糖尿病患者饮食治疗100例临床分析

目的通过严格的饮食管理,配合运动和药物治疗,更有效地控制血糖,促进糖尿病患者的早日康复。方法对100例糖尿病患者进行营养要求评估,制定饮食计划,从饮食治疗的益处,各种营养分配等方面给予指导,定时监测血糖,个体床旁强化饮食指导,观察进食后情况。结果95例患者能严格遵守饮食原则,血糖控制良好。结论良好的饮食管理能有效控制糖尿病患者体质量,利于血糖、血脂、血压的正常,减少并发症的发生,提高生活质量,是控制糖尿病的关键。     

食物血糖生成指数在糖尿病病人饮食指导中的应用

目的探讨根据糖尿病饮食原则,运用食物血糖生成指数(GI)对糖尿病病人进行饮食教育指导的方法。方法2002年2月～2003年2月对52例糖尿病病人,应用GI的饮食概念和糖尿病相关的饮食知识,采用集体上课、小组教育和个人教育等多种形式进行饮食指导。结果饮食教育指导前后病人对糖尿病饮食知识的掌握率比较,均P<0.01,差异有统计学意义;病人血糖控制良好。结论应用GI的饮食概念对糖尿病病人进行饮食教育指导,能提高病人对糖尿病饮食知识的掌握程度,提高病人的营养与饮食水平,有利于病人调节糖代谢和降低血糖水平。     

厌恶疗法对糖尿病患者饮食治疗依从性的影响

目的探讨厌恶疗法对糖尿病患者饮食治疗依从性的影响。方法将92例门诊糖尿病患者随机分为实验组48例,对照组44例,对照组患者采用集体授课的健康教育方式,实验组患者除接受常规糖尿病健康教育外,同时采用厌恶疗法。比较干预后3个月两组患者饮食治疗依从性、空腹血糖(fasting plasma glucose,FPG)、随机血糖(random plasma glucose,RPG)、糖化血红蛋白(glycosylated hemoglobinAlc,GHbA1c)变化情况及研究组患者焦虑、抑郁情况。结果干预后两组患者饮食依从性评分比较,差异具有统计学意义(P<0.001),实验组评分明显高于对照组;干预后两组患者各项代谢指标比较,差异具有统计学意义(均P<0.01),实验组明显优于对照组;实验组患者干预前后焦虑、抑郁评分比较,差异无统计学意义(均P>0.05)。结论厌恶疗法干预效果优于单纯理论知识讲解的健康教育方法,其可提高糖尿病患者饮食依从性,有利于糖尿病患者代谢的控制。     

Developing service provision for patients in primary care

This article outlines the government's changes to the way that primary and community health services will be commissioned and provided. It also discusses the opportunities that exist for nurses to lead and develop services for the benefit of patients in the implementation of changes.     

血糖生成指数在糖尿病饮食治疗和教育中的应用现状

糖尿病医学营养治疗(Medical Nutrition Therapy,MNT)是所有糖尿病综合治疗(饮食、运动、药物、血糖监测和教育)的基础,其目标是通过合理的食物选择,平衡膳食摄入,并与胰岛素或口服降糖药和体力活动相配合,达到并维持理想血糖、血脂和血压水平;通过合理的能量摄入达到或维持理想体重,减少急性和慢性并发症的危险.指导糖尿病患者进行合理的饮食是控制糖尿病最为重要的措施之一.纵观我国糖尿病教育现状[1],曾接受过糖尿病教育者仅占60.3%,其中又有60%的患者不控制饮食,糖尿病患者的饮食治疗也存在饮食结构不合理[2],表现为碳水化合物供热比偏低(<55%)、脂肪供热比偏高(>30%).近年来,血糖生成指数(glycemic in-dex,GI)在糖尿病饮食治疗中的作用受到了国内外专家广泛关注,越来越多的证据表明[3.7-9],低GI膳食对糖尿病个体化医学营养治疗有潜在的重要价值,很有必要在糖尿病饮食管理的教育中推广运用.     

