应重视对餐后高血糖的防治

糖尿病 (ＤＭ)是危害人体健康的主要疾病之一 ,是发达国家和发展中国家共同面临的严峻问题。持续高血糖状态是引起糖尿病血管病变的主要原因。故严格控制血糖是预防或延缓糖尿病慢性并发症的关键。以往医务工作者较重视空腹血糖的控制 ,而对餐后高血糖的危害性认识不足 ,重视不够。近年随着对ＤＭ发病机制与治疗的深入研究 ,学者们逐渐关注对餐后高血糖的防治。餐后高血糖症分为空腹血糖正常的餐后高血糖症和空腹血糖增高的餐后高血糖症前者见于糖耐量低减 (ＩＧＴ)和轻型糖尿病 ,后者如糖尿病。本文主要叙述ＩＧＴ有关的餐后高血糖症的发生…     

对餐后高血糖病人实施行为干预的效果观察

糖尿病(diabetes mellitus，DM)是继心脑血管疾病、恶性肿瘤、慢性支气管炎之后，严重威胁人类健康的主要慢性非传染性疾病，已成为致死、致残并造成医疗开支剧增的主要疾病，是全球所面临的主要公共卫生问题，目前已引起了各国政府的高度重视。近年来，许多研究表明葡萄糖耐量减低(impaired glucose tolerance，IGT)是发展成为DM的一个危险阶段。为了降低糖尿病的患病率，IGT的研究受到愈来愈多的关注。现对社区筛查出的37例餐后高血糖病人进行行为干预，观察其血糖水平的变化，以期探讨行为干预对IGT人群的优化方案。     

单纯餐后高血糖对脑梗死发病及预后的影响

目的:探讨单纯餐后高血糖对急性脑梗死患者病情严重程度及预后的影响。方法:检测241例急性期脑梗死患者的血糖,依血糖情况分为血糖正常组、单纯餐后高血糖组、非单纯餐后高血糖组。在发病2周后,复查头颅CT,计算梗死灶体积,并随访3个月后患者的神经功能康复情况,3组之间进行比较。结果:正常血糖组、单纯餐后高血糖组、非单纯餐后高血糖组的梗死灶体积分别是(4.083±2.641)cm3、(5.942±2.923)cm3、(6.052±2.583)cm3;3组间入院时及6个月后的NIHSS评分分别是:8.742±2.474、5.892±1.961;10.321±2.193、7.104±2.351;10.533±2.962、7.243±2.174。3组间比较,后2组比血糖正常组脑梗死灶大,神经功能受损程度高,预后差(P<0.05)。而单纯餐后高血糖组与非单纯性餐后高血糖组相比,梗死灶、神经功能受损程度及预后差异无显著性(P>0.05)。结论:单纯餐后高血糖可加重脑梗死神经功能损伤程度,梗死灶大,临床预后差。     

立足国人-《中国2型糖尿病患者餐后高血糖管理专家共识》解读

《中国2型糖尿病患者餐后高血糖管理专家共识》基于我国糖尿病特点及国人循证的不断丰富应运而生,为我国糖尿病管理提供了新指导。《共识》回答了以下4个核心问题：①为什么要着重强调餐后血糖的重要性？②控制餐后血糖能否带来获益？③餐后血糖的控制目标及监测人群是什么？④餐后血糖应如何干预？     

