浅议口腔保健在临床中的意义体现

本文探讨口腔保健知识在临床治疗工作中的重要作用.分析中选取600例口腔就诊患者进行总结研究,根据每个人的特点进行归纳,明确患者对口腔保健知识的认识情况.对其中一半的患者进行口腔保健知识教育工作.经过实验表明口腔保健知识干预前后患者0HI值分布存在明显的变化.得出结论,口腔教育的干预效果显著,口腔患者保健知识普及工作尚需完善,对患者的健康教育工作任重道远.     

家庭强化教育对农村糖尿病患者治疗依从性的影响

目的 提高农村糖尿病患者治疗依从性及治疗效果.方法 将187例农村糖尿病患者按住院时间分为对照组(91例)和实验组(96例).对照组按传统的糖尿病健康教育方法 实施教育;实验组在住院过程实施家庭强化教育.观察两组治疗依从性及血糖控制情况.结果 出院后半年,两组饮食疗法、胰岛素注射、自我监测、运动疗法、定期复查依从性为23.1%～77.1%,实验组治疗依从性显著高于对照组(均P＜0.01);其空腹血糖、餐后2 h血糖及HbAlc控制良好率显著高于对照组,低血糖发生率显著低于对照组(均P＜0.01).结论 农村糖尿病患者的治疗依从性偏低,说明医院内的健康教育对农村糖尿病患者治疗的影响有限,应在农村基层建立有效的糖尿病患者教育管理网,家庭强化教育能提高农村糖尿病患者治疗依从性,有利于疾病控制.     

家庭强化教育对农村糖尿病患者治疗依从性的影响

目的提高农村糖尿病患者治疗依从性及治疗效果。方法将187例农村糖尿病患者按住院时间分为对照组（91例）和实验组（96例）。对照组按传统的糖尿病健康教育方法实施教育;实验组在住院过程实施家庭强化教育。观察两组治疗依从性及血糖控制情况。结果出院后半年,两组饮食疗法、胰岛素注射、自我监测、运动疗法、定期复查依从性为23．1％～77．1％,实验组治疗依从性显著高于对照组（均P〈O．01）;其空腹血糖、餐后2h血糖及HbAlc控制良好率显著高于对照组,低血糖发生率显著低于对照组（均P＜O．01）。结论农村糖尿病患者的治疗依从性偏低,说明医院内的健康教育对农村糖尿病患者治疗的影响有限,应在农村基层建立有效的糖尿病患者教育管理网,家庭强化教育能提高农村糖尿病患者治疗依从性,有利于痰病控制。     

老年糖尿病患者口腔健康生活质量及影响因素的研究进展

对老年糖尿病患者的口腔健康状况及口腔健康相关生活质量状况进行综述,对影响老年糖尿病患者的口腔健康生活状况因素进行归纳,为医护人员有针对性地采取措施提高老年糖尿病患者的口腔健康生活质量提供参考。     

种植义齿患者口腔健康管理的研究进展

阐述种植义齿患者口腔健康的影响因素包括牙周病史、糖尿病、吸烟史、口腔卫生不良、缺乏定期维护;指出种植义齿患者口腔自我健康管理依从性较差;介绍种植义齿患者口腔管理相关评估工具;患者口腔健康管理的干预措施包括患者及其照顾者管理、医护人员管理、多学科合作管理。指出应加强口腔专科护士在种植义齿患者口腔健康管理中的主导作用,提升口腔护理质量。     

2型糖尿病患者饮食治疗依从性研究

目的 了解2型糖尿病患者饮食治疗依从性及其影响因素,为进一步有效开展糖尿病患者饮食教育提供依据.方法 对349例2型糖尿病患者进行饮食治疗依从性及有关疾病知识、健康信念和自我效能等问卷调查,分析患者饮食治疗依从性的影响因素.结果 患者饮食依从性总分8.58±2.44;患者饮食治疗依从性与其年龄、应用技能、健康信念、自我效能呈显著正相关(P＜0.05,P＜0.01).结论 提高患者饮食治疗依从性需重视其实际操作技能训练及健康信念、自我效能的影响作用,同时应特别关注非老年患者的饮食治疗依从性.     

