诺和锐联合二甲双胍治疗妊娠期糖尿病的临床效果观察

目的 研究诺和锐联合二甲双胍治疗妊娠期糖尿病的临床效果。方法 选取 2021 年 8 月至 2022 年 11 月期间本院收治的妊 娠期糖尿病患者 100 例作为研究对象。按照随机双色球法进行分组，分为对照组和观察组，每组各 50 例。对照组采用诺和锐 治疗；观察组采用诺和锐联合二甲双胍治疗。分析对比两组的糖代谢及胰岛素抵抗指数与血清指标，胰岛素使用量及血糖达标 时间，妊娠方式及妊娠结局。结果 治疗后，观察组的空腹血糖、饭后 2h 血糖、胰岛素抵抗指数、同型半胱氨酸及胱抑素 C 水 平均显著低于对照组（P<0.05）。观察组的剖宫产、引产、妊娠高血压、低血糖、羊水过多、酮症酸中毒、恶心、腹泻、高渗 性昏迷、新生儿窘迫、新生儿低血糖、新生儿黄疸、巨大儿发生率均显著低于对照组（P<0.05）。观察组超氧化物歧化酶、自 然分娩、妊娠成功率均显著高于对照组（P<0.05）。结论 诺和锐联合二甲双胍治疗妊娠期糖尿病，能改善糖代谢及胰岛素抵抗 指数与血清指标，降低胰岛素使用量及血糖达标时间，改善妊娠方式和妊娠结局。     

胰岛素治疗对妊娠期合并糖尿病患者妊娠结局的影响

目的探讨胰岛素治疗对妊娠期合并糖尿病患者妊娠结局的影响。方法:选取2013年10月~2015年5月我院确诊治疗的妊娠期合并糖尿病患者80例,依据随机分配原则分为胰岛双胍组和二甲双胍组,每组40例,二甲双胍组患者给予二甲双胍口服治疗,胰岛双胍组在此基础上给予胰岛素皮下注射治疗,采用新生儿窒息评分(Apgar)评估新生儿窒息情况,统计分析所有患者治疗前后空腹和餐后2h血糖及妊娠结局情况。结果:治疗前,胰岛双胍组和二甲双胍组患者空腹和餐后2h血糖基本相同,无显著差异性(P0.05),但前者治疗后空腹和餐后2h血糖明显低于后者,差异有统计学意义(P0.05);胰岛双胍组患者剖宫产率、巨大儿发生率明显低于二甲双胍组,前者Apgar得分明显高于后者,差异有统计学意义(P0.05)。结论胰岛素治疗可有效控制妊娠期合并糖尿病患者的血糖水平,有利于改善患者妊娠结局,值得临床作进一步推广。     

二甲双胍对妊娠期糖尿病患者妊娠结局及新生儿的影响

目的观察二甲双胍对妊娠期糖尿病患者妊娠结局及新生儿的影响。方法选择2014年8月至2016年10月河北省邢台市内丘人民医院收治妊娠糖尿病患者60例,分为对照组和观察组,每组30例。对照组采用胰岛素进行治疗,观察组采用二甲双胍进行治疗,比较两组临床疗效、不良妊娠结局及对新生儿的影响。结果观察组治疗后空腹血糖、餐后2h血糖及糖化血红蛋白水平低于对照组(P0.05);观察组治疗后羊水指数、体质量指数、孕期增长体质量及分娩时体质量低于对照组(P0.05);观察组治疗后新生儿窘迫、高胆红素血症、巨大儿、新生儿低血糖发生率低于对照组(P0.05);观察组治疗后孕妇剖宫产率,以及酮症酸中毒、妊娠高血压综合征、胎膜早破及产后出血发生率低于对照组(P0.05)。结论妊娠期糖尿病患者采用二甲双胍治疗效果理想,能改善妊娠结局,对新生儿的影响较小,值得推广应用。     

