东菱克栓酶治疗短暂性脑缺血发作的临床分析

短暂性脑缺血发作（transient ischemic attack，TIA）近年来发病率逐年增高，发病年龄也出现年轻化。频繁发作的TIA更是神经内科的急症，迅速终止TIA是防治缺血性脑血管病的一项重要原则。东菱克栓酶（（DF-521））为一种单一成分的酶制剂，能明显降低纤维蛋白原、迅速控制TIA发作，疗效确切。我院于2004年3月至2006年3月应用DF-521治疗TIA患者38例，取得了较好的疗效。现报告如下。     

东菱克栓酶治疗脑梗塞对血流变性的影响

目的对脑梗塞患者应用东菱克栓酶治疗前后 ,观察血流变的变化 ,进一步分析血流变对诊断治疗预防脑梗塞的临床意义。方法随机选择38例脑梗塞患者 (男20例 ,女18例 )在发病72h之内给予东菱克栓酶 (DF -521)治疗 ,检测治疗前后血流变指标。正常对照组是相似年龄的38人 (男21例 ,女17例 )。结果脑梗塞组治疗前血流变各项指标均显著高于对照组 (P<0.05) ,治疗后血流变各项指标均显著性降低 (P<0.05) ,其中纤维蛋白原下降幅度较大 (P<0.001)。结论东菱克栓酶主要作用是降低纤维蛋白原含量 ,改善微循环 ,促进血栓溶解     

东菱精纯克栓酶治疗急性脑梗死的疗效观察

我科2005年2月至7月应用东菱精纯克栓酶治疗40例急性脑梗死患者取得显著疗效，现报告如下：     

东菱精纯克栓酶对人胃癌及鼻咽癌荷瘤裸鼠转移及血液流变学的影响

目的：观察东菱精纯克栓酶对胃癌及鼻咽癌荷瘤裸鼠转移及血液流变学的影响。方法：用人胃癌及鼻咽癌细胞株分别接种裸鼠背部皮下,同时每周二次裸鼠腹腔内注射东菱精纯克栓酶,７０天处死裸鼠,观察裸鼠转移情况及血液流变学变化结果,东菱精纯克栓酶治疗组,胃癌及鼻咽癌荷瘤裸鼠的转移率均明显低于对照组,差异有显著性意义（Ｐ＜０．０５）。结论：东菱精纯克栓酶对胃癌及鼻咽癌荷瘤裸鼠转移能力有明显的抑制作用,并能降低血液和粘度。     

东菱克栓酶对大鼠急性肠系膜微动脉血栓溶栓作用的实验研究

目的 探讨东菱克栓酶（ＤＦ－５２１）对在鼠肠系膜微动脉血栓的溶栓时间和机制。方法 采用光化学诱导法和静脉注射荧光素钠制作大鼠肠系膜微动脉血栓模型,经显微电视摄像系统和多媒体计算机图像处理技术相结合,定量分析不同剂量组ＤＦ－５２１的溶栓时间以及血管再通程度。     

东菱克栓酶治疗高纤维蛋白原血症的甲襞微循环观察

目的 :探讨东菱克栓酶对高纤维蛋白原血症的甲襞微循环的影响。方法 :使用东菱克栓酶治疗高纤维蛋白原血症 ,应用田氏甲襞微循环综合定量评分方法 ,观察治疗前后的甲襞微循环。结果 :高纤维蛋白原血症治疗前甲襞微循环的总积分值及流态、袢周状态积分值明显高于治疗后 ,治疗前后比较具有显著性差异 (P <0 .0 5 )。结论 :东菱克栓酶可以有效地改善高纤维蛋白原血症的甲襞微循环。     

东菱精纯克栓酶对人胃癌及鼻咽癌荷瘤裸鼠转移及血液流变学 …

目的；观察东菱精纯克栓酶对胃癌及鼻咽癌荷瘤裸鼠转移及血液流变学的影响。方法：用人胃癌及鼻咽癌细胞株分别接种裸鼠背部皮下，同时每周二次裸鼠腹腔内注射东菱精纯克栓酶，７０天处死裸鼠，观察裸鼠转移情况及血液流变学变化结果，东菱精纯克栓酶治疗组，胃癌及鼻咽癌荷瘤裸鼠的转移率均明显低于对照组，差异有显著性意义。     

