妊娠期糖尿病患者产前胰岛素泵短期强化综合干预的效果观察

目的：探讨妊娠期糖尿病（gestational diabetes mellitus,GDM）患者实施产前胰岛素泵短期强化综合干预对血糖控制和妊娠结局的影响。方法2010年6月-2013年6月符合研究标准的GDM产前胰岛素强化治疗的64例患者随机分成综合干预组和常规护理组各32例。常规护理组患者给予常规护理干预,包括饮食与运动指导,相关知识宣教,胰岛素泵治疗的优越性介绍,胰岛素泵安装与护理以及并发症的防范。综合干预组患者在常规护理干预的基础上,给予短期强化综合干预,包括按照应用上肢功率计运动,举办沙龙活动和实施胰岛素泵个体化技术培训。观察两组患者遵医行为,血糖控制情况,记录低血糖、酮症酸中毒和皮肤感染发生情况,以及妊娠高血压综合征、早产、巨大儿等妇科、儿科、产科并发症情况。结果综合干预组遵医行为显著优于常规护理组（P＜0.05）,两组血糖达标时间差异无统计学意义,但综合干预组日均胰岛素用量显著低于常规护理组（P＜0.05）。综合干预组产妇低血糖症状发生率显著均低于常规护理组（P＜0.05）,两组产妇妊娠高血压综合征、早产及胎儿窘迫等差异无统计学意义。两组新生儿并发症差异无统计学意义。结论 GDM产前胰岛素泵短期强化治疗综合干预显著增强患者的遵医行为,有助平稳控制产前高血糖,可减少胰岛素用量,有效控制产妇低血糖症状发生。     

运动疗法联合个体化饮食控制对妊娠期糖尿病血糖控制及母婴结局的影响

目的探讨运动疗法联合个体化饮食控制对妊娠期糖尿病(GDM)血糖控制及母婴结局的影响。方法选取2015年6月～2016年7月收治的GDM患者94例,按随机数字表法分为对照组和观察组各47例。对照组予以常规护理干预,观察组在对照组基础上予以运动疗法联合个体化饮食控制干预。对比干预前后两组血糖水平变化及母婴结局。结果干预后,与对照组相比,观察组FPG、2hPG水平较低,差异有统计学意义(P0.05);观察组与对照组剖宫产、巨大儿、胎膜早破、胎儿窘迫比较,差异有统计学意义(P0.05)。结论运动疗法与个体化饮食控制联合应用于妊娠期糖尿病,可降低血糖水平,改善母婴结局。     

运动疗法联合饮食指导对孕妇血糖控制及妊娠结局的影响

目的探讨运动疗法联合饮食指导对妊娠期糖尿病(GDM)孕妇血糖控制及妊娠结局的影响。方法选择2013年1月~2014年1月在院建档产检并诊断为GDM的孕妇120例,随机分为治疗组和对照组,各60例。治疗组采用运动疗法联合饮食指导。对照组采用常规护理。观察两组血糖控制情况及母婴并发症发生率。结果治疗组餐前30min、餐后2h、零点血糖达标率均高于对照组,两组比较有显著性差异(P0.01)。治疗组母婴并发症发生率明显低于对照组,两组比较有显著性差异(P0.01)。结论运动疗法联合饮食指导对GDM孕妇临床疗效显著,明显降低了母婴并发症的发生几率。     