2型糖尿病患者饮食治疗依从性研究

目的了解2型糖尿病患者饮食治疗依从性及其影响因素，为进一步有效开展糖尿病患者饮食教育提供依据。方法对3．49例2型糖尿病患者进行饮食治疗依从性及有关疾病知识、健康信念和自我效能等问卷调查，分析患者饮食治疗依从性的影响因素。结果患者饮食依从性总分8．58±2．44；患者饮食治疗依从性与其年龄、应用技能、健康信念、自我效能呈显著正相关（P〈0．05，P〈0．01）。结论提高患者饮食治疗依从性需重视其实际操作技能训练及健康信念、自我效能的影响作用，同时应特别关注非老年患者的饮食治疗依从性。     

综合护理对口腔正畸固定矫治的效果

目的 分析综合护理对口腔正畸固定矫治患者的干预效果。方法 选取本院2018年2月-2021年 9月收治70例口腔正畸患者为研究对象,按照随机数表法分为对照组和试验组,各35例。对照组采用常规 护理干预,试验组采用综合护理干预,比较两组牙釉质脱矿程度、依从性、护理满意度和口腔健康状况。 结果 试验组牙釉质脱矿程度0度占比为45.71%,高于对照组的17.14%,差异有统计学意义（P＜0.05）;试 验组患者依从性为94.29%,高于对照组的77.14%,差异有统计学意义（P＜0.05）;试验组患者护理满意度 为97.14%,高于对照组的80.00%,差异有统计学意义（P＜0.05）;两组矫治后菌斑指数（PLI）、牙龈指 数（GI）得分均高于矫治前,且试验组低于对照组,差异有统计学意义（P＜0.05）。结论 口腔正畸患者 行固定矫治时给予综合护理干预能够改善患者口腔健康状况、治疗依从性和满意度,并有效改善牙釉质脱 落情况。     

长沙市2型糖尿病患者医学营养治疗教育与执行现状调查

目的了解长沙市2型糖尿病患者医学营养治疗教育及执行现状,分析影响因素,为完善针对性干预策略提供参考。方法采用自制糖尿病医学营养治疗教育及执行情况调查问卷对213例2型糖尿病患者进行现状调查。结果问卷总分为(9.13±3.77)分,3个维度得分率依次为依从性(58.67%)、态度(48.75%)、知识(36.60%);单因素分析显示,受教育程度在本科及以上、居住在地级市者得分相对高于其他者(均P0.05);多因素分析显示,近6个月血糖自我监测次数及职业类别是影响患者医学营养治疗教育及执行的重要因素(均P0.05)。结论患者医学营养治疗教育及执行现状不容乐观,应充分考虑患者认知、态度、执行力差异,建立更加完善的糖尿病教育机制,提升患者教育效果,从而提高其执行依从性。     

健康教育对门诊高血压患者治疗依从性的研究

目的:探讨健康教育对高血压患者服药依从性及治疗效果的影响.方法:根据132例高血压患者的不同情况,对其进行有目的、有计划、有步骤的健康宣教.结果:经健康教育后,患者治疗主动性有明显提高,服药依从性增强,血压控制率也得以提高.结论:健康教育可使高血压患者对自身疾病有比较清楚的认识,改变不良生活习惯,提高治疗依从性.     