不同时间窗东菱克栓酶治疗缺血性脑卒中的临床观察

目的通过不同时间窗观察东菱克栓酶对脑梗塞患者的疗效及不良反应，寻找该药治疗脑梗塞的最佳时间及可能避免继发出血的方法。方法将５０例脑梗塞患者随机分成治疗组及对照组。治疗组按不同时间窗分３组（１２内，１２～７２ｈ，７２ｈ～ ７ｄ）。治疗组给予东菱克栓酶 ３０ＢＵ治疗（第 １，２，３．４ｄ分别用 １０ＢＵ，１０ＢＵ，ＳＢＵ，ＳＢＵ），对照组用低分子右旋糖酐和丹参治疗。观察各组疗效及不良反应，并做实验室及影像学检查。结果各时间窗疗效较对照组均有显著差异。治疗组ＦＩＢ明显降低，而对其他凝血指标无明显影响。结论１周内使用东菱克栓酶均有明显效果，使用２０ＢＵ后，及时复查ＦＩＢ并调整用药可减少出血倾向。     

结缔组织病患者用蝮蛇清栓酶前后血液流变学及前列腺素的变化

用蝮蛇清栓酶治疗结缔组织病患者１００例，并于治疗前后检测患者的血液流变学，血栓弹力图，血纤维蛋白原，ＴＸＢ２和６－ｋ－ＰＧＦ１α。结果表明蝮蛇清栓酶治疗前结缔组织病患者均有血粘滞度增高，治疗后明显改善。临床疗效观察表明蝮蛇清栓酶对干燥综合征和硬皮病有一定的疗效，而对皮肌炎无效。     

东菱克栓酶治疗急性脑梗死凝血与纤溶系统的研究

目的探讨东菱克栓酶治疗急性脑梗死对凝血与纤溶系统的影响及意义。方法检测3C例急性脑梗死患者治疗前后凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fg)、D-二聚体水平。正常对照组20人。结果脑梗死患者组治疗前跟正常对照组相比各项指标均有显著性差异(P<0.05),脑梗死患者组PT、APTT较短,纤维蛋白原含量较高,D-二聚体稍有增加;治疗后与治疗前相比PT、APTT明显延长,纤维蛋白原大幅降低,D-二聚体含量大幅增加(P<0.01)。结论 脑梗死患者体内呈高凝状态,导致血栓形成。用东菱克栓酶治疗后,使高凝变为低凝,激活纤溶系统,从而栓予溶解及血管再通。凝血和纤溶系统在整个疾病过程中起到了中间环节的作用,观察凝血和纤溶系统的变化对诊断及治疗脑梗死具有重要的临床意义。     

Qualitative Content Analysis of Complementary Topical Therapies Used to Manage Diabetic Foot in Jordan

In order to alleviate diabetic foot problems, patients sometimes seek complementary therapies outside the professional context. This paper describes the use of complementary remedies as a topical treatment for diabetic foot ulcers among Jordanians. Qualitative content analysis was used to analyse written responses of 68 patients with diabetes who have used complementary therapies to treat diabetic foot problems. These 68 persons represented a subgroup of the study population surveyed using a questionnaire, to the effect of investigating diabetic foot treatments provided in Jordan. Informants were recruited from eight healthcare facilities established in the southern part of Jordan plus from one hospital established in the Jordanian capital. The study was approved by the Boards of Ethics of the participating healthcare facilities. Content analysis yielded the category “Complementary Therapies Used”, which included a range of household items (olive oil, sesame oil, honey, and vinegar), and also some indigenous Jordanian herbs (Wormwood, Myrrh, Caper, and Henna among others). The remedies were used either as a monotherapy or as mixtures, to the common goal of treating diabetic foot problems. Other interventions like Al-cowy were also sought from traditional healers. Educational campaigns are required to increase the awareness of patients and their families on possible hazards of unwise complementary therapy use. The decisions on the use of such therapies should be made in agreement with the attending healthcare professionals.     