二甲双胍和胰岛素治疗妊娠合并糖尿病对母婴结局的影响

目的 观察并比较二甲双胍和胰岛素治疗妊娠合并糖尿病对母婴结局的影响.方法 回顾性分析245例妊娠合并糖尿病患者,135例采用二甲双胍治疗(二甲双胍组),初始剂量500mg,2次/d,逐渐升至2500mg/d,若还未达到达标标准,则同时给予胰岛素治疗,二甲双胍持续用药到婴儿出生.110例进行常规胰岛素治疗(胰岛素组),控制血糖达标后,继续稳定治疗,直到婴儿出生.2组患者均给予常规饮食控制.观察2组母婴结局及并发症.结果 胰岛素组治疗期间体重增加明显高于二甲双胍组[(2.88±0.们)kg与(0.95±0.30)kg,t=8.31,P＜0.05];子痫前期发生率二甲双胍组明显低于胰岛素组(3.8%与10.0%,x2=4.68,P＜0.05);巨大儿(14.2%与23.6%,x2=6.28,P＜0.05)、低血糖(8.5%与18.2%,x2=7.63,P＜0.05)、黄疸症(12.3%与30.9%,x2=13.72,P＜0.005)的发生率二甲双胍组明显低于胰岛素组;产后空腹血糖二甲双胍组明显高于胰岛素组[(4.68±0.33)mmol/L与(5.04±0.27)mmol/L,t=3.22,P＜0.05].蛋白尿症、引产术、剖腹产、早产儿、2 h血糖、糖耐量检测异常、胎儿畸形及呼吸窘迫等的发生率2组比较差异均无统计学意义(P均＞0.05).结论 二甲双胍治疗妊娠合并糖尿病能降低孕妇的体重增加状况,能改善新生儿结局.     

二甲双胍和胰岛素治疗妊娠合并糖尿病对母婴结局的影响

目的 观察并比较二甲双胍和胰岛素治疗妊娠合并糖尿病对母婴结局的影响.方法 回顾性分析245例妊娠合并糖尿病患者,135例采用二甲双胍治疗(二甲双胍组),初始剂量500mg,2次/d,逐渐升至2500mg/d,若还未达到达标标准,则同时给予胰岛素治疗,二甲双胍持续用药到婴儿出生.110例进行常规胰岛素治疗(胰岛素组),控制血糖达标后,继续稳定治疗,直到婴儿出生.2组患者均给予常规饮食控制.观察2组母婴结局及并发症.结果 胰岛素组治疗期间体重增加明显高于二甲双胍组[(2.88±0.们)kg与(0.95±0.30)kg,t=8.31,P＜0.05];子痫前期发生率二甲双胍组明显低于胰岛素组(3.8%与10.0%,x2=4.68,P＜0.05);巨大儿(14.2%与23.6%,x2=6.28,P＜0.05)、低血糖(8.5%与18.2%,x2=7.63,P＜0.05)、黄疸症(12.3%与30.9%,x2=13.72,P＜0.005)的发生率二甲双胍组明显低于胰岛素组;产后空腹血糖二甲双胍组明显高于胰岛素组[(4.68±0.33)mmol/L与(5.04±0.27)mmol/L,t=3.22,P＜0.05].蛋白尿症、引产术、剖腹产、早产儿、2 h血糖、糖耐量检测异常、胎儿畸形及呼吸窘迫等的发生率2组比较差异均无统计学意义(P均＞0.05).结论 二甲双胍治疗妊娠合并糖尿病能降低孕妇的体重增加状况,能改善新生儿结局.     

二甲双胍联合门冬胰岛素30对妊娠期糖尿病患者血糖控制及妊娠结局的影响

目的研究二甲双胍联合门冬胰岛素30对妊娠期糖尿病患者血糖控制及妊娠结局的影响。方法选取我院108例妊娠期糖尿病患者,随机分为对照组和观察组各54例。对照组5给予门冬胰岛素30治疗,观察组给予二甲双胍联合门冬胰岛素30治疗,观察比较两组治疗前后FPG、1hPG及2hPG水平变化情况,并比较两组不良妊娠结局发生率、不良反应发生率及血清s ICAM-1、Leptin、HbA1c水平。结果分娩前观察组FPG、1hPG及2hPG水平均低于对照组,观察组不良妊娠结局发生率5.56%,显著低于对照组的18.52%,差异具有统计学意义(P0.05);两组不良反应发生率比较,差异无统计学意义(P0.05);分娩前观察组血清s ICAM-1、Leptin、HbA1c水平均低于对照组,差异具有统计学意义(P0.05)。结论二甲双胍联合门冬胰岛素30治疗妊娠期糖尿病,可有效控制血糖水平,降低血清s ICAM-1、Leptin、HbA1c水平,改善妊娠结局。     

