2型糖尿病患者胰岛素用药障碍的心理分析及护理干预

目的：探讨2型糖尿病患者接受胰岛素的程度及用药障碍的原因,采取有效护理措施进行护理干预。方法：采用发放问卷调查的方法,对胰岛素治疗的100例2型糖尿病患者进行心理调查。结果：37例患者愿意接受胰岛素治疗,63例患者拒绝接受胰岛素治疗,拒绝的主要原因有：28.6%的患者担心用药成瘾;74.6%的患者认为是病情严重的表现;58.7%的患者担心发生低血糖;46.1%的患者担心使用胰岛素会使体重增加;36.5%的患者对针头存在恐惧;66.7%（40～60岁）的患者认为工作繁忙,无法定时注射;17.4%的患者因经济因素而拒绝治疗。结论：有胰岛素治疗适应证的2型糖尿病患者大部分对胰岛素存在用药障碍,应针对其原因给予对应的护理干预。     

200例住院糖尿病患者胰岛素笔注射的护理体会

糖尿病是一种慢性进展性疾病,需长期坚持治疗。胰岛素注射装置的便利与否及患者的接受程度,影响了胰岛素治疗措施实施的依从性。因此,让患者在住院期间学会胰岛素注射,并且出院后不因为对胰岛素注射过程的恐惧而拒绝胰岛素治疗,是糖尿病护理的重要工作内容。本文对此进行总结。     

糖尿病患者胰岛素治疗依从性的调查研究

目的探讨影响糖尿病患者胰岛素治疗依从性的因素,从而提高患者治疗依从性。方法采用问卷调查法,向214例门诊和住院的糖尿病患者应用胰岛素治疗进行调查。结果经调查的214例患者中,影响治疗依从性差的主要原因是患者对胰岛素治疗的认识不足:对注射胰岛素感到不方便,嫌注射胰岛素要受皮肉之苦,认为注射胰岛素治疗费用高,认为注射胰岛素治疗会成瘾等方面。结论糖尿病患者对胰岛素治疗的认识不足、对注射胰岛素感到不方便和要受皮肉之苦、治疗费用高、治疗会成瘾、对疾病认识程度是影响糖尿病患者胰岛素治疗依从性的主要因素。针对以上因素,实施相应的护理措施,从而提高胰岛素治疗依从性。     

糖尿病患者37例拒绝胰岛素治疗原因分析与对策

注射胰岛素是治疗糖尿病的重要手段,糖尿病患者在首次使用胰岛素治疗前往往存在一些心理问题,影响到治疗效果。为使患者接受治疗,稳定病情,提高生存质量,我们对37例拒绝胰岛素治疗的患者进行了心理问题调查并采取相应的护理对策,现报道如下：     

胰岛素治疗过程中的常见问题及对策

目的探讨在胰岛素治疗过程中常见问题,提出相应的解决方法。方法在我院展开护理人员对胰岛素的剂型、保存、使用方法、注射方法、注射装置和注意事项等情况的问卷调查,并对我院收治的100例2型糖尿病患者进行综合分析。结果据调查结果显示,存在患者用药依从性差、使用胰岛素操作不规范、担心胰岛素的不良反应以及临床医师忽略注射胰岛素过程等问题。结论针对胰岛素出现的各种问题,积极采取有效的措施可提高护理质量,增加治疗效果。     

临床护理路径在2型糖尿病胰岛素注射中的应用

目的：对临床护理路径在2型糖尿病胰岛素注射中的应用效果进行观察和分析。方法选择50例于2012年5月-2013年10月间在本院进行糖尿病胰岛素注射治疗的患者资料进行研究和分析,将患者分为对照组和观察组两组,每组各有25例患者,对对照组患者进行常规护理,对观察组患者应用临床护理路径,对两组患者的护理效果进行观察和探讨。结果观察组17例患者对护理质量满意,6例比较满意,2例不满意,护理满意度为92%,对照组12例满意,8例比较满意,5例不满意,护理满意度为80%,两组患者护理满意度差异具有统计学意义（P〈0.05）。结论对2型糖尿病胰岛素注射患者应用临床护理路径能够取得理想的临床治疗效果。     

2型糖尿病患者的护理评估和护理措施

目的分析研究2型糖尿病患者的护理评估和护理措施。方法对36例糖尿病患者进行综合护理及应用胰岛素治疗时护理。结果36例患者均取得满意效果，有效预防了并发症的发生，提高了生活质量。结论正确评估和精心的护理及有效的治疗措施是糖尿病患者康复的关键。     