超声检测诊断餐后高血糖对血管内皮依赖性舒张功能的影响

目的　研究口服葡萄糖耐量试验后 ,急性高血糖是否引起糖耐量低减和正常人血管内皮舒张功能损伤及其与血糖的关系。方法　采用高分辨率超声测定糖耐量低减患者和正常人血流介导的肱动脉内皮依赖性舒张。结果　糖耐量低减组空腹时内皮依赖性血管舒张功能较正常对照组降低 (P<0 .0 0 1) ;糖耐量试验后 ,糖耐量低减组肱动脉内皮依赖性舒张功能 1h、 2 h、 3h时与空腹时的差异有显著性意义 (分别为 P<0 .0 0 1、 P<0 .0 0 1、 P<0 .0 0 5 ) ;而正常对照组 1h、2 h时较空腹时减低 (分别为 P<0 .0 0 1、 P<0 .0 0 5 )。多因素线性相关性分析 ,血管内皮依赖性舒张功能损伤和血糖呈明显负相关(r=- 0 .5 7,P<0 .0 0 1)。结论　糖耐量低减患者已存在内皮依赖性血管舒张功能损伤 ,同时急性高血糖能使正常人内皮依赖性血管舒张功能损伤 ,对于糖耐量低减患者的内皮依赖性血管舒张功能损伤更为严重     

餐后高血糖与异常妊娠的临床探讨

1999年1月～2001年6月作者收治有异常生育史的中期妊娠孕妇48例,现就其高危因素与餐后血糖关系探讨如下。     

社区中老年人餐后血糖的调查分析与对策

目的　调查社区中老年人餐后血糖的情况。方法　于 2 0 0 0年 5月～ 2 0 0 1年 3月对上海地区5个街道 2个居委会 4 0岁以上的中老年人 331例进行餐后 2h血糖的测试。确诊为糖尿病的患者不纳入此范围。结果　 331例中老年人餐后血糖高者 4 1例 ,占调查人数的 12 38%;4 0岁～ 4 9岁人数为 66例 ,餐后血糖高者为 17例 ,占 2 5 76%;5 0岁～ 5 9岁人数为 185例 ,餐后血糖高者为 15例 ,占 8 11%,≥ 60岁的人数为 80例 ,餐后血糖高者 9例 ,占 11 2 5 %。将上述餐后高血糖者 3组人数进行统计学处理 ,χ2 为 14 0 9,P <0 0 1,差异有显著性。结论　必须加强对 4 0岁～ 4 9岁人群餐后高血糖的防治。     

原发性高血压患者腹型肥胖与餐后高血糖的相关性研究

目的探讨原发性高血压患者中腹型肥胖与餐后高血糖的关系。方法对89例无糖尿病病史且入院后空腹血糖正常的原发性高血压患者,测量血压、身高、体重、腰围及测定口服75g葡萄糖耐量试验（OGTT）、糖化血红蛋白（GHbA1c）、血清总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）。结果根据腰围分为腹型肥胖组45例和非腹型肥胖组44例,腹型肥胖组发生葡萄糖耐量减低（IGT）及糖尿病（DM）远远高于非腹型肥胖组（26.7%vs9.1%、15.6%vs4.5%,P〈0.05）;腹型肥胖组在体重指数（BMI）、GHbA1c、TC、TG、LDL-C明显高于非腹型肥胖,而HDL-C则明显降低。结论腹型肥胖可以作为空腹血糖正常的原发性高血压患者伴发餐后高血糖（IGT、DM）的高危预测指标。     

老年糖尿病患者餐后高血糖原因分析及护理

为使糖尿病（DM）患者餐后血糖控制在良好范围，延缓其慢性并发症的发生、发展，我们对36例住院老年DM患者的餐后高血糖进行临床分析，旨在提高患者对餐后高血糖的认识。现报告如下。     

餐后高血糖的危害和治疗

糖尿病(DM)是以高血糖为突出表现的慢性代谢性疾病。近年来大量基础和临床研究发现餐后高血糖(PPHG)的危害比空腹高血糖大,决定着DM慢性并发症的发生和发展。治疗PPHG,减少并发症日益受到重视。下面就PPHG的危害和治疗综述。1 PPHG的基本理论     

重视吸入性肺炎的防治

１引言 吸入性肺炎（aspiration pneumonia）是吸入来自鼻咽部分泌物或胃内反流的强酸、固体食物等引起的临床病理综合征。其发病与神经系统、消化系统和呼吸系统疾病有关,病因包括内源性、外源性和医源性。其诱发因素包括：①昏迷状态;②损害吞咽或咳嗽反射的物质或药物;③使用鼻胃管或气管内导管;④气管切开;⑤解剖异常如气管－食管瘘,胃出口梗阻。可见吸入性肺炎的发生与某些临床情况与治疗密切相关,如由于药物或种经系统疾病引起的意识障碍,或插管和气管切开,其发生率可增加７０％,因此应引起临床医师的重视。２吸入性肺炎的…     