2型糖尿病患者糖尿病足的相关危险因素分析

目的 探讨2型糖尿病患者糖尿病足的危险因素。方法 对2004年3月至2008年1月深圳市人民医院497例2型糖尿病患者（糖尿病足组56例、非糖尿病足组441例）的临床资料和生化指标进行回顾性分析，包括病人性别、年龄、病程、体重、血压、吸烟史、高血压病史、周围神经病变、视网膜病变、外周血管病变等。然后进行多因素非条件Logistic回归分析。结果 糖尿病足组和非糖尿病足组相比．年龄、平均动脉压、空腹血糖、餐后2h血糖、血胆固醇、血甘油三酯、估测的肾小球滤过率（eGFR）、高血压病史、周围神经病变史、外周血管病、视网膜病变差异有统计学意义（P〈0．05）。结论 周围神经病变、外周血管病变、糖尿病肾病是糖尿病足发生的独立危险因素。     

The Association between Cognitive Impairment and Diabetic Foot Care: Role of Neuropathy and Glycated Hemoglobin

Diabetes mellitus is associated with impairment in cognitive functions which can complicate adherence to self-care behaviors. We evaluated the incidence of cognitive impairment in patients with diabetes mellitus to determine the strength of the association between diabetic foot (a complication that occurs in about 10% of diabetic patients), adherence to the clinician’s recommendations, glycemic control, and cognitive function. A prospective study was carried out in a probabilistic sample of older patients with diabetic foot living in three nursing homes. Cognitive functions were evaluated by the MMSE (Mini-Mental State Examination), the Trail Making test (TMT), and the Michigan neuropathy screening instrument (MNSI). There were no significant associations between cognitive function and neuropathy or foot alterations, although glycated hemoglobin (HB1Ac > 7%) significantly (p < 0.05) associated with MMSE and adherence to treatment in the 1 month follow-up visit. Receiver operating characteristic curve analysis showed that both HB1Ac and the MNSI score significantly (p < 0.05) discriminate subsequent adherence to treatment for foot complication, with a sensitivity of 80.0–73.3% and specificity 70.6–64.7%, respectively. Proper control of foot complications in diabetic patients involves appropriate glycemic control and less severe neuropathy, and seems to be unrelated to cognitive dysfunction, and warrants further studies in order to tailor appropriate treatments to central and peripheral nervous system disorders. Poor glycemic control (Hb1Ac level > 7%) and a neuropathy score of 5.5 in the MNSI are the best-cut off points to discriminate poor adherence to the clinician’s recommendations for self-care behaviors in people with diabetic foot complication. In this study, we observed that foot disorders were associated with impaired global cognitive function in elderly patients (aged ≥ 65). Podiatrists and physicians should consider cognitive dysfunction as an important chronic complication in the management of diabetic foot.     

卡维地洛治疗高血压病血液流变学变化观察160例

目的:观察卡维地洛治疗高血压血液流变学变化的疗效,方法:选择轻、中度高血压病144例,分治疗对照组,治疗组服用卡维地洛观察6周对照组,美托洛尔同样服用6周,两组同时观察血液流变学,血压、心率等变化,观察卡维地络疗效。结果:口服卡维地洛后血液流变学各项指标均有改变,对轻、中度高血压与美托络尔对照疗效明显,总有效率为 90％。结论:表明卡维地洛降压对轻、中度高血压疗效肯定并有降粘作用。     