二甲双胍联合门冬胰岛素对妊娠期糖尿病患者生化指标及母婴结局的影响

目的:探究妊娠期糖尿病患者采用二甲双胍联合门冬胰岛素治疗对生化指标及母婴结局的影响。方法:选择2016年3月-2017年8月期间在虞城县人民医院妇产科治疗的50例妊娠期糖尿病患者作为研究对象,按随机数表法分成两组,各25例,对照组给予单独门冬胰岛素治疗,观察组在此基础上使用二甲双胍治疗,比较两组患者分娩前生化指标及母婴结局。结果:观察组分娩前FBG、2h-PG、TC、Hb Alc等生化指标水平均低于对照组,差异有统计学意义(P 0. 05);观察组羊水过多、早产、剖宫产、新生儿呼吸窘迫及新生儿黄疸等发生率均低于对照组,差异有统计学意义(P 0. 05)。结论:妊娠期糖尿病患者早期进行饮食控制与运动训练,同时接受二甲双胍联合门冬胰岛素治疗,可显著控制血糖,改善母婴结局。     

二甲双胍治疗妊娠期糖尿病的疗效及安全性

将2013年5月~2014年5月我院收治的80例妊娠期糖尿病患者,随机分为2组,每组40例。对照组给予诺和灵30R皮下注射治疗,观察组给予二甲双胍片口服治疗,对比两组患者的血糖控制情况与妊娠结局。结果观察组糖化血红蛋白指数、空腹血糖指数、餐后2h血糖水平,明显优于对照组(P<0.05);两组妊娠结局无显著差异(P>0.05)。二甲双胍片用于妊娠期糖尿病治疗效果确切,且不会造成严重的不良妊娠结局,安全性高,值得推广应用。     

二甲双胍结合津力达颗粒对妊娠期糖尿病患者血脂及新生儿结局的影响

目的探讨二甲双胍结合津力达颗粒对妊娠期糖尿病患者血脂及新生儿结局的影响。方法选择2017年9月～2019年9月我院接诊的妊娠期糖尿病患者96例,采用随机数表法分为对照组和研究组各48例。对照组患者口服二甲双胍治疗,研究组患者加用津力达颗粒治疗,对比两组患者血糖、血脂水平及新生儿结局。结果治疗后,研究组患者血糖、血脂控制效果均优于对照组,差异有统计学意义(P<0.05);研究组巨大儿、新生儿黄疸、新生儿呼吸窘迫发生率均低于对照组,差异有统计学意义(P<0.05)。结论妊娠期糖尿病采用二甲双胍联合津力达颗粒治疗可有效调节血糖、血脂水平,改善新生儿不良结局,值得临床推广应用。     

二甲双胍和胰岛素在妊娠糖尿病患者中的疗效对比观察及对新生儿的影响研究

目的观察二甲双胍和胰岛素在妊娠糖尿病患者的临床治疗效果及对新生儿的影响。方法取2012年8月至2016年10月医院收治妊娠期糖尿病患者60例,采用随机数字方法分为对照组(n=30)和观察组(n=30)。对照组采用胰岛素治疗,观察组在对照组基础上联合二甲双胍治疗,比较2组临床疗效及对新生儿的影响。结果观察组治疗后空腹血糖、餐后2h血糖、餐后4h血糖水平,低于对照组,差异有统计学意义(P0.05);观察组平均糖化血红蛋白水平,高于对照组,差异有统计学意义(P0.05);观察组治疗后新生儿窒息、胎儿窘迫、呼吸窘迫、巨大胎儿及早产发生率低于对照组,差异有统计学意义(P0.05);2组治疗前胱抑素C(Cys C)及同型半胱氨酸(Hcy)水平比较差异无统计学意义(P0.05);观察组治疗后CysC及Hcy水平低于对照组,差异有统计学意义(P0.05);观察组治疗后血糖达标所需时间短于对照组,差异有统计学意义(P0.05);观察组胰岛素用量少于对照组,差异有统计学意义(P0.05)。结论与胰岛素治疗相比,妊娠糖尿病患者采用二甲双胍治疗效果理想,能改善新生儿结局,值得推广应用。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.