糖尿病病人静脉药物治疗中溶液应用研究进展

介绍了葡萄糖的替代溶液在糖尿病病人静脉药物治疗中应用研究进展,替代溶液既能补充热量又不影响病人血糖波动,克服了静脉输注葡萄糖、生理盐水对病人的影响.     

硫酸奈替米星葡萄糖注射液与双黄连注射液配伍禁忌1例分析

患者，男，23岁，于2004年8月9日因“急性上呼吸道感染”在门诊接受治疗，医嘱为硫酸奈替米星葡萄糖注射液100ml、5％葡萄糖注射液250ml加双黄连注射液40ml静脉点滴，每日一次。病人取药后到门诊输液室输液，常规消毒皮肤，顺利静脉穿刺成功后先输硫酸奈替米星葡萄糖注射     

电解质溶液浓度对葡萄糖注射液微粒检测的影响

目的 探讨电解质溶液浓度对装量100mL以上的葡萄糖注射液微粒检测的影响。方法 采用10％和20％氯化钠溶液，各取10mL，分别加入同一瓶的葡萄糖注射液各90mL，在KF-4微粒计数器上进行微粒测定。结果 在加入不同电解质溶液浓度条件下测得每mL含10、25μm以上的微粒数日均符合药典要求。两种条件下测得的数值接近，经秩和检验，得α=0．05，即两种浓度对微粒检查无显著性差异。结论 电解质溶液浓度对葡萄糖注射液微粒检测影响不大，该法简便、快速、重现性好，为葡萄糖注射液微粒检测提供了实验依据。     

木糖醇注射液对糖尿病血糖影响的临床研究

目的：探讨2型糖尿病静脉输液，寻找替代葡萄糖注射液，为木糖醇注射液的临床推广应用提供实验依据，方法：采用5％木糖醇注射液，5％葡萄糖注射液＋胰岛素8^u，生理盐水做对照观察，静脉滴注前，2h后 观察血糖变化情况。结果：5％木糖醇组，静脉滴注前和2h后比较，血糖略有下降（P＞0．05）。5％葡萄糖＋胰岛素组：静脉滴注前和2h后比较，血糖明显升高（P＜0．01）。生理盐水组：静脉滴注前和2h后，血糖变化不明显（P＞0．05）。结论：木糖醇注射液可替代葡萄糖注射液，静脉滴注后血糖略有下降，但无统计学意义，明显优于葡萄糖注射液。     

5％与10％葡萄糖注射液对腹泻患儿血糖和胰岛素水平影响的研究

目的：观察小剂量5％葡萄糖注射液对腹泻患儿血糖和胰岛素水平的影响，并与10％葡萄糖注射液对比。方法：采用随机双盲平行对照的临床试验设计，共入选患者50例随机分为两组，实验组（25例）静脉输注5％葡萄糖注射液100ml，对照组（25例）静脉输注10％葡萄糖注射液100ml。测定患儿给药前、给药后15、30、60min的血糖和血胰岛素水平。结果：实验组血糖和血胰岛素的波动小于对照组（P〈0．05）。结论：100ml剂量中5％葡萄糖注射液对血糖和血胰岛素的影响小于10％葡萄糖注射液。     

青霉素G钠注射液的合理配制

青霉素Ｇ钠瓶装粉针剂需在用时配制 ,现就其溶液配制中的几个问题讨论如下。1　溶媒的选择青霉素Ｇ钠溶液最稳定的ｐＨ值为 6 0～ 6 8,偏离该ｐＨ值可加速青霉素Ｇ的水解 ,降低其疗效。注射用水的ｐＨ值为 7 0 ,生理盐水的ｐＨ值为 4 7～7 0 ,此两种溶液中青霉素Ｇ钠较为稳定。但注射用水仅可作为肌内注射的溶媒 ,不宜作静脉注射。青霉素Ｇ钠本身含有一定量的钠盐 ,大剂量静脉给药时用生理盐水不适合于需限钠病人。可选用低浓度的葡萄糖作溶媒 ,并于 1小时内输完。 10 %葡萄糖和 5 %葡萄糖盐水其ｐＨ值为 3 2～ 3 5 ,而且葡萄糖是一种具…     

复方乳酸钠葡萄糖注射液与复方乳酸钠山梨醇注射液的临床应用

乳酸钠林格注射液因其电解质组成、含量及渗透浓度与细胞外液近似,因此在心功能能承受情况下可以迅速大量输入,以补充细胞外液欠缺,但当此溶液中加入葡萄糖或山梨醇后,由于溶液的渗透浓度倍增,及机体利用葡萄糖和山梨醇的能力所限,迅速大量输入便会产生明显不良影响,从而使乳酸钠林格液作为细胞外液替代剂的功用发挥受     