胰岛素泵强化治疗2型糖尿病的护理

目的了解2型糖尿病胰岛素泵强化治疗的护理过程及特点,并观察其疗效。方法对30例2型糖尿病患者应用胰岛素泵强化治疗进行了全程护理。结果30例患者用胰岛素泵强化治疗后血糖控制良好,低血糖发生次数减少,生活质量相应提高。结论胰岛素泵注射胰岛素能更快更有效地控制血糖,为患者提供了一种全新的选择。     

护理干预对2型糖尿病患者胰岛素治疗依从性的影响

目的探讨护理干预对2型糖尿病患者胰岛素治疗依从性的影响。方法86例有并发症或血糖控制不佳的2型糖尿病患者,随机分为对照组和干预组,每组43例,对照组采取常规教育措施,干预组除常规教育外,并进行有针对性的护理干预,观察两组患者对胰岛素治疗依从性的差异。结果对照组和干预组患者对胰岛素治疗的依从性分别是41．9％、83．7％,两组比较差异有统计学意义（P〈0．01）。结论护理干预可有效地提高2型糖尿病患者对胰岛素治疗的依从性。     

老年糖尿病病人低血糖反应的影响因素与护理分析

目的 探讨老年糖尿病病人低血糖反应的影响因素与护理措施.方法 对我院住院治疗的70例老年糖尿病低血糖患者进行精心细致的护理,并分析患者发生低血糖的原因.结果 70例患者在治疗后病情稳定,经过医护人员的精心护理和治疗后,病情好转出院.出院后所有患者电话随访3个月,无一例患者再次发生低血糖.结论 老年糖尿病患者低血糖的主要原因是降糖药服用不合理及胰岛素注射不当,给予老年糖尿病低血糖患者精心细致的护理,可以提高患者的治疗效果,降低患者低血糖的发生率.     

Insulin injection technique can be taught without hospitalization

Although hospitalization of the diabetic may be seen as a failure of management, and places the patient in an artificial situation, admission for initiation of insulin therapy is the custom in most Ethiopian hospitals. From January 1987 to January 1988, 144 diabetics were taught insulin injection technique in the Diabetic Clinic of Yekatit 12 Hospital in Addis Ababa, Ethiopia, by two nurses in early morning, six days weekly, sessions. Of these, 85 were inpatients aged 6 to 73 years from all wards, admitted because of ketoacidosis, intercurrent illnesses or rural home. The 59 outpatients, aged 7 to 70 years, attended each morning, and started therapy with 8 to 12 units of Lente insulin daily, the dose being increased every 2 or 3 days by small increments until control was attained. These outpatients needed an average of 4.7 mornings (range 1-13) to learn the technique, and an additional 3 to 4 weeks of frequent checkup to achieve control: several continued their jobs while learning. The method failed with 2 very symptomatic patients; there were no severe hypoglycaemic reactions or other complications. In addition to the financial saving for patients, and reduction of hospital bed use by diabetics, the patients helped and encouraged each other, learning faster than when taught individually as "ill" inpatients.     

小剂量蕲蛇酶联合足量胰岛素治疗肥胖中青年的2型糖尿病

目的探讨改善微循环药物联合足量胰岛素注射,恢复和/或增强胰岛素敏感性的方法以及治疗肥胖中青年2型糖尿病的疗效。方法接受小剂量蕲蛇酶联合足量胰岛素注射为试验组,口服二甲双胍联合小剂量胰岛素注射为对照组。比较两组患者治疗前后的11项临床指标。结果试验组治疗后与胰岛素敏感性有关的7项指标和4项伴随表现指标与对照组比较有显著性差异(P<0.01)。试验组44例缓解,对照组6例缓解。结论改善微循环药物联合足量胰岛素注射的作用能够恢复肥胖中青年2型糖尿病患者胰岛素敏感性,多数患者(44/51)可得到缓解。     

我院静脉药物配置中心差错分析与防范措施

目的探讨静脉药物配置中心减少配置差错的有效措施,保障患者用药安全。方法归纳分析医院静脉药物配置中心2008年1月至2008年8月发生的差错,并根据原因提出针对性防范措施。结果371742份输液中发生审方差错13份,内部差错112份,漏错14份,差错2份。常见的差错类型有药师溶剂贴错、摆药错误、给药时间错误等。结论静脉药物配置中心通过建立完善的质量控制体系,提高临床医务人员药学知识,提高药师审方能力,加强药师、护士配置查对工作,将明显减少配置差错,促进临床安全用药。     

