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1.
目的分析和研究糖尿病病人外科手术中不同麻醉方法的运用效果。方法通过选取2012年5月—2014年5月期间,于该院进行外科手术的27例糖尿病患者,将其分为2组,A组13例,采用全身麻醉法进行手术,B组14例,采用硬膜外麻醉法进行手术,对比2组患者术后血糖情况。结果 A组经全身麻醉后,术后1 h血糖为(13.4±2.6)mmol/L,术后24 h血糖为(16.4±2.3)mmol/L;B组经硬膜外麻醉后,术后1h血糖为(12.2±2.3)mmol/L,术后24h血糖为(13.4±2.4)mmol/L。B组血糖控制效果优于A组,2组差异具有统计学意义(P0.05)。结论全身麻醉与硬膜外麻醉用于糖尿病患者施行外科手术,均能起到在术后控制患者血糖的作用,但硬膜外麻醉相对于全身麻醉血糖控制效果更好,更值得推广。  相似文献   

2.
目的探讨糖尿病患者经皮肾镜碎石术的麻醉方法与麻醉效果。方法选择2015年8月—2017年10月期间在该院择期行经皮肾镜碎石术的78例2型糖尿病患者作为研究对象,随机分为对照组和观察组,各39例。观察组患者采用连续硬膜外麻醉,对照组气管插管静吸复合全麻,对比分析两组术前、麻醉后30 min、60 min及术毕时刻血糖指标情况,并观察两组患者术中及术后不良反应情况。结果术前和术毕时刻,观察组和对照组血糖指标比较差异无统计学意义(P0.05)。麻醉后30 min和60 min,观察组血糖指标(8.36±1.12)、(8.46±1.46)mmol/L显著高于对照组(7.34±1.38)mmol/L、(6.98±1.23)mmol/L,组间差异有统计学意义(P0.05)。全部患者麻醉效果确切,顺利完成手术。对照组麻醉期间不良反应发生率(12.82%)显著高于观察组(2.56%),组间差异有统计学意义(P0.05);无严重麻醉并发症、酮症酸中毒等糖尿病并发症发生。结论糖尿病患者经皮肾镜碎石术中采用连续硬膜外麻醉效果较好,既可维持血糖稳定性,又可降低不良反应风险,值得参考借鉴。  相似文献   

3.
目的分析剖宫产术前禁食禁饮时间对妊娠期糖尿病产妇及新生儿血糖的影响。方法选择该院在2017年10月—2019年10月收治的86例妊娠期糖尿病产妇,依据术前禁食禁饮时间分组,常规组43例产妇术前8 h禁食,6 h禁饮,试验组的43例产妇术前4 h禁食,2 h禁饮,比较两组产妇及新生儿的血糖和妊娠结局。结果术前,试验组产妇血糖为(5.62±0.39)mmol/L,常规组产妇血糖为(5.64±0.47)mmol/L,两组差异无统计学意义(P0.05)。术后,试验组产妇血糖为(6.81±0.53)mmol/L,新生儿血糖为(4.71±1.16)mmol/L;常规组产妇血糖为(8.22±0.54)mmol/L,新生儿血糖为(4.03±1.21)mmol/L,差异有统计学意义(P0.05)。试验组产妇术后高血糖的共2例,新生儿低血糖的共1例,不良妊娠结局发生率为6.98%(3例);常规组产妇切口感染的共2例,术后高血糖的共4例,新生儿低血糖的共4例,不良妊娠结局发生率为23.26%(10)例,差异有统计学意义(P0.05)。结论在剖宫产术前缩短禁食禁饮时间,可让产妇及新生儿保持稳定的血糖状态,不良妊娠结局发生率得到显著降低。  相似文献   

4.
目的探究全身麻醉、硬膜外麻醉对糖尿病患者围手术期血糖的影响,为临床提供指导。方法以2015年10月—2018年4月该院收治的108例糖尿病患者为观察对象,结合麻醉方式的不同将其分为全麻组(58例,应用全身麻醉)、硬膜外麻醉组(50例,应用硬膜外麻醉)。研究对比全麻组和硬膜外麻醉组患者的血糖水平、血流动力学水平及胰岛素使用剂量。结果硬膜外麻醉组手术结束时血糖(8.10±0.18)mmol/L、术后3 h血糖(13.36±2.06)mmol/L、术后23 h血糖(12.56±3.80)mmol/L相比全身麻醉组明显更低(P0.05);硬膜外麻醉组患者手术开始时、手术结束时MAP、HR相比全麻组明显更低(P0.05);硬膜外麻醉组患者胰岛素使用剂量(20.24±2.35)U相比全麻组(27.24±2.58)U明显更少(P0.05)。结论相比于全身麻醉,硬膜外麻醉对糖尿病患者围手术期血糖的影响更小,安全性更高。  相似文献   