一般护理

900883临床静脉翰液的正确配制/李磊才实用护理杂志,一1989,5(一。),一40~42,39 临床静脉输液用药时要注意稀释液的选择,。.9%氯化钠PH值为5.3~7,5%葡萄糖及10%葡萄糖溶液PH为4左右(浓度越高PH值越低),青尽素、红霉素类抗生素作静脉输入时,如病人无钠盐摄入禁忌症,宜选用。.9帕氯化钠作稀释液,对抗菌效价影响小。溶液配制后放置时间越长效价影响越大,致敏机会亦增加,抗生素应现用现配。抗生素作静脉应用应遵循溶液少,浓度高,分次给药的原则。·配制溶液时要注意药物的相互作用。维生素C是较强的还原剂,不能与维生素K3,青霉素混合.青霉素…     

丹红注射液对冠状动脉介入治疗病人血小板活化状态的影响

[目的]观察丹红注射液对冠状动脉介入治疗(PCI)后病人血小板活化状态的影响.[方法]将42例急性冠状动脉综合征(ACS)病人随机分为丹红治疗组(21例)和常规治疗组(21例),在冠状动脉介入治疗前和术后次日采用流式细胞仪检测血小板活化指标CD62P、CD63.丹红治疗组于PCI术后即加用丹红注射液40 mL加入5%葡萄糖溶液中静脉输注,14 d后复查上述指标,并进行治疗前后比较和组间比较.[结果]经丹红注射液治疗后, CD62P、CD63较治疗前明显下降(P＜0.01).[结论]丹红注射液具有抑制血小板活化的作用,在预防和治疗血栓性疾病中有一定的临床价值.     

手术后高渗葡萄糖液滴注速度与尿糖关系的探讨

禁食病人常需静脉输注高渗葡萄糖溶液以提供其能量需要。在外周静脉滴注中多选用10%葡萄糖液,习惯上不加用胰岛素。从理论上说,一个正常成人每小时能耐受36g外源性葡萄糖而不发生糖尿。如以10%     

Diabetes Screening in Canada (DIASCAN) Study: prevalence of undiagnosed diabetes and glucose intolerance in family physician offices

OBJECTIVE--To assess the prevalence of undiagnosed diabetes and glucose intolerance in individuals > or =40 years of age who contacted their family physician for routine care. RESEARCH DESIGN AND METHODS--The study used a stratified randomized selection of family physicians across Canada that was proportional to provincial and urban/rural populations based on Statistics Canada Census data (1996). Consecutive patients > or =40 years of age were screened for diabetes. If a casual fingerprick blood glucose was >5.5 mmol/l, the patient returned for a fasting venous blood glucose test. If the fasting blood glucose was 6.1-6.9 mmol/l, a 2-h 75-g post-glucose load venous blood glucose was obtained. Results of these tests were used to classify patients in diagnostic categories. RESULTS--Data were available for 9,042 patients. Previously undiagnosed diabetes was discovered in 2.2% of the patients, and new glucose intolerance was found in an additional 3.5% of patients. Overall, 16.4% of patients had previously known diabetes. The decrease in fasting plasma glucose criterion from 7.8 to 7.0 mmol/l resulted in a 2.2% versus a 1.6% prevalence of new diabetes. Several risk factors were reported in a significantly greater proportion of patients with new glucose intolerance and either new and known diabetes compared with the normal glucose tolerance group of patients. CONCLUSIONS--Routine screening for diabetes by family physicians is justified in patients > or =40 years of age, given the finding of previously undiagnosed diabetes in 2.2% of these patients and newly diagnosed glucose intolerance in an additional 3.5% of these patients. Another 16.4% of primary care patients > or =40 years of age have known diabetes. This has important implications regarding health resources and physician education.     

Validation of capillary glucose measurements to detect glucose intolerance or type 2 diabetes mellitus in the general population

BACKGROUND: The use of an oral glucose tolerance test (OGTT) has been recommended to diagnose type 2 diabetes, but an OGTT with venous blood sampling may not be feasible in the screening phase preceding large epidemiological studies. We have conducted a population-based screening in 2715 men and women and evaluated the diagnostic validity of capillary plasma glucose concentration measurements versus venous plasma glucose concentration measurements in a subset of 350 subjects. METHODS: During a single OGTT, glucose concentrations were measured in venous plasma as well as in capillary plasma. RESULTS: Based on the 1999 WHO criteria for venous glucose concentrations, the study population (n=350) yielded 97 subjects with type 2 diabetes mellitus, 77 subjects with impaired glucose tolerance and 176 subjects with normal glucose tolerance. Sensitivity and specificity to diagnose type 2 diabetes mellitus by capillary plasma were 84% and 98%, respectively. Consistent classification by either venous or capillary plasma glucose measurements was 78% (kappa=0.65, p<0.001). CONCLUSION: Capillary glucose measurements are suitable for use in epidemiological studies to diagnose and detect type 2 diabetes and normal glucose tolerance. Use of capillary measurements can result in cost-effective inclusion schemes in epidemiological studies.     