糖尿病足伤口处理中的护理风险及其相关性研究

目的 探讨影响糖尿病足伤口处理中护理风险的相关因素,为降低护理风险所采取的护理措施提供理论依据。方法 采用自行设计的一般资料调查表、护理风险表对在本院门诊就诊的79例2型糖尿病足患者进行问卷调查,并分析影响糖尿病足伤口处理中护理风险的相关因素。结果 护理差错缺陷率为0.62%,愈合率为88.61%,满意度为93.67%。患者年龄、文化程度、糖尿病治疗情况、对糖尿病足认识程度、就诊情况及伤口治疗情况与护理差错缺陷率、伤口愈合情况和满意度有相关性（P＜0.05）;吸烟与伤口愈合情况有相关性（P＜0.05）;并发糖尿病其它并发症与护理差错缺陷率有相关性（P＜0.05）。结论 年龄越大、文化程度越低、不坚持糖尿病治疗、对糖尿病足认识模糊、有伤口不及时就诊和不坚持伤口治疗、吸烟及并发糖尿病其它并发症的糖尿病足患者护理风险高,在制定护理风险管理措施时,应根据患者具体情况,规避不利因素,以降低护理差错缺陷率、提高治愈率及患者的满意度。     

Risk Factors Associated with Amputation-Free Survival in Patient with Diabetic Foot Ulcers

Purpose

To determine the 1-year survival rate, 1-year amputation-free survival rate and the risk factors of amputation for patients with diabetic foot ulcers.

Materials and Methods

One hundred seventy-three patients with diabetic foot ulcers were included in our study. Mean patient age was 67.5 (range, 29 to 87, SD ±11.4) years. 74% of the patients were male. Time from study entry to amputation and time to death were evaluated separately as censored event times by Kaplan-Meier curves and log-rank tests. A multivariate Cox proportional hazards regression analysis was carried out for determining the risk factors of amputation.

Results

The survival rate and amputation-free survival rate were 96.5% (n=167), 65.9% (n=114), respectively, over one year study period. Severity of ulcer was the strongest significant risk factor of amputation [hazard ratio (HR): 7.99; confidence interval (CI): 3.12 to 20.47]. Peripheral artery disease was also independent risk factor of amputation (HR: 2.64; CI: 1.52 to 4.59).

Conclusion

In assessing the prognosis of diabetic foot ulcers, clinicians should consider the severity of ulcer and presence of peripheral artery disease. Our study provides important insights into clinical practice and supplementary information for both physicians and patients.     

VSD负压封闭引流在治疗糖尿病足中的护理观察

目的探索VSD负压引流术治疗糖尿病足的护理。方法回顾性分析我院2012年1月~2014年6月共收治的治糖尿病足患者2l例。结果持续负压吸引引流是种全方位引流方法治疗,具有引流管不容易被堵塞,操作方便、简单易行等优点。结论持续负压吸引引流对于糖尿病足创面引流效果好,创面愈合快。     

促血管生成因子对糖尿病足作用机制的研究进展

糖尿病足是继发于糖尿病终末期的下肢溃疡缺血性疾病。促血管生成因子在糖尿病下肢缺血性疾病中的作用机制十分复杂,不同促血管生成因子发挥的作用不尽相同。在缺血损伤区域的修复过程中,促血管生成因子的表达上升,参与组织缺血损伤区血管结构的重建,改善局部血液循环,使组织缺血损伤得到修复。病理情况下,促血管生成因子参与炎症级联反应,与缺血/再灌注损伤关系密切,还可能诱导硬化斑块破裂、增加能量的代谢消耗,产生不利影响。近年来,随着再生医学研究的深入,促血管生成因子开始应用于糖尿病足的治疗中,逐渐成为糖尿病足新的治疗靶点。     

基于VAS评分改进的护理模式对糖尿病足患者的影响

目的 探讨视觉模拟评分在糖尿病足患者护理中的应用效果。方法 选取2016年1月~2017年3月对84例糖尿病足患者进行常规护理的同时采用VAS量表进行疼痛评分,根据评分结果给予及时有效的护理,观察患者护理干预前后疼痛程度、血糖达标率以及满意度情况。结果 干预后患者疼痛症状1~3分者占64.29%,4~6分者占29.76%,7~9分者占5.95%,无疼痛症状10分者,疼痛程度较干预前减轻,差异具有统计学意义（P＜0.05）。干预后血糖达标率和满意度分别为85.71%和94.27%,均高于干预前的8.33%和65.12%,差异具有统计学意义（P＜0.05）。结论 采用VAS评分改进的护理模式,可以有效改善糖尿病足患者的疼痛症状,控制血糖水平,提高其生活质量。