胰岛素持续泵入与皮下注射胰岛素对高龄妊娠期糖尿病孕妇血清HbA1c、Hcy、Cys-C水平及母婴结局的影响

目的探究高龄妊娠期糖尿病(GDM)孕妇采用胰岛素持续泵入与皮下注射胰岛素治疗对其血清胱抑素C(Cys-C)、糖化血红蛋白(HbA1c)、同型半胱氨酸(Hcy)水平及母婴结局的影响。方法前瞻性将西安大兴医院2014年2月至2016年4月110例高龄GDM孕妇依照随机抽签法分组,对照组55例三餐前皮下注射门冬胰岛素注射液+睡前皮下注射精蛋白生物合成人胰岛素注射液治疗,观察组55例门冬胰岛素注射液加入胰岛素泵持续泵入治疗。统计分析治疗前后两组HbA1c、空腹血糖(FPG)、餐后2 h血糖(2hPG)、血清Cys-C、Hcy水平及治疗后胰岛素用量、血糖达标时间、血糖飘移率、低血糖发生率、母婴结局,并采用简明健康状况量表(SF-36)评估两组治疗前后生活质量。结果治疗前2hPG、HbA1c、FPG等血糖指标组间比较无显著差异(P0.05),观察组治疗1个月后2hPG、HbA1c、FPG等血糖指标均较治疗前降低,且低于对照组(P0.05);治疗前血清Cys-C、Hcy组间比较无显著差异(P0.05),观察组治疗1个月后血清Cys-C、Hcy均较治疗前降低,且低于对照组(P0.05);经1个月治疗,观察组胰岛素用量、血糖达标时间均低于对照组,且低血糖发生率3.64%、血糖飘移发生率5.45%低于对照组16.36%、20.00%(P0.05);观察组治疗1个月后SF-36评分均较治疗前升高,且高于对照组(P0.05);观察组早产、羊水过多、妊高症、新生儿呼吸窘迫症发生率均低于对照组(P0.05),而两组巨大儿发生率无显著差异(P0.05)。结论胰岛素持续泵入治疗高龄GDM孕妇血糖控制效果更为显著,能有效降低Hcy、Cys-C等血清指标,减少胰岛素用量,缩短血糖达标时间,降低低血糖发生率,改善母婴结局,提高患者生活质量。     

时间护理在妊娠期糖尿病孕妇门诊血糖检测中的应用

[目的]探讨时间护理在妊娠期糖尿病(GDM)孕妇门诊血糖检测中的应用。[方法]将100例GDM孕期保健孕妇随机分为观察组50例行时间护理,对照组50例行常规护理。观察并比较两组病人护理前后的空腹血糖、餐后2h血糖和糖化血红蛋白变化,分娩方式、妊娠结局及婴儿出生评分。[结果]两组病人经护理后血糖值控制至孕末期未使用胰岛素治疗;两组病人护理后糖化血红蛋白、空腹血糖、餐后2h血糖均降低,且低于对照组(P0.05);观察组剖宫产率为14%,低于对照组的32%(P0.05);观察组妊娠高血压综合征、胎膜早破、早产、巨大儿、胎儿窘迫发生率均低于对照组(P0.05);观察组新生儿1min Apgar评分9分~10分40例(占80%),多于对照组33例(占66%),两组比较差异有统计学意义(P0.05)。[结论]在GDM病人门诊血糖检测中应用时间护理,有利于加强孕期门诊血糖监测管理,改善妊娠结局,提高优生质量,保障母婴安全渡过孕期。     

个体化医学营养疗法(MNT)联合运动疗法治疗妊娠期糖尿病(GDM)的效果

目的 探讨个体化医学营养疗法(MNT)联合运动疗法治疗妊娠期糖尿病(GDM)的效果。方法 选取我院2019年6月～2020年6月收治的74例GDM患者,按就诊单双日分成对照组和观察组各37例。两组均予以常规护理,观察组加用MNT联合运动疗法治疗。对比两组治疗效果。结果 观察组母婴不良结局发生率显著低于对照组,血糖水平改善情况优于对照组,差异有统计学意义(P0.05)。结论 MNT联合运动疗法共同干预GDM,可稳定患者血糖,确保胎儿健康成长,且显著改善母婴结局,具有推广价值。     