5.
目的:比较腰麻与骶管麻醉在肛门手术中的效果.方法:回顾性分析2008-09/2012-05应用腰麻及骶管麻醉行肛门手术病例共74例,36例采用腰麻(腰麻组),38例采用骶管麻醉(骶麻组).两组性别、年龄、病种分类及手术时间等资料相比,P>0.05.比较两组麻醉效果、起效时间、术中心血管系统不良反应情况、术后尿潴留的发生、术后感觉恢复时间.结果:腰麻组与骶麻组麻醉效果满意率分别为95%和79%(P<0.05),腰麻组与骶麻组术中心血管系统不良反应的发生率分别为30.6%和5.3%(P<0.01),腰麻组与骶麻组的平均麻醉起效时间分别为1.98min和8.99min(P<0.01),腰麻组与骶麻组分别发生尿潴留4例、3例(P>0.05),腰麻组与骶麻组术后平均感觉恢复时间分别为324min和288min(P>0.05).结论:肛门手术中应用腰麻效果优于骶管麻醉,但术中应密切监测血压、心率情况,及时处理血流动力学的改变.  相似文献   

6.
目的探讨呼吸三通管联合呼吸胸廓带对右美托咪啶麻醉下胃镜诊疗患者应激反应及疼痛程度的影响.方法选择2014-05/2016-05行右美托咪啶麻醉下胃镜诊疗的106例患者为研究对象,采用随机数字表法分为观察组和对照组各53例.对照组采用面罩给氧,观察组联合呼吸三通管和呼吸胸廓带给氧,比较两组应激反应、疼痛程度与体动分级、并发症等指标.结果胃镜经过咽喉部时(T2),观察组血糖(BG)、肾上腺素(E)、皮质醇(Cor)均明显低于对照组(5.82 mmol/L±0.74 mmol/L vs 6.35mmol/L±0.91 mmol/L、83.46 pg/m L±8.15pg/m L vs 90.65 pg/m L±9.47 pg/m L、188.49ng/m L±13.67 ng/m L vs 237.82 ng/m L±24.34ng/m L,P0.05);术毕时(T3),观察组的直观模拟标尺评分明显低于对照组(1.86分±0.27分vs 2.41分±0.53分,P0.05),体动分级Ⅰ级者明显高于对照组,Ⅲ级者明显低对照组(P0.05);观察组心动过速等并发症明显低于对照组(9.43%vs 30.19%,P0.05).结论呼吸三通管联合呼吸胸廓带有助于抑制右美托咪啶麻醉下胃镜诊疗患者机体应激反应,缓解疼痛程度,降低并发症发生几率.  相似文献   

7.
目的探讨子宫肌瘤合并糖尿病患者采用手术室护理干预的价值。方法选择2016年3月—2017年10月期间在该院择期行手术治疗的76例子宫肌瘤合并糖尿病患者,随机分为对照组和观察组,各38例。对照组术前严格控制血糖指标,并常规行子宫肌瘤围术期护理,观察组增加综合化手术室护理,对比两组围术期血糖指标变化,并比较两组手术时间和住院时间。结果观察组麻醉前血糖指标(8.36±1.04)mmol/L和术后2 h血糖指标(8.25±1.38)mmol/L与对照组[(8.67±1.13)mmol/L、(8.31±1.23)mmol/L]比较,差异无统计学意义(P0.05)。观察组术中血糖指标(7.87±1.36)mmol/L及术毕血糖指标(7.56±1.23)mmol/L均显著低于对照组[(9.12±1.44)mmol/L、(8.95±1.39)mmol/L],差异有统计学意义(P0.05)。观察组手术时间为(69.13±17.51)min,对照组为(82.24±18.03)min,差异有统计学意义(P0.05)。观察组住院时间为(4.23±1.25)d,对照组为(5.78±1.83)d,差异有统计学意义(P0.05)。结论子宫肌瘤合并糖尿病术中应用综合化手术室护理有助于术中血糖控制,并缩短了手术与住院时间,有助于改善患者预后,降低手术护理风险。  相似文献   