2型糖尿病患者牙周炎认知情况调查

目的：了解2型糖尿病（DM）患者对DM并发症牙周炎的认知程度。方法：于2009年9月～2010年9月对来我院门诊就诊的147例2型DM患者就其对DM牙周炎认知程度以问卷形式进行调查。结果：2型DM患者对DM牙周炎总体认知正确率仅为43.8%。大学以上学历程度者对DM与牙周炎关系、牙周炎症状及牙周炎局部因素的认知正确率分别为56.6%、59.2%和43.4%,高中及大专学历者对上述3者的认知正确率分别为50%、49%和35.6%,初中以下学历者则分别为39.9%、43.4%和26.3%,3组之间比较,差异有统计学上显著意义（P〈0.05）。结论：2型DM患者对DM牙周疾病的认知水平较低,随着学历程度的下降,2型DM患者对DM牙周炎的认知程度降低更明显,应加强2型DM牙周炎患者的健康教育,以达到有效控制DM和防治牙周炎的目的。     

Ⅱ型糖尿病伴牙周病患者牙周干预后口腔健康状况的变化

目的:观察Ⅱ型糖尿病伴慢性牙周炎患者牙周干预后口腔健康状况的变化。方法:120例Ⅱ型糖尿病伴慢性牙周炎患者随机分为实验组和对照组,均进行牙周指数的基线检查(包括:牙龈指数GI、菌斑指数PLI、龈沟出血指数SBI、附着丧失AL)、口腔卫生宣教及正确刷牙方法指导。实验组还给予牙周干预治疗。6个月后记录两组牙周指数等的变化。结果:①两组牙周指数的基线检查差异无统计学意义(P>0.05);②干预后两组的牙周指数变化除龈沟出血指数外均有统计学差异(P<0.05)③干预后两组在糖尿病与牙周病关系知晓率、定期口腔检查、规律运动习惯、每天刷牙次数方面差异也有统计学差异(P<0.05)。结论:积极的牙周干预措施不仅可明显改善Ⅱ型糖尿病伴慢性牙周炎患者的口腔健康状况,还可提高患者口腔保健意识和能力。     

护理干预对口腔癌患者卫生行为的影响

目的探讨口腔癌患者口腔卫生行为,为口腔癌的预防提供理论依据。方法对84例口腔癌患者进行护理干预,并采用问卷对其进行卫生行为的调查。结果口腔卫生状况不良者占89.28%;牙列不齐、残根深、不良修复体及有明显局部刺激因素占52.38%;50.00%以上患者有不良嗜好,干预后患者的口腔保健认知程度、口腔卫生行为较干预前显著提高(均P<0.01)。结论不良的口腔卫生习惯、嗜好及长期的局部慢性刺激是诱发口腔癌发生的重要因素,尽早去除致病因素,做好口腔的健康教育对预防口腔癌有重要意义。     

护理干预对口腔癌患者卫生行为的影响

目的探讨口腔癌患者口腔卫生行为，为口腔癌的预防提供理论依据。方法对84例口腔癌患者进行护理干预，并采用问卷对其进行卫生行为的调查。结果口腔卫生状况不良者占89．28％；牙列不齐、残根深、不良修复体及有明显局部刺激因素占52．38％；50．00％以上患者有不良嗜好，干预后患者的口腔保健认知程度、口腔卫生行为较干预前显著提高（均P〈0．01）。结论不良的口腔卫生习惯、嗜好及长期的局部慢性刺激是诱发口腔癌发生的重要因素，尽早去除致病因素，做好口腔的健康教育对预防口腔癌有重要意义。     

Oral and dental manifestations in diabetic and nondiabetic uremic patients receiving hemodialysis.

OBJECTIVE: The aim of this study was to examine the dental condition and oral manifestations in diabetic and nondiabetic uremic patients undergoing hemodialysis. STUDY DESIGN: A total of 128 patients undergoing hemodialysis therapy were classified into the diabetic and nondiabetic groups and examined for uremic oral manifestations, dental caries, and the periodontal status. All the patients received predialytic salivary pH examination. In the diabetic group, the correlation between oral findings and glycemic controlled levels, which was collected based on Hb A1C values, were further studied. RESULTS: The diabetic group exhibited significantly higher prevalence of caries and more severe dry mouth, taste change, and mucosa pain than the nondiabetic group. The diabetic group tended to have lower predialytic salivary pH, and patients with poor glycemic control (ie, Hb A1C > 9%) showed higher incidence of dry mouth, mucosal pain, and tongue coating. However, the DMFT and CPI index were not associated with glycemic control in the diabetic group. CONCLUSIONS: This study reveals that diabetic uremic patients undergoing maintained hemodialysis exhibited a potentially higher risk for dental decay and xerostomia. Lower salivary pH and poor glycemic control may affect oral manifestations. Further research is needed to clarify the combined influence of diabetic nephropathy on oral health.     