Lack of primary effect of sulphonylurea (glipizide) on plasma lipoproteins and insulin action in former Type 2 diabetics with attenuated insulin secretion

Summary A double-blind, placebo-controlled investigation has been made into the effects of 8 weeks of glipizide treatment in diabetics previously classified as Type 2 but with subsequent attenuation of insulin secretion and thence maintained on exogenous insulin.Although all patients were exposed to therapeutic plasma concentrations of glipizide, fasting blood glucose, haemoglobin A₁ and plasma lipoproteins (HDL, LDL, total cholesterol and triglycerides) did not show any consistent improvement following this treatment.It appears unlikely that SU (glipizide) has any primary effect on insulin action or on plasma lipoproteins. Its primary action is to augment insulin release and availability, so, its use should be restricted to Type 2 diabetics who retain insulin secretion.     

Consequences of alcohol use in diabetics

The hormone insulin, which is produced in the pancreas, is an important regulator of blood sugar levels. In people with diabetes, the pancreas does not produce sufficient insulin (type 1 diabetes) or the body does not respond appropriately to the insulin (type 2 diabetes). Alcohol consumption by diabetics can worsen blood sugar control in those patients. For example, long-term alcohol use in well-nourished diabetics can result in excessive blood sugar levels. Conversely, long-term alcohol ingestion in diabetics who are not adequately nourished can lead to dangerously low blood sugar levels. Heavy drinking, particularly in diabetics, also can cause the accumulation of certain acids in the blood that may result in severe health consequences. Finally, alcohol consumption can worsen diabetes-related medical complications, such as disturbances in fat metabolism, nerve damage, and eye disease.     

手术室专科护士术前干预对患者SAS焦虑评分及术后满意度的影响

目的 研究手术室专科护士术前干预对全麻患者术前焦虑及的影响,寻找评价手术室专科护士工作的指标与方法.方法 选择于全麻下进行手术的患者120例.所有患者随机分为对照组和干预组,使用手术室专科护士和普通护士分别对干预组和对照组患者进行术前干预.采用问卷调查方法,用焦虑自评量表(SAS)于手术前1 d下午和术晨入手术室后15 min对患者进行评估,记录其分值.并于术后1 d随访,使用问卷调查患者对护理工作的满意度.结果 两组患者干预前SAS评分无明显差异,而干预组患者干预后的SAS评分明显下降(P<0.01),对照组患者SAS评分则无明显改变.而两组患者对护理工作的满意度则无明显差异.结论 ①手术室专科护士对全麻患者有效的心理、行为干预可以明显减轻患者的焦虑感,消除其恐惧心理,使之更好地配合手术.②由于受到多种因素的干扰,患者满意度不适宜作为评价手术室专科护士对全麻患者围术期干预的客观指标.     

Human insulin. A review of its biological activity, pharmacokinetics and therapeutic use

Human insulin, whether produced by recombinant DNA techniques (biosynthetic, insulin crb) or enzymatic modification of porcine insulin (semisynthetic, insulin emp) is equivalent in biological activity to porcine insulin following intravenous administration. Slight differences between human and porcine insulin in hypoglycaemic activity after subcutaneous injection appear to be related to differences in absorption, and are unlikely to be of major clinical importance. Similarly, reported minor differences in counterregulator hormone response to human insulin compared with porcine insulin need further study, but they are unlikely to have important clinical implications. In clinical use the therapeutic efficacy of human insulin is similar to that of porcine insulin. The lower antigenicity with human insulin relative to purified porcine insulin is of potential therapeutic value, and it is logical to use human insulin in newly diagnosed diabetics, in patients treated intermittently with insulin, in cases of immunological insulin resistance, and in patients with allergy and local reaction against animal insulin. Thus, human insulin seems to have no disadvantages compared with purified porcine insulin and may have some advantages. While there appears to be no compelling reason to change patients whose diabetes is presently well controlled with purified porcine insulin to human insulin, the availability of human insulin at a price equal to or less than that of animal origin makes such a change logical. In the meantime, human insulin should be considered the insulin of 'first choice' for newly diagnosed diabetics requiring insulin therapy and in carbohydrate intolerance and diabetes occurring during pregnancy.     

