987例住院2型糖尿病患者糖化血红蛋白控制现状及慢性并发症的流行病学调查

【目的】了解武汉市住院糖尿病（DM）患者并发症的流行病学及糖化血红蛋白（HbA1c）控制现状。【方法】对1075例住院DM患者进行调查,收集资料,并对987例住院2型糖尿病（T2DM）患者的HbA1c控制现状及慢性并发症发病率进行调查。[结果]T2DM患者占DM总人数的96．39％,平均HbA1c水平为9．20％。其中≤7％的患者仅占23．81％,而高达34．95％的患者HbA1c水平〉10％。合并糖尿病酮症（酸中毒）等急性并发症占11.04％;糖尿病肾病占29．69％;糖尿病视网膜病变占11．04％;下肢血管病变占62．41Vo;周围神经病变占39．01％;糖尿病足占3．14％;慢性并发症总患病率达79．03％。另合并高血压病占52．08％;冠心病占12．16％;脑梗死占21．28％;高脂血症占51．27％;高尿酸血症占8．11％;白内障占15．50%。【结论】糖尿病患者慢性并发症发病率高,且HbA1c水平控制差,糖尿病防治任重道远。     

新诊断2型糖尿病慢性并发症临床调查

【目的】探讨糖尿病（DM）慢性并发症发生情况及临床特点,以加强早期防治。【方法】对2008年3月至2009年2月在辽宁中医药大学附属医院、中国医科大学附属第四医院内分泌科住院治疗,并且在1年内确诊患2型糖尿病（T2DM）的80例新诊断T2DM患者患DM并发症情况进行调查。【结果】新诊断T2DM的并发症以周围神经病变（39．00％）和高血压为主（36．50％）。未发现患DM并发症者39例（48．75％）,19例（23．75％）患二种并发症。【结论】新诊断T2DM患者并发症以高血压和周围神经病变为主,临床上应注意早期防治。     

老年人糖尿病慢性并发症临床分析

目的研究老年人T2DM慢性并发症原因，为老年人T2DM早期诊断，合理有效治疗及并发症的预防提供线索。方法应用回顾性调查分析。结果1997～2007年老年人T2DM463例，其中有慢性并发症195例（占44．5％）；2种并发症34例（17.4％），3种者109例（56％），52例（26．6％）有4种以上并发症。高血脂症、高血压、糖尿病肾病、冠心病、脑梗塞等为最常见并发症。典型临床症状少（22例），首诊确诊率低（32例），漏、误诊率高（88例），正确合理用药少（9例），81％的老年人T2DM患者不能合理膳食，大多数老年人T2DM患者不运动及糖尿病知识贫乏。结论老年人T2DM慢性并发症发生率高，原因是多方面的。     

老年人群代谢综合征调查分析

目的：调查老年体检人员代谢综合征（MS）及其相关疾病的患病情况。方法：检测559例体检人员的身高、体重、腰围、血压、心率、体重指数（BMI）、空腹血糖、总胆固醇、甘油三脂、高密度脂蛋白等指标，并对调查结果进行统计分析。结果：老年男性MS发病率为14．15％，60-70岁组的MS发病率为最高，达22．41％；老年女性MS发病率为20．56％，80岁以上的发病率较高，达30．43％。在MS各种组合中，男性和女性均以肥胖＋高血压＋高血脂这种组合比例最大，占40％以上。MS患者伴发脂肪肝、糖尿病、高血压的比例均高于非代谢综合征的患者（P〈0．05，P〈0．01）。脂肪肝（OR=4．287，95％CI：1．737～10．583，P=0．002）、腰围（OR=3．783，95％CI：1．019～14．050，P=0．047），脂肪肝和腰围与MS密切相关。结论；本次调查显示老年人MS发病率有增高趋势，最多见的表现形式为肥胖＋高血压＋高血脂组合，MS合并脂肪肝、糖尿病、高血压的比例亦有增高，脂肪肝和腰围对MS具有显著危险性。     

糖尿病合并亚临床甲状腺功能减退症的研究进展

糖尿病及甲状腺疾病均是常见的内分泌代谢性疾病,糖尿病患者合并甲状腺疾病的发病率较健康人群高4．8％～31．4％［1］。1型糖尿病（T1DM ）患者易合并自身免疫性甲状腺疾病（AITD）的机制与二者享有共同的遗传易感基因 HLA-DR3、CTLA4、PTPN22有关［2］。2型糖尿病（T2DM ）患者甲状腺疾病发病风险增高的机制尚不清楚,可能与 T2DM 患者存在一定程度的免疫系统异常有关。亚临床甲状腺功能减退症（以下简称亚临床甲减）是最常见的甲状腺疾病,发病率为4．3％左右。多项研究显示,T2DM 患者合并亚临床甲减的发病率可高达10．7％～22．4％,且女性患者发病率高于男性［3-4］。亚临床甲减可影响糖尿病患者体内糖、脂代谢,胰岛素抵抗程度及心血管疾病发病风险,并可能与糖尿病微血管并发症的发生有关。本文就糖尿病合并亚临床甲减的研究进展进行综述。     

老年人2型糖尿病就诊分析

目的：寻找老年人2型糖尿病的早期诊断方法及误诊原因。方法：分析我院近三年来收治住院的60岁以上2型糖尿病患者47例。结果：单纯高血糖住院者9例，占19．1％；有并发症或合并症住院者38例，占80．9％；并发症或合并症分别以高血压、脑梗塞、高脂血症、末梢神经炎者居多，其中有的患者有几种并发症。结论：2型糖尿病是老年患者常见病，早期症状并不典型，“大肚子细腿”为糖尿病高危人群的中国标志，定期检查血糖可早期诊断，做好糖尿病人自我管理十分重要。     