重视对新生儿高胆红素血症的防治

1 引 言新生儿黄疸是新生儿期最常见的临床现象,由于新生儿胆红素代谢特点引起血中胆红素水平增高,出现皮肤、黏膜、巩膜黄染。新生儿黄疸分为生理性和病理性,病理性黄疸是指黄疸出现早、进展快、消退迟。高胆红素血症指胆红素超过205 μmol／L,严重者可发展为胆红素脑病。胆红素脑病可危及新生儿生命,存活儿也可能因为中枢神经系统损害而致残。我国高胆红素血症新生儿占住院新生儿的首位,高达50％至55％。本病可早防早治。在发达国家,对有高危因素的新生儿进行预防性治疗,发病率已很低。我国是该病的高发区,但对此仍未引起足够的…     

吕梁市机关干部对高血糖防治知识了解状况的调查

随着人们生活水平的提高，高血脂、高血糖、高血压病人越来越多，心脑血管疾病也相应增加。为了做到早发现、早预防、早治疗，保证机关干部身体健康，吕梁市每年对机关干部组织体检1次。笔者借此机会对2007年1200名机关干部健康体检者进行问卷调查，了解他们对高血糖防治知识的了解状况。现介绍如下。     

吕梁市机关干部对高血糖防治知识了解状况的调查

随着人们生活水平的提高,高血脂、高血糖、高血压病人越来越多,心脑血管疾病也相应增加.为了做到早发现,早预防、早治疗,保证机关干部身体健康.     

Pharmacological treatment of hyperglycemia in type 2 diabetes

Diabetes mellitus is a major public health problem, affecting about 10% of the population. Pharmacotherapy aims to protect against microvascular complications, including blindness, end-stage kidney disease, and amputations. Landmark clinical trials have demonstrated that intensive glycemic control slows progression of microvascular complications (retinopathy, nephropathy, and neuropathy). Long-term follow-up has demonstrated that intensive glycemic control also decreases risk of macrovascular disease, albeit rigorous evidence of macrovascular benefit did not emerge for over a decade. The US FDA’s recent requirement for dedicated cardiovascular outcome trials ushered in a golden age for understanding the clinical profiles of new type 2 diabetes drugs. Some clinical trials with sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP1) receptor agonists reported data demonstrating cardiovascular benefit (decreased risk of major adverse cardiovascular events and hospitalization for heart failure) and slower progression of diabetic kidney disease. This Review discusses current guidelines for use of the 12 classes of drugs approved to promote glycemic control in patients with type 2 diabetes. The Review also anticipates future developments with potential to improve the standard of care: availability of generic dipeptidylpeptidase-4 (DPP4) inhibitors and SGLT2 inhibitors; precision medicine to identify the best drugs for individual patients; and new therapies to protect against chronic complications of diabetes.

Diabetes mellitus is a major public health problem, affecting about 10% of the population (1). Chronic complications of diabetes cause enormous human suffering, including blindness, kidney failure, amputations, myocardial infarction, and stroke. Inspired by the desire to develop better therapies, many researchers have investigated the pathophysiology of type 2 diabetes (T2D). While type 1 diabetes (T1D) is caused by autoimmune destruction of insulin-secreting β cells of the pancreas, T2D is often associated with obesity and is characterized by both impaired insulin secretion and insulin resistance (2). T2D is a progressive disease. Insulin resistance manifests early in the natural history prior to occurrence of overt hyperglycemia. So long as pancreatic β cells secrete sufficient insulin to compensate for insulin resistance, glucose levels are maintained at relatively normal levels (3). Overt diabetes occurs when β cells no longer secrete sufficient insulin to maintain normoglycemia. Fasting hyperglycemia is driven by increased hepatic glucose production due to relatively low insulin levels combined with hepatic insulin resistance. Severity of metabolic defects increases over time, primarily because of increasingly severe impairment in insulin secretion.This Review will discuss the state of the art in pharmacotherapy of T2D. Treatment aims to prevent or delay occurrence of microvascular and macrovascular complications — the main causes of morbidity and mortality in T2D. We focus specifically on hemoglobin A_1c–lowering (HbA1c-lowering) drugs, although antihypertensives, lipid-lowering drugs, optimal nutrition, and physical exercise also contribute to a holistic approach to treatment.     