The role of community-based nurses in harm reduction for HIV prevention: a South East and South Asia case study

International studies have explored the use of community-based nurses for harm reduction programs and HIV prevention. However, none have explored this role within the countries of Nepal, Myanmar, and China where the legal and political environment may adversely affect uptake of services by people who use injection drugs. Based on experiences as a nurse and harm reduction technical adviser for the development of community-based nursing initiatives in Nepal, Myanmar and China, I review some of the strengths and challenges associated with harm reduction programs in these countries. Community-based nurses play an important role in increasing the access and uptake of public health services by people who inject drugs. Within the context of harm reduction programs, community-based nurses develop a unique trust with people who inject drugs by providing non-discriminatory health care. Nurses act as information bridges between communities of people who use injection drugs, law enforcement, political and health care stakeholders. In doing so, they facilitate timely policy and programmatic responses. However, community-based nurses are prone to burnout due to long working hours and a limited pool of human resources. Community-based nurses have proven essential to the effective implementation of harm reduction program for HIV prevention in Nepal, Myanmar and China. Increased attention and support to these health care professionals have the potential to strengthen existing programs targeting people who inject drugs.     

Inhaled insulin

Inhalation of regular insulin for meal time glucose control has been found to be safe, efficacious and reliable in Type I and Type II diabetics. The administration of regular insulin through the human lungs by inhalation has been conducted in at least 14 short studies in both normal and diabetic subjects beginning as early as 1925. In all studies, significant insulin absorption and lowering of blood glucose was observed in the absence of penetration enhancers. Although a concern of variable dosing was raised in early studies, the development of new reproducible delivery systems has ensured that the variability of aerosol insulin can be as good, if not better, than subcutaneous (SC) injection. In the longest controlled studies in humans to date, both Type I and Type II insulin-dependent diabetics used a novel inhaled dry powder insulin delivery system for 3 months for meal time glucose control. The study results indicate that inhaled insulin provides equivalent glucose control, measured by hemoglobin A1c, when directly compared to SC injection. Interim results from an additional study with Type II diabetics who were failing oral hypoglycemic agents suggest that adjunctive therapy with inhaled insulin markedly improved glycemic control with a low risk of hypoglycemia. In all the 3 month studies the system was efficacious, well tolerated, well liked, and resulted in reproducible results. A potential advantage of aerosol insulin is that it is more rapidly absorbed (serum peak at 5-60 min) and cleared than SC injection (peak at 60-150 min), which provides a more relevant and convenient therapy for meal time glucose control. The relative efficiency of insulin delivery by aerosol, compared to SC injection, has been estimated from the dose measured at the exit point of the aerosol device, and found to range between 8 and 25% of SC, depending on the study.     

不同胰岛素强化治疗对于初诊2型糖尿病患者胰岛β细胞功能的影响

目的观察胰岛素泵和不同胰岛素多次强化治疗对初诊2型糖尿病患者胰岛β细胞功能的影响。方法新诊断的2型糖尿病患者90例,将患者随机分为胰岛素泵治疗组及多次皮下注射胰岛素A及B组。分别予两周的治疗,检测治疗前后患者的空腹和餐后2h血糖,胰岛素水平。通过静脉葡萄糖耐量实验得到葡萄糖（AUGG）和胰岛素（AUGINS）曲线下面积、胰岛素分泌指数（Homα β）和胰岛素抵抗指数（Homα IR）,评价不同胰岛素强化治疗对2型糖尿病患者胰岛β细胞功能的影响。结果胰岛素泵组治疗后多数患者都恢复了不同程度的第一时相分泌,治疗后AIR、Homα β较治疗前显著性升高（P〈O．01）,Homα IR无显著性差异（P〉O．05）。多次胰岛素注射组治疗前后,AIR、Homα β和Homα IR均无统计学差异（P〉0．05）。三组患者治疗后胰岛素泵组患者AIR、HomaB较多次胰岛素注射A、B组显著性升高（P〈0．01）,三组患者的Homα IR治疗后差异无统计学意义（P〉O．05）。结论对于初诊2型糖尿病患者,短期胰岛素泵强化治疗和多次皮下注射胰岛素治疗均能很好控制患者血糖水平,但是胰岛素泵治疗可以显著改善T2DM患者的胰岛β细胞功能。