Community provision for informal live-in carers of stroke patients

Stroke is common and disabling. Most stroke patients are cared for at home by informal carers. This study of informal carers of stroke patients measured service provision and satisfaction with different aspects of community care received by these carers. Dissatisfaction was expressed with training and information provision for carers, communication between carers and community services, speed of response and coordination of community services, and perceived support. Problems of information provision were most marked for those patients with most disability and/or older carers.     

Improving palliative care provision for patients with heart failure

In the last 14 years, research has identified that patients with heart failure suffer symptoms as severe as people with cancer and would greatly benefit from a palliative care approach. In spite of this fact, it is recognized within the National Service Framework for Heart Failure (Department of Health (DoH), 2000b) and the Cancer Plan (DoH, 2000a) that service provision from a palliative care perspective remains inadequate. In order to address the palliative care needs for patients with heart failure and their families a multidisciplinary team approach between primary and secondary care is needed. This article will review the literature relating to improvement of services from a palliative care perspective. It discusses the quality of life experienced by patients with heart failure and their families and the barriers to providing a palliative care approach from a multidisciplinary team perspective. Finally, it attempts to present future recommendations to develop a structured service provision.     

Reduced albuminuria after dietary protein restriction in insulin-dependent diabetic patients with clinical nephropathy

Recent clinical investigations have demonstrated that an early restriction of dietary protein intake may reduce the rate of progression of chronic renal failure in humans. In this study the effects of a restricted-protein diet on kidney function in type I diabetic patients with clinical nephropathy were evaluated. Sixteen patients (9 men, 7 women) with mean age 37.1 +/- 9.8 yr, mean duration of diabetes 17.7 +/- 6.6 yr, proteinuria greater than 0.5 g/24 h, and serum creatinine concentration of 0.7-1.9 mg/dl were studied. Patients were randomly divided into two groups. The low-protein diet (LPD) group comprised seven patients who were kept for 4.5 +/- 1 mo on a diet containing 0.71 +/- 0.12 g X kg-1 X day-1 protein. The normal-protein diet (NPD) group comprised nine patients as controls maintained for 11.7 +/- 7 mo on their usual diabetic diet containing 1.44 +/- 0.12 g X kg-1 X day-1 protein. All patients were studied every 1-2 mo. Metabolic control was assessed by evaluation of 5-8 blood glucose determinations/day and by glycosylated hemoglobin, whereas renal function was evaluated by albumin, IgG and beta 2-microglobulin urinary excretion rates, serum creatinine concentration, and creatinine clearance. At each visit, serum concentrations of total protein, albumin, phosphate, calcium, and electrolytes and weight and blood pressure were also measured. A significant reduction (434 +/- 244 to 205 +/- 212 micrograms/min, mean +/- SD) in albumin excretion rate was found in all LPD patients after dietary protein restriction, with a significant reincrease (689 +/- 201 micrograms/min) in the same patients several months after interruption of diet.(ABSTRACT TRUNCATED AT 250 WORDS)     

时效性激励护理模式在糖尿病患者饮食护理中的应用效果

目的 探讨时效性激励护理模式在糖尿病患者饮食治疗护理中的应用效果。方法 选取内分泌科收治的80例糖尿病患者,将其随机分成对照组和观察组,对照组采取常规护理,观察组采用时效性激励护理,干预3个月,比较2组患者合理饮食的依从性、空腹血糖、餐后2 h血糖水平及生活质量评分。结果 干预3个月后,观察组饮食控制依从性及血糖控制情况均好于对照组(P＜0.05),生活质量各维度评分均低于对照组(P＜0.05)。结论 采取时效性激励护理,帮助糖尿病患者进行合理饮食安排和有效饮食控制,使糖尿病患者的病情得到控制与改善,从而提高患者的生活质量,值得推广使用。     

饮食干预对精神障碍合并糖尿病患者血糖的影响

目的 探讨饮食干预对精神障碍合并糖尿病患者血糖的影响.方法 选择2009年8月1日-12月31日我院收治的精神障碍合并糖尿病患者52例,随机分为两组.对照组实施一般护理,实验组在一般护理的基础上进行饮食干预,在干预前后测定空腹血糖、餐后2 h血糖和糖化血红蛋白及患者对饮食干预的认知状况.结果 干预后,实验组血糖控制状况...     