The role of oral dryness in interdialytic weight gain by diabetic and non-diabetic haemodialysis patients.

BACKGROUND: Factors influencing the percentage of daily interdialytic weight gain (IDWG%) and their interactions in haemodialysis (HD) patients have not been well-defined, especially in diabetic patients. We analysed contributing factors for the increase of IDWG%, particularly xerostomia (oral dryness), among diabetic and non-diabetic HD patients. METHODS: We collected 3 month prospective data in 184 stable HD patients (116 non-diabetic and 68 diabetic), including assessments of xerostomia by 100 mm visual analog scales (VASs), and the unstimulated whole salivary (UWS) flow rate was measured in 91 patients by a spitting method. RESULTS: Diabetic patients have higher IDWG% (P = 0.042) and VAS oral dryness score (P = 0.021), whereas, have lower UWS (P = 0.032). In non-diabetic patients, the VAS oral dryness score, age, Kt/V and blood urea nitrogen (BUN) level correlated independently with IDWG%. In diabetic patients, the haemoglobin A(1C) (HbA(IC)) correlated significantly with IDWG% after controlling for age, Kt/V and BUN level; however, when VAS oral dryness score was introduced into the regression model, the effect of HbA(IC) became marginally significant (P = 0.073) while the VAS oral dryness score became significantly correlated with IDWG%. The increases in IDWG% per unit change in VAS oral dryness score did not show significant difference between the non-diabetic and total diabetic patients; however, it was larger in patients with HbA(IC) >or=9%. CONCLUSIONS: Xerostomia plays a significant role in increasing IDWG% among diabetic and non-diabetic HD patients. In diabetic patients, the increased IDWG% associated with the increasing HbA(1C) level is largely dependent on the severity of xerostomia, and we speculate that insulin deficiency may operate synergistically with xerostomia in increasing IDWG% in patients with HbA(1C) >or=9%.     

Weight loss and changes in use of antidiabetic medication in obese type 2 diabetics after laparoscopic gastric banding

BackgroundInterest in bariatric surgery is growing as an effective method for long-term metabolic control in morbidly obese patients with type 2 diabetes. We analyzed the weight loss and changes in use of diabetic medication in obese patients with type 2 diabetes treated with laparoscopic adjustable gastric banding (LAGB).MethodsFrom 1993 to 2005, 1791 morbid obese patients underwent LAGB at our institution. Of the 1791 patients, 394 (22%) had type 2 diabetes mellitus at baseline. Of the 394 patients with diabetes, 52 were receiving diabetic medication. The median follow-up period for the drug-treated diabetic patients was 3 years (range .25–9).ResultsThe drug-treated diabetic patients were older (age 47.6 ± 7.5 versus 37.5 ± 10.7 years, P <.001), weighed more (body mass index 49.1 ± 9.5 versus 45.6 ± 7.5 kg/m², P 0.001), and were more frequently affected by co-morbidities than the nondiabetic patients at surgery. The percentage of excess weight loss 1 year after surgery was less (32.4% ± 14.1% versus 41.1% ± 19.9%, P <.01) for the drug-treated diabetic patients than for the nondiabetic patients. This difference was maintained for 5 years of follow-up. A significant decline occurred in the use of both oral diabetic medication and insulin after surgery. Of the 52 patients treated with oral antidiabetic medication at baseline, 33 required oral antidiabetic medication at the end of follow-up. Of the 6 patients who also required insulin at baseline, 2 did so at the end of follow-up. The use of diabetic medication had increased in 4 patients (7.7%), was unchanged in 12 (23.1%), had decreased in 17 (32.7%), and was suspended in 19 (36.5%) of 52 patients.ConclusionThe amount of weight loss after LAGB was less in drug-treated diabetic patients than in nondiabetic patients. However, LAGB was associated with a sustained reduction in the use of diabetic medication.     