女性2型糖尿病患者合并无症状菌尿的临床特点及防治

目的 探讨影响女性2型糖尿病患者合并无症状菌尿的临床特点及防治措施。方法 分析300例女性2型糖尿病患者(75例伴无症状菌尿，225例不伴有无症状菌尿)和100例正常对照组的临床特点。结果 女性2型糖尿病合并无症状菌尿的发病率为25％；与无症状菌尿有关的危险因素包括年龄、病程、血糖水平、高脂血症、糖尿病神经病变、大血管疾病等；糖尿病合并无症状菌尿的病原微生物主要以大肠埃希氏菌为主。结论 女性2型糖尿病患者合并无症状菌尿的发病率较高，可能是糖尿病慢性并发症的一个组成部分。     

100例老年慢性阻塞性肺疾病急性加重的临床分析

目的：探讨老年慢性阻塞性肺疾病（COPD）急性加重的发生，发展及治疗。方法：2003年9月到2004年2月，我院65岁以上的老年COPD急性加重的住院患者。结果：100例中合并慢性肺源性心脏病59例、冠心病17例、厚发性高血压41例、合并高血压性心脏病12例、糖尿病14例、老年瓣膜性心脏病7例；发生心衰52例、呼吸衰竭37例、肾功能不全23例、肝功能不全8例、心律失常7例；其中合并1种其他脏器病变的患者24例，合并2种其他脏器病变的患者33例，合并3种及3种以上其他脏器病变的患者37例；死亡8例。合并1种其他脏器病变（1例）12．5；2；，合并2种其他脏器的病变（2例）25％，合并3种及3种以上其他脏器的病变（5例）62．5j}；；死亡组与非死亡组患者入院时的血白细胞，动脉血气等实验室指标比较，统计测定显著性差异。结论：老年呼吸道防御功能下降招致呼吸道反复感染，可能是老年人COPD发病率增加的原因；老年COPD病患者多合并呼吸，心脏和其他脏器的病变；急性加重患者的处理，应在积极抗感染的同时注意其他脏嚣合并症功能衰竭的治疗。     

血压水平与2型糖尿病患者微血管和大血管并发症发生的关系

目的：检测2型糖尿病合并高血压和糖尿病血压正常患者体质量指数、凝血状态等指标，了解两类患者心脑血管及微血管并发症的发生率。 方法：选择2000—01／2003—06在南京医科大学第一附属医院门诊及内分泌住院的2型糖尿病患者1231例，糖尿病合并高血压组502例；糖尿病血压正常组729例。观察所有患者的病程及体质量指数；所有患者均清晨空腹静脉采血，测定体外血栓形成试验；检测尿白蛋白／肌酐比值。统计冠心病、脑血管病及视网膜病变的发生率。 结果：1231例患者均进入结果分析。①病程比较：糖尿病合并高血压组明显高于糖尿病血压正常组[男：（5．76&;#177;0．39,4．57&;#177;0.49），F=28．71,P〈0．05；女：（5．58&;#177;0．69，4．55&;#177;0．31），F=28．71，P〈0．05]。②体质量指数比较：糖尿病合并高血压组明显高于糖尿病血压正常组[男：（24．76&;#177;0．46,20．11&;#177;0．76）。F=20．40，P〈0．05；女：（24．03&;#177;0．22，21．23&;#177;1．43），F=20．40，P〈0．05]。③血栓长度比较：糖尿病合并高血压组和糖尿病血压正常组均明显高于正常参考值（26．14&;#177;4．54，24．35&;#177;2．69，8.26&;#177;1．56，F=54．81。P〈0．05）。④冠心病、脑血管疾病及视网膜病变发生率比较：糖尿病合并高血压组明显高于糖尿病血压正常组[（10．96，5．08）％，（12．55，6．45）％，（23．51，14．68）％，χ^2=14．42，13．20，15．05，P〈0．01]。⑤尿白蛋白／肌酐阳性率比较：糖尿病合并高血压组明显高于糖尿病血压正常组（25．14％，11．80％，在35．79，P〈0．01）。 结论：与血压正常患者比较，2型糖尿病合并高血压患者的病程更长，心脑血管并发症、糖尿病视网膜病变及肾脏病变发生率均显著升高，因此应强化降压治疗，使糖尿病并发症的发生率和危害性降到最低水平。     

糖尿病合并代谢综合征564例报告

目的 探索糖尿病（DM）合并与未合并代谢综合征（MS）时各并发疾病的变化情况。方法 采用回顾法,将我院2002年1月～2005年7月收治的DM患者资料进行整理和统计。结果 DM合并MS的发病率为80．1％,DM合并与未合并MS各并发疾病的发病率比较：血脂紊乱：59．2％、38．6％（P〈0．001）;超重或肥胖：56．6％、34．3％（P〈0．001）;高血压：53．7％、30．7％（P〈0．001）;冠心病：59．4％、29．3％（P〈0．001）;心肌梗死：8．5％、3．6％（P〈0．05）;脑梗死：14．9％、7．9％（P〈0．05）;脑出血：8．7％、3．6％（P〈0．05）;病死率：4．8％、0．7％（P〈0．05）。DM病程5～年新增MS发病率最高为33．7％。60～岁年龄段DM并发MS发病率最高为91．1％,结论 DM合并与未合并MS比较,血脂紊乱、超重或肥胖、高血压、冠心病的发病率极度上升（P〈0．001）;心肌梗死、脑梗死、脑出血、病死率上升幅度没有以上并发疾病高,但也有明显上升（P〈0．05）。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.