糖尿病患者对食物血糖生成指数知识的接受性及膳食调整

背景: 血糖生成指数是含碳水化合物食物的生理学特征性指数, 食物血糖生成指数在糖尿病、心血管病和肥胖等慢性病的预防控制中具有重要的应用价值和实际意义。目的: 了解与传统的食物交换表为主要宣传材料的教育方法相比较, 糖尿病患者对食物血糖生成指数知识的接受性和实际意义。设计: 对比观察实验。单位: 中国疾病预防控制中心营养与食品安全所。对象: 选择 2000- 10/2002- 02 在北京市第六医院内分泌科就诊的糖尿病患者 72 例, 年龄 18～70 岁, 平均 58 岁, 男女各半。方法: 将 72 例糖尿病患者随机分为 2 组: ①血糖生成指数组: 以不同食物的血糖生成指数为主要教育材料。②食物交换表组: 以传统的食物交换表为主要教育材料。采用课堂讲座、个别辅导、电话咨询等方式教育 5个月。观察教育前后糖尿病患者对所授知识的知晓率、食物选择和血糖变化等。主要观察指标: 教育前后营养教育知识知晓率、空腹血糖及餐后 2 h 血糖变化。结果: 纳入糖尿病患者 72 例, 均进入结果分析。①患者教育后对各个问题的正确回答率明显高于教育前(P < 0.01)。教育前, 血糖生成指数组对血糖生成指数问题正确回答率低于食物交换表组对食物交换表问题的正确回答率(0, 6.5%, P < 0.01); 教育后, 血糖生成指数组对血糖生成指数问题正确回答率高于食物交换表组对食物交换表问题的正确回答率(92.2%, 79.4%, P < 0.01)。而对相同问题的平均正确回答率, 两组间差异不明显(P > 0.05)。在谷类食物的种类及制作方法、水果类、豆类及其制品的选择上, 血糖生成指数组均优于食物交换表组(P < 0.01) 。②两组教育后空腹血糖和餐后 2 h 血糖均低于教育前(P < 0.01) , 但组间比较, 差异不明显(P > 0.05) 。结论: 在糖尿病营养教育中, 患者对血糖生成指数知识的接受性优于食物交换表知识。     

糖尿病人腹腔镜胆囊切除术

目的　总结分析胆囊疾病合并糖尿病患者行腹腔镜胆囊切除术的安全可行性。方法　比较分析了 5 6例胆囊疾病合并糖尿病患者与同期 6 8例随机抽样的没有合并糖尿病的胆囊疾病患者的解剖病理和治疗效果。结果　与同期没有合并糖尿病的胆囊疾病相比 ,合并糖尿病的胆囊疾病术中发现胆囊壁水肿、胆囊三角脂肪堆积较严重 ,胆囊粘连解剖更困难 ,手术难度增加 (P <0 .0 5 ) ,但两组术后并发症无显著性差异 (P >0 .0 5 )。结论　合并糖尿病的胆囊疾病患者行腹腔镜胆囊切除术是安全可行的。     

品质圈管理在非专科住院糖尿病患者饮食健康教育中的应用

目的探讨品质圈管理在非专科住院糖尿病患者饮食健康教育中的应用效果。方法成立品质圈小组,确立提高非专科住院糖尿病患者饮食健康教育为活动课题,对118例非专科住院糖尿病患者进行干预前后对照研究,分别于入院当日、出院当日通过发放问卷调查了解干预前后患者对糖尿病饮食知识的掌握情况。结果品质圈管理实施后非专科住院糖尿病患者对饮食知识知晓率提高,与实施前比较差异均具有统计学意义(P<0.01)。结论开展品质圈管理能有效提高非专科住院糖尿病患者饮食知识的认知水平。     

Effects of dietary fiber and carbohydrate on glucose and lipoprotein metabolism in diabetic patients.