Post-renal transplant diabetes mellitus--a retrospective study.

The prevalence of post-transplant diabetes mellitus in 222 consecutive live related renal allograft recipients over a 3-year period was found to be 11.7%. Most of them (20 of 26) developed diabetes mellitus within the first 4 months of transplantation. Post-transplant diabetic patients were older, and had a significantly greater incidence of avascular necrosis of bone. An assessment of risk factors showed that abnormal postprandial blood sugar pretransplant was a significant predictor for development of post-transplant diabetes, whereas cumulative oral steroid dose, weight gain after transplant, type of immunosuppression employed, and graft function were not important. We conclude that post-transplant diabetes mellitus frequently develops in patients with a predisposition by virtue of older age and pretransplant postprandial hyperglycaemia. While steroids are important in the pathogenesis, there was no demonstrable dose-response relationship; post-transplant diabetic patients may be a group with a greater propensity to steroid-induced complications.     

One year course of oral sulodexide in the management of diabetic nephropathy

BACKGROUND: Diabetic nephropathy is a multifactorial diabetic complication whose long-term consequences involve chronic renal insufficiency and increased rate of cardiovascular death. Besides oxidative stress, and hemodynamic changes, glycosaminoglycans (GAGs) are an additional component implicated in the onset of glomerular abnormalities. GAG replacement therapy was envisaged in the nineties for the treatment of diabetic nephropathy and sulodexide is the most extensively investigated GAG to reduce albuminuria in diabetic patients. METHODS: In this study we have evaluated the effect of a long-term course of oral sulodexide at a moderate dosage in the treatment of patients affected by diabetic nephropathy. Thirty patients with type 1 and 2 diabetes mellitus (DM) have been treated with 50 mg/ daily oral sulodexide for 12 months while thirty matched diabetic patients constituted the control group. All the patients attended monthly visits and controls of biochemical and metabolic parameters. RESULTS: At 12 months albuminuria was greatly reduced in patients treated with sulodexide and increased in the control group (260% and +29% vs baseline, respectively; p = 0.0001). The drug appeared active in both type 1 and type 2 diabetes and in both micro- and macroalbuminuric patients. No change in metabolic control and no systemic side effects were reported. CONCLUSIONS: In our diabetic patients sulodexide therapy has been proven to greatly reduce albuminuria, and to have the potential to delay progression from incipient to overt nephropathy.     

The influence of pre-admission hypoglycaemic therapy on cardiac morbidity and mortality in type 2 diabetic patients undergoing major non-cardiac surgery: a prospective observational study

It remains unclear whether type 2 diabetics treated with either insulin or oral hypoglycaemic agents have the same incidence of cardiac morbidity and mortality after major non-cardiac surgery. We prospectively studied 360 type 2 diabetic patients undergoing major non-cardiac surgery of which 105 were treated with insulin only, 171 were treated with oral hypoglycaemics only and 84 were treated with a combination of insulin and oral hypoglycaemics. All-cause mortality after 30 days and after 12 months was highest in the insulin (10% and 26%) and lowest in the oral hypoglycaemics group (2% and 13%; p = 0.02 and 0.007, respectively). Insulin treatment was independently associated with increased mortality after 30 days (hazard ratio 3.93; 95% CI 1.22-12.64; p = 0.022) and 12 months (hazard ratio 2.03; 95% CI 1.16-3.58; p = 0.014) after multivariate adjustment for age, sex and the revised cardiac risk index (insulin treatment excluded). The increased mortality in insulin-treated diabetic patients may be due to a more progressive disease state in these patients rather than the treatment modality itself.