8.
目的探讨早期肠内营养支持在糖尿病合并消化道肿瘤患者术后的护理措施。方法从该院收治的糖尿病合并消化道肿瘤患者中随机选取38例,患者术后24 h实施早期肠内营养支持,观察患者实施早期肠内营养支持前后营养评定指标、免疫指标、生化指标的变化。实施护理干预措施,对患者血糖进行监测控制。结果实施早期肠内营养支持后,无1例患者出现死亡、并发症现象,仅有6例患者存在腹泻现象,针对处理后明显好转。84.21%(32/38)患者平均血糖保持为(7.9±0.7)mmol/L,比较稳定。所有患者在实施早期肠内营养支持后5 d和8 d,血清白蛋白、前清蛋白、转铁蛋白、IgG、IgA、IgM等指标与实施前相比较有显著提高(P0.05);患者的丙酸氨基转移酶、总胆红素指标没有明显变化(P0.05)。结论合并糖尿病消化道肿瘤患者术后实施早期肠内营养支持,并对患者的血糖变化进行全面监测,加上良好的护理,能有效减少手术及糖尿病并发症的发生,有利于患者恢复。  相似文献   

9.
目的:探讨三种消化道重建术对非肥胖性2型糖尿病患者糖脂代谢的影响.方法:回顾性分析2008-02/2011-05在甘肃省人民医院普外科接受BillrothⅠ术(10)、BillrothⅡ术(13)和Roux-en-Y术(16)治疗的39例合并有2型糖尿病患者临床资料,比较3组手术治疗非肥胖性2型糖尿病的临床结局.结果:39例患者术后均无严重并发症,3组术式术前与术后检测指标比较空腹血糖、糖化血红蛋白、总胆固醇、甘油三酯和低密度脂蛋白下降分别为2.6mmol/L±0.7mmol/L、2.1%±0.7%、1.5mmol/L±0.5mmol/L、0.8mmol/L±0.3mmol/L和1.0mmol/L±0.4mmol/L,高密度脂蛋白、空腹胰岛素和空腹C肽增高分别为0.3mmol/L±0.07mmol/L、6.1mU/L±3.2mU/L、0.28nmol/L±0.06nmol/L.3组术式组内比较差异有统计学意义(P<0.05).3组术式组间比较,Roux-en-Y术组术后空腹血糖、糖化血红蛋白、甘油三酯和低密度脂蛋白均降至正常,与其他两组组间比较差异有统计学意义(P<0.05).术后在不需要药物和饮食控制的情况下BillrothⅠ术、BillrothⅡ术和Roux-en-Y术改善患者糖脂异常的有效率分别为40.0%、69.2%和81.3%.结论:三种消化道重建术可改善非肥胖性2型糖尿病患者糖脂代谢异常,机制尚不完全明确.  相似文献   

10.
目的总结分析硬膜外麻醉和全身麻醉对2型糖尿病患者围手术期血糖的影响。方法随机选取该院2014年2月1日—2015年1月1日期间的2型糖尿病患者围手术期患者,其中,30例接受全身麻醉的患者被设为对照组,30例接受硬膜外麻醉的患者被设为试验组,观察、比较两组患者的血糖情况。结果试验组手术切皮充CO2气腹时、手术结束时的血糖(8.5±1.5)mmol/L、(8.2±2.2)mmol/L均优于对照组(12.4±2.5)mmol/L、(11.5±2.3)mmol/L,差异具有统计学意义(P0.05);试验组手术后3 h、23 h血糖(13.3±2.3)mmol/L、(12.5±2.5)mmol/L均优于对照组(15.4±5.4)mmol/L、(16.3±2.9)mmol/L,试验组胰岛素用量(20.2±4.2)U优于对照组(27.1±6.3)U,差异均具有统计学意义(P0.05)。结论 2型糖尿病经硬膜外麻醉的围手术期血糖情况显著优于全身麻醉,减少胰岛素用量,可考虑于临床中合理推广。  相似文献   

11.
The immunoneuroendocrine role of melatonin   总被引:19,自引:0,他引:19  
Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.  相似文献   

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Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.  相似文献   

14.
Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.  相似文献   

15.
Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.  相似文献   

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Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the Mr range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [125I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (Ka of 4.7 ± 0.2 × 109 M-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of Mr 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.  相似文献   

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20.
PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.  相似文献   

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