P＜0.001）.但治疗后两组FC-P水平,比较差异无统计学意义.结论 酮症倾向的T2DM发病原因可能与更高水平的随机血糖、TG、肥胖及与之伴随的慢性炎症有关.     

医院内科医务人员职业倦怠现状与管理对策

职业倦怠是在服务行业中最容易出现的情形性耗竭症状,尤其是在医疗服务行业中最为常见,医务人员的职业倦怠会影响自身健康及工作质量,还不利于医患关系的建立,临床应针对医务人员的职业倦怠情情况实施相应的对策。文章从职业倦怠的概念、职业倦怠的症状与表现、医院内科医务人员的职业倦怠现状、管理对策等方面进行综述。     

翻转课堂在社区护士糖尿病护理能力培训中的应用

目的:探讨翻转课堂在社区护士糖尿病护理能力培训中的应用效果。方法:参加我院糖尿病专科护士培训的360名社区护士分为PPT课堂组和翻转课堂组。PPT课堂组使用PPT形式集体授课,课后提问交流;翻转课堂组先自学,授课当天进行多种形式的交流及现场模拟操作。分别在培训结束后(A卷)和结束后2周(B卷)进行考核,并对2组社区护士进行问卷调查。结果:培训后翻转课堂组平均成绩为(28.3±1.5),PPT课堂组平均成绩为(27.9±1.6),差异无统计学意义(P〉0.05),培训2周后,翻转课堂组平均成绩为(27.3±2.1)高于PPT课堂组平均成绩(23.3±3.7),(P<0.05);2组社区护士在培训氛围、培训效果、知识点掌握时间的持久性、突发应变能力、解决问题的能力、培训内容转为临床运用的能力方面差异均有统计学意义(P<0.05)o结论:翻转课堂具有知识在线化、互动性强、增加知识点记忆时间、提高护士的综合能力等优点,对社区护士的培训具有较好的适应性和可操作性。     

2型糖尿病大血管病变与视黄醇结合蛋白4及高敏C反应蛋白关系的研究

Objective To investigate the levels of serum retinol-binding protein 4 (RBP4) and high sensitive C reactive protein (hs-CRP) in type 2 diabetic mellitus (T2DM) patients with macrovascular complications. Methods All of 115 subjects were divided into 3 groups: normal control group (35subjects), T2DM patients with macrovascular complications group (40 subjects) and simple T2DM patients group (40 subjects). Serum RBP4 and hs-CRP was detected and fasting blood glucose(FBG), glycosylated hemoglobin A1c (HbA1c), triacylglycerol (TG), total cholesterol (TC), high density lipopretein cholesferel (HDL-C), low density lipoprotein cholesferol(LDL-C) and fasting insulin(FINS) were measured. Body mass index (BMI) and HOMA-IR was calculated. The correlation of RBP4 and other factors were analyzed.Results The concentrations of RBP4 and hs-CRP were significantly increased in T2DM patients with macrovascular complications group and simple T2DM patients group compared with those in normal control group [hs-CRP:(9.12±4.21),(2.01±1.96), (0.98±0.36)mg/L; RBP4:(30.70 ± 5.45), (20.02±5.32),(12.02±3.45)mg/L] (P<0.01). Also,the concentrations of RBP4 and hs-CRP were significantly increased in T2DM patients with macrovascular complications group compared with those in simple T2DM patients group (P<0.01). Univariate analysis showed that serum RBP4 was positively associated with LDL-C,BMI,FBG,hs-CRP,FINS,HOMA-IR (r=0.325, 0.597, 0.323, 0.571, 0.275, 0.463,P<0.05 or <0.01).Conclusions The concentrations of RBP4 and hs-CRP are significantly higher in T2DM patients. The changes of RBP4 and hs-CRP are closely related to the occurrence and development of diabetic macrovascular complications.     

2型糖尿病大血管病变与视黄醇结合蛋白4及高敏C反应蛋白关系的研究

Objective To investigate the levels of serum retinol-binding protein 4 (RBP4) and high sensitive C reactive protein (hs-CRP) in type 2 diabetic mellitus (T2DM) patients with macrovascular complications. Methods All of 115 subjects were divided into 3 groups: normal control group (35subjects), T2DM patients with macrovascular complications group (40 subjects) and simple T2DM patients group (40 subjects). Serum RBP4 and hs-CRP was detected and fasting blood glucose(FBG), glycosylated hemoglobin A1c (HbA1c), triacylglycerol (TG), total cholesterol (TC), high density lipopretein cholesferel (HDL-C), low density lipoprotein cholesferol(LDL-C) and fasting insulin(FINS) were measured. Body mass index (BMI) and HOMA-IR was calculated. The correlation of RBP4 and other factors were analyzed.Results The concentrations of RBP4 and hs-CRP were significantly increased in T2DM patients with macrovascular complications group and simple T2DM patients group compared with those in normal control group [hs-CRP:(9.12±4.21),(2.01±1.96), (0.98±0.36)mg/L; RBP4:(30.70 ± 5.45), (20.02±5.32),(12.02±3.45)mg/L] (P<0.01). Also,the concentrations of RBP4 and hs-CRP were significantly increased in T2DM patients with macrovascular complications group compared with those in simple T2DM patients group (P<0.01). Univariate analysis showed that serum RBP4 was positively associated with LDL-C,BMI,FBG,hs-CRP,FINS,HOMA-IR (r=0.325, 0.597, 0.323, 0.571, 0.275, 0.463,P<0.05 or <0.01).Conclusions The concentrations of RBP4 and hs-CRP are significantly higher in T2DM patients. The changes of RBP4 and hs-CRP are closely related to the occurrence and development of diabetic macrovascular complications.     

罗格列酮治疗2型糖尿病45例临床观察

目的观察马来酸罗格列酮治疗2型糖尿病（T2DM）前后血清高敏C反应蛋白（hsCRP）的变化，探讨其可能的药物作用。方法86例双胍类和磺脲类药物治疗3个月以上的T2DM病人随机分为罗格列酮组与对照组，进行为期16周的临床观察。结果罗格列酮组治疗前后比较空腹血糖（FPG）、餐后2h血糖（PPG）及糖化血红蛋白（HbA1c）均明显下降（P〈0．01），胰岛素抵抗指数（IRI）明显下降（P〈0．05），高密度脂蛋白胆固醇（HDL-C）明显升高（P〈0．01），低密度脂蛋白胆固醇（LDL-C）明显下降（P〈0．01），胆固醇（CH）和甘油三酯（TG）无明显变化，收缩压（SBP）平均下降9．6mmHg（P〈0．01），舒张压（DBP）平均下降6．1mmHg（P〈0．01），体重指数（BMI）无明显变化，hsCRP明显下降（P〈0．01）。而对照组各观察指标无明显变化。结论T2DM患者慢性高血糖状态与炎症关系密切。罗格列酮治疗在改善胰岛素敏感性的同时，还具有抗炎、调脂、降压等作用，长期使用可预防T2DM心血管疾病的发生。