社区2型糖尿病患者空腹血糖控制效果的影响因素分析

目的 研究社区2型糖尿病患者空腹血糖的控制效果及其影响因素。方法 选取2017年7月至2018年4月于南京市玄武区8家社区的1 220例2型糖尿病患者为研究对象,根据其空腹静脉血糖、空腹末梢第1滴血血糖值、空腹末梢第2滴血血糖值的情况分为空腹血糖控制正常组和空腹血糖控制异常组。比较两组患者的性别、年龄、体重指数(BMI)、糖尿病病程等临床资料,采用单因素方差分析、多因素非条件Logistic回归分析法探究空腹血糖控制效果的影响因素。结果 1 220例社区2型糖尿病患者空腹血糖控制达标率为50.41%,多因素非条件Logistic回归结果显示,性别、糖尿病病程、是否存在高血压、血脂控制是否正常、是否为向心型肥胖是社区2型糖尿病患者空腹血糖控制效果的影响因素。结论 性别、糖尿病病程、是否存在高血压、血脂控制是否正常、是否为向心型肥胖对社区2型糖尿病患者空腹血糖的控制有重要影响,临床对这些因素应给予重视,并结合社区患者的实际情况给予针对性的干预措施,以期提高患者的血糖控制效果。     

社区老年糖尿病患者自行注射胰岛素的健康教育

目的探讨对社区自行注射胰岛素的老年糖尿病患者进行健康教育的效果。方法对5个社区182例自行注射胰岛素的老年糖尿病患者进行连续4周、每周1次的健康教育,在健康教育前、健康教育2周、4周末进行相关知识和技能以及血糖控制情况的调查。结果社区老年自行注射胰岛素的糖尿病患者在健康教育2周及4周后,对注射部位的选择和更换胰岛素保存方式、针头处置、消毒方法、进针角度等知识和技能与健康教育前有显著差别(P<0.01);患者的血糖控制水平及局部皮肤情况与健康教育前也有显著差别(P<0.01)。结论健康教育可以显著提高社区老年糖尿病患者自行注射胰岛素的相关知识和技能,改善血糖水平;同时,对社区老年糖尿病患者进行健康教育宜采用多种手段相结合的方式。     

指尖及手臂部位测定毛细血管血糖和静脉血浆血糖的对比研究

目的研究手臂毛细血管血糖监测的可行性。方法用利舒坦血糖仪对住院糖尿病患者同步测定空腹及餐后2h的手臂毛细血管血糖、指尖毛细血管血糖与同时抽取静脉血用全自动生化仪测定的血浆血糖值作比较。将患者对针刺手臂、指尖的痛觉评分作比较。结果空腹及餐后2h手臂毛细血管血糖与指尖毛细血管血糖及静脉血浆血糖的均值比较,差异无统计学意义;空腹及餐后2h静脉血浆血糖、指尖毛细血管血糖、手臂毛细血管血糖三组相关性良好,r值均在0.950以上,P〈0.001;手臂、指尖的痛觉评分比较,P〈0.001。结论手臂毛细血管血糖监测能精确反应糖尿病患者空腹及餐后2h血糖,且针刺手臂疼痛较轻,患者依从性高。     

艾塞那肽注射液治疗老年2型糖尿病病人的观察及护理

[目的]总结艾塞那肽注射液治疗老年2型糖尿病病人的观察及护理。[方法]对15例老年2型糖尿病病人应用艾塞那肽注射液治疗,同时加强观察及护理。[结果]1例病人因严重肾功能不全在使用艾塞那肽注射液2个月后停用;艾塞那肽注射液治疗3个月后病人空腹血糖、餐后2h血糖、糖化血红蛋白、体重指数等指标均低于治疗前;出现恶心等轻度胃肠道反应7例,呕吐1例,低血糖1例,胃肠道副反应为一过性且症状较轻。[结论]艾塞那肽注射液能降低老年2型糖尿病病人的血糖水平,是一种安全有效的降糖药物。     

Assessment of laboratory methods for detection of unsuspected diabetes in primary health care