中医辅助治疗对妊娠期糖尿病临床有效性指标的影响

目的:观察在西医治疗(胰岛素治疗)的基础上给予中医治疗对妊娠期糖尿病患者的临床疗效评价,并评估其安全性及母婴结局。方法:选取符合标准的妊娠期糖尿病患者100例,随机分为观察组和对照组,每组各50例。.对照组给予生物合成人胰岛素+门冬胰岛素治疗,观察组在此基础上给予口服中药汤剂,比较2组患者治疗前与治疗过程中3餐后2h血糖变化,并比较2组患者治疗过程中的不良反应及其母婴结局。结果:餐后2h血糖比较显示2组患者均无统计学差异(P0.05),2组患者的血糖达标时间、分娩孕周等指标均无统计学差异(P0.05),观察组胰岛素用量与体重增加量均低于对照组(P0.05),2组患者的满意度调查结果显示观察组优于对照组(P0.05),2组患者治疗过程中发生餐前低血糖、皮疹等不良事件均无统计学差异(P0.05),2组患者的母婴结局均无统计学差异(P0.05)。结论:胰岛素治疗的基础上给予中药汤剂治疗能减少胰岛素用量,安全可靠,患者满意率高。     

动态血糖监测联合胰岛素泵在围手术期糖尿病患者中的应用

目的 :探讨动态血糖监测联合胰岛素泵应用于围手术期糖尿病患者血糖控制的效果。方法 :选取2011年1月至2013年2月我院收治的100例围手术期糖尿病患者,根据血糖监测方案不同分为2组,对照组采用每日8次血糖监测方案,观察组采取动态血糖监测,对2组患者动态血糖监测、输注胰岛素前和围手术期的各项数据进行统计分析。结果:动态血糖监测、输注胰岛素前2组患者的体质量指数、空腹血糖、2 h血浆葡萄糖及糖化血红蛋白水平差异无统计学意义(P>0.05),而在血糖达标时间、胰岛素用量、住院时间及术后并发症发生率对比上,动态血糖监测组均显著优于对照组,差异有统计学意义(P<0.05)。动态血糖监测组的血糖控制情况亦显著优于对照组,差异有统计学意义(P<0.05)。结论:动态血糖监测可提高围手术期糖尿病患者的血糖控制效果,缩短血糖达标时间和住院时间,减少胰岛素用量,可更好地控制术后并发症的发生,值得在临床上推广和应用。     

饮食护理对妊娠期糖尿病患者血糖控制及母婴结局的影响

目的探讨饮食护理对妊娠期糖尿病(GDM)患者血糖控制及母婴结局的影响。方法选取我院2015年2月~2016年6月收治的GDM患者68例,随机数字表法分为对照组和观察组各34例。对照组予以常规护理干预,观察组在对照组基础上予以饮食护理干预。对比两组干预前后血糖水平变化及母婴结局。结果干预后,观察组2h PG、FPG水平均低于对照组,差异有统计学意义(P0.05);观察组妊娠期高血压发生率为5.88%、剖宫产率为11.77%、早产儿发生率为2.94%、胎儿宫内窘迫发生率为5.88%,均低于对照组的32.35%、47.06%、23.53%和29.41%,差异有统计学意义(P0.05);观察组新生儿窒息率为2.94%,对照组为5.88%,差异无统计学意义(P0.05)。结论饮食护理应用于妊娠期糖尿病患者,可有效控制患者血糖水平,并改善母婴结局。     

全程护理干预对妊娠期糖尿病孕妇分娩结局的影响

目的探讨产前全程护理干预对妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇妊娠结局的影响。方法选择在上海交通大学附属第六人民医院产科门诊正规产前检查并住院分娩的孕产妇为研究对象,以2011年6月—2012年6月确诊的GDM孕产妇202例为对照组,以2014年1—12月确诊的GDM孕产妇303例为观察组。观察组采用全程护理干预,包括建立针对GDM的专项健康教育课程、制定针对GDM的饮食护理、制定适合GDM孕妇的运动方案及胰岛素应用指导等,比较两组孕妇分娩结局。结果两组孕妇剖宫产率和自然分娩率比较差异无统计学意义(P0.05);对照组中子痫前期、产后出血、糖尿病并发症和巨大儿发生率高于观察组,差异有统计学意义。对照组孕期体重增幅高于干预组,差异有统计学意义。两组新生儿Apgar评分比较差异无统计学意义。结论全程护理干预可以显著降低GDM孕妇子痫前期、产后出血、糖尿病并发症、巨大儿的发生率,控制孕期体重合理增长,值得在临床推广应用。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.