Peripheral triacylglycerol extraction in the fasting and post-prandial states.

1. Triacylglycerol extraction by subcutaneous adipose tissue and forearm muscle was studied in nine normal subjects after an overnight fast and after the consumption of a mixed meal. 2. There was an inverse correlation between the total plasma fractional triacylglycerol extraction across the adipose tissue and the fasting arterial plasma triacylglycerol concentration. In contrast, there was no correlation between the lower fractional triacylglycerol extraction across the forearm muscle and the fasting plasma triacylglycerol concentration. 3. Chylomicron-triacylglycerol concentrations in arterial(ized) plasma increased post-prandially and peaked at 240-300 min. There was a comparable increase in the very-low-density lipoprotein-triacylglycerol concentration, peaking at 300 min. 4. Clearance of chylomicron-triacylglycerol by adipose tissue increased after the meal (P less than 0.05). In contrast, the clearance of very-low-density lipoprotein-triacylglycerol by adipose tissue decreased post-prandially (P less than 0.05). 5. Although there was significant uptake of chylomicron-triacylglycerol by the forearm muscle post-prandially, this was less than by the adipose tissue. Very-low-density lipoprotein-triacylglycerol was unaffected by passage through the forearm muscle at any time. 6. We conclude that the extraction of lipoprotein-triacylglycerol by human adipose tissue is important in determining the fasting plasma triacylglycerol concentration. Chylomicron-triacylglycerol, appearing in the plasma post-prandially, may compete with very-low-density lipoprotein-triacylglycerol for clearance by adipose tissue lipoprotein lipase, and this mechanism may explain, at least in part, the post-prandial rise in very-low-density lipoprotein-triacylglycerol. Forearm muscle, in contrast, appears to play a much smaller role in the extraction of plasma triacylglycerol, especially that in the very-low-density lipoprotein fraction.     

Tuberculosis prevention and treatment

Tuberculosis (TB) is one of the oldest known diseases and has claimed more lives than any other Today, about one-third of the world's population is infected with TB. In 2003, 1,379 cases of new, active and relapsed TB were reported in Canada. TB is caused by Mycobacterium tuberculosis. Only 10 per cent of infected individuals will develop active TB. Pulmonary TB can be spread by an infectious person through the aerosolization of droplets when coughing, talking, spitting, sneezing or singing. Symptoms of pulmonary TB are a cough with or without sputum production lasting at least three weeks, chest pain, hemoptysis, fever, night sweats, weight loss, lack of appetite, chills and weakness. Extrapulmonary TB is generally not associated with person-to-person spread. Common sites include the throat, lymph nodes, abdomen, intestines, long bones of the legs, spine, kidneys, bladder, skin, eyes and meninges. The risk factors for TB infection and disease include close contact with an active pulmonary TB case, HIV infection or AIDS, inactive disease not adequately treated, low income, underlying medical condition, homelessness, alcoholism, injection drug use, aboriginal background or occupation in health care. Risk settings include travel or residence in an endemic area or work or residence in a correctional facility, shelter, rooming house, residential facility, hospital or long-term care facility. Nurses need to advocate for the prompt diagnosis and isolation of suspected and confirmed TB cases. Knowing when to institute such measures as isolation in a negative pressure room, using respirator masks and limiting interpersonal contacts is vital to the nursing care of TB patients. In addition, the role of the public health department needs to be understood; for example, all jurisdictions have legislated requirements for reporting new positive TB skin tests to public health.