In order to assess different methods for early detection of unsuspected diabetes, urine and venous blood samples were collected at random from 1082 patients visiting a primary health care centre in southern Sweden. Blood glucose was analysed by the hexokinase method along with the Dextrostix-Eyetone reflectance meter. Urine glucose was determined by Clinistix, Diastix, Neostix, Rediatest, Clinitest and quantitatively by the hexokinase method. Patients fulfilling the criteria of a positive screen were subjected to a diagnostic investigation with an oral glucose tolerance test. Out of 89 positive screenees, 37 patients were classified as diabetics, showing a prevalence of diabetes in the study population of 3.4% according to the WHO criteria. Impaired glucose tolerance was found in 14 patients. In a control group of 56 patients, randomly selected among negative screenees, no cases of diabetes were found. Random blood glucose measurement by the hexokinase method, using 7 mmol/l as a screening level, had a significantly higher sensitivity (95%) than all urine glucose methods (59-30%) with comparable specificity (97-99%). Use of the Dextrostix-Eyetone reflectance meter resulted in a decrease in sensitivity to 75% without any change in specificity or predictability, compared with the hexokinase method. Urine testing for glucose was found to be a suboptimal method for early case finding of diabetes among patients receiving primary health care.     

Analytical validation of the new plasma calibrated Accu-Chek Test Strips (Roche Diagnostics).

BACKGROUND: The Accu-Chek Inform glucose monitor is a point-of-care system for testing blood glucose. New test strips, calibrated to deliver glucose plasma-like values, were launched on the market in May 2005. The aim of our study was to perform analytical validation of these new strips. METHODS: We compared the new plasma strips with whole blood strips; results for the plasma strips with plasma values obtained using a clinical analyzer and with whole blood values given by the glucose electrode of a blood gas analyzer; and the influence of the type of blood (capillary or venous) on the results obtained by the glucose monitor with the plasma calibrated strips. RESULTS: Plasma strips give on average 7% higher results than the previous whole blood strips. However, the results given by the plasma strips on capillary whole blood, even if well correlated, are not completely comparable with those given by an analyzer for venous plasma. Nevertheless, these plasma strips and the glucose electrode of a blood gas analyzer give comparable results. CONCLUSIONS: Accu-Chek Inform plasma strips are a good method for monitoring of blood glucose values in patients with diabetes.     

Diagnosis of impaired glucose tolerance in hypertensive patients in daily clinical practice

Many patients with hypertension suffer from impaired glucose tolerance or type 2 diabetes mellitus. Although these diagnoses are generally simple and reliable, it is more difficult to diagnose impaired glucose tolerance. As the gold standard (oral glucose tolerance test (OGTT)) is complicated to perform, a simpler alternative would be useful. The aims of the Pre-Diabetes Score study are to correlate demographic and/or laboratory parameters that are clinically simple to determine with the results of the OGTT and to determine the diagnostic significance of the combinations of parameters with regard to impaired glucose tolerance. A total of 260 patients were included in the evaluation; 39% had impaired glucose tolerance and 12% had diabetes mellitus. A combination of HbA1c of > or =6%, a venous fasting glucose of > or =110 mg/dl, an age of > or =55 years, a systolic blood pressure of > or =140 mmHg and an enlarged waist size is highly predictive of impaired glucose tolerance.     

Venous thrombosis is associated with hyperglycemia at diagnosis: a case–control study

Background: Patients with (undiagnosed) diabetes mellitus, impaired glucose tolerance or stress‐induced hyperglycemia may be at greater risk for venous thrombosis and present with relative hyperglycemia during the thrombotic event. Objectives: To assess whether venous thrombosis is associated with hyperglycemia at diagnosis. Patients/methods: We performed a case–control study, derived from a cohort of consecutive patients referred for suspected deep vein thrombosis. Cases were patients with confirmed symptomatic venous thrombosis of the lower extremity. Controls were randomly selected in a 1 : 2 ratio from individuals in whom this diagnosis was excluded. We measured plasma glucose levels upon presentation to the hospital. Results: In total, 188 patients with thrombosis and 370 controls were studied. The glucose cut‐off levels for the first to fourth quartiles were as follows: first quartile, < 5.3 mmol L^?1; second quartile, 5.3–5.7 mmol L^?1; third quartile, 5.7–6.6 mmol L^?1; and fourth quartile, ≥ 6.6 mmol L^?1. When adjusted for body mass index, a known history of diabetes mellitus, age, sex, ethnicity and whether known risk factors for deep vein thrombosis were present, the odds ratios for deep vein thrombosis in the second, third and fourth quartiles of glucose levels as compared with the first quartile were 1.59 [95% confidence interval (CI) 0.89–2.85], 2.04 (95% CI  1.15–3.62) and 2.21 (95% CI  1.20–4.05), respectively; P for trend = 0.001. Conclusions: Increased glucose levels measured at presentation were associated with venous thrombosis. Experimental evidence supports a potential causal role for hyperglycemia in this process. As this is the first report on the association between (stress) hyperglycemia and venous thrombosis, confirmation in other studies is required.