Dietary recommendations for the treatment of diabetic patients issued by national and international diabetes associations consistently emphasize the need to increase carbohydrate consumption. However, these recommendations have been questioned on the basis of growing evidence that, in both insulin-dependent and non-insulin-dependent diabetic patients, a high-carbohydrate diet does not offer any advantage in terms of blood glucose and plasma lipid concentrations compared with a high-fat (mainly unsaturated) diet. It has been shown repeatedly that a high-carbohydrate diet increases plasma insulin and triglyceride levels and can deteriorate blood glucose control in the postprandial period. However, much of the controversy between advocates and detractors of dietary carbohydrate can be settled by taking into account dietary fiber. Several studies have shown that the adverse metabolic effects of high-carbohydrate diets are neutralized when fiber and carbohydrate are increased simultaneously in the diet for diabetic patients. In particular, these studies demonstrated that a high-carbohydrate/high-fiber diet significantly improves blood glucose control and reduces plasma cholesterol levels in diabetic patients compared with a low-carbohydrate/low-fiber diet. In addition, a high-carbohydrate/high-fiber diet does not increase plasma insulin and triglyceride concentrations, despite the higher consumption of carbohydrates. Unfortunately, dietary fiber represents a heterogenous category, and there is still much to understand as to which foods should be preferred to maximize the metabolic effects of fiber. There are indications that only water-soluble fiber is active on plasma glucose and lipoprotein metabolism in humans. Therefore, in practice, the consumption of legumes, vegetables, and fruits--rich in water-soluble fiber--should be particularly encouraged. The mechanisms by which dietary fiber exerts its hypoglycemic and hypolipidemic activities are unknown. However, the ability of dietary fiber to retard food digestion and nutrient absorption certainly has an important influence on lipid and carbohydrate metabolism. The beneficial effects of high-fiber foods are also exerted by some foods not particularly rich in fiber. The fiber content and physical form of the food can influence the accessibility of nutrients by digestive enzymes, thus delaying digestion and absorption. The identification of these foods with a low-glycemic response would help enlarge the list of foods particularly suitable for diabetic patients. In conclusion, a diet low in cholesterol and saturated fat should be recommended to all diabetic patients to prevent cardiovascular disease. A balanced increase in consumption of fiber-rich foods and unsaturated fat is the most rational way to replace foods rich in saturated fat and cholesterol in the diabetic diet.     

The provision of follow-up care for patients in the home environment

Despite increasing evidence that post-myocardial infarction patients and their families suffer prolonged psychological disturbance, there appears to be little published research regarding follow-up care for these patients in the home environment.A survey of 30 coronary care units (27 responded) across England and Wales was conducted to identify the current provision of home follow-up for coronary patients.Although the majority of respondents (89.9%) felt that home follow-up for coronary coronary patients in necessary, only 3 units (11.1%) actually had such a service in their area. In these areas, the home follow-up was provided by community nurses.None of the areas who did provide home follow-up for coronary patients had analysed the impact of this intervention on patient recovery.Further research is recommended to identify the effects of follow-up care in the home environment on morbidity and readmission of coronary patients.     

An audit of provision of long-term oxygen therapy for COPD patients

Long-term oxygen therapy can reduce morbidity and mortality in COPD patients with chronic hypoxaemia. However, there is a need to provide ongoing support for these patients, ensuring that they receive appropriate information and education, and that their condition is fully monitored to prevent any unnecessary complications and improve their overall quality of life.