护理干预对初发肥胖2型糖尿病患者强化治疗效果的影响

目的:探讨护理干预对初发肥胖2型糖尿病(DM)患者强化治疗效果的影响.方法:将100例初发肥胖2型DM患者随机分为观察组51例和对照组49例,观察组在常规护理的基础上给予护理干预,对照组给予常规护理.住院治疗14d出院,每半月复诊1次,半年后比较两组患者强化治疗的效果.结果:与对照组相比,观察组服糖后0.5h胰岛素分泌水平的升高更为明显(P＜0.05),空腹和服糖后2h胰岛素分泌水平有显著差异(P＜0.05);观察组在治疗前后血糖和体重指数均有明显变化(P＜0.05),与对照组相比体重指数有显著差异(P＜0.05).结论:护理干预对DM患者血糖的稳定控制起着积极的作用,对DM强化治疗有显著效果.     

心理行为干预对2型糖尿病初诊患者治疗依从性的影响

目的:探讨心理行为干预对初诊2型糖尿病患者治疗依从性的影响.方法:初诊2型糖尿病患者70例随机分为干预组(35例)和对照组(35例).对照组按照传统的护理方法进行指导,干预组在此基础上采用心理行为干预.结果:治疗3周后,干预组糖尿病患者治疗依从性优于对照组(P＜0.05);两组干预前后血糖各指标差异显著,干预组干预后空腹血糖,餐后2 h血糖较对照组显著下降(P＜0.05).结论:应用心理行为干预可以提高初诊2型糖尿病患者治疗依从性,改善和控制血糖.     

问题导向式健康教育在2型糖尿病患者中的应用

目的:探讨问题导向式健康教育在2型糖尿病(T2DM)患者中的应用方法及效果。方法:将142例T2DM患者随机分为对照组和观察组各71例,对照组给予糖尿病常规健康教育,观察组采用问题导向式健康教育,比较两组效果。结果:两组干预2个月糖尿病自我效能量表(DSES)评分高于干预前(P0.05),观察组干预2个月DSES评分高于对照组(P0.05);观察组干预2个月糖尿病自护行为量表(SDSCA)评分高于对照组(P0.05);观察组空腹血糖(FBG)、餐后2 h血糖(2 hPBG)、糖化血红蛋白(HbA_1c)水平低于对照组(P0.05)。结论:实施问题导向式健康教育能够有效提升T2DM患者自我效能感及自护能力,改善其血糖水平。     

目视化健康教育模式对2型糖尿病患者的影响

目的:探讨目视化健康教育模式对2型糖尿病(T2DM)患者的影响。方法:将2019年1月1日～6月30日接受治疗的T2DM患者80例按照随机编号法分为对照组和观察组各40例,对照组给予常规健康教育,观察组给予目视化健康教育模式;比较两组干预前后T2DM知晓情况、血糖指标[包括空腹血糖(FBG)、餐后2 h血糖(2 h PBG)、糖化血红蛋白(HbA_1c)]、自我效能感[采用糖尿病管理自我效能量表(DMSES)]、心理痛苦情况。结果:干预后,两组对T2DM诊断方法、治疗方法、危险因素、预防知识的知晓情况均优于干预前(P0.05),且观察组均优于对照组(P0.01);干预后,两组FBG、2 h PBG、HbA_1c均低于干预前(P0.05),且观察组均低于对照组(P0.01,P0.05);干预后,观察组DMSES中饮食控制、锻炼、自我检测、医疗评分及总分均高于对照组(P0.05,P0.01);干预后,两组情感负担、生活规律相关痛苦、人际关系相关痛苦、医生相关痛苦评分均低于干预前(P0.05),且观察组均低于对照组(P0.01)。结论:目视化健康教育模式可提高患者对糖尿病知识的知晓率,改善血糖紊乱症状,提升自我效能感,缓解患者焦虑、抑郁状况,值得临床推广。     

基于IMB模型的延续性健康教育在2型糖尿病患者中的应用

目的:探讨基于信息、动机、行为技巧(IMB)模型的延续性健康教育在2型糖尿病(T2DM)患者中的应用效果。方法:选取2018年6月1日～2020年6月30日收治的118例2型糖尿病(T2DM)患者为研究对象,按照随机数字表法分为观察组和对照组各59例。对照组给予常规护理和健康教育,观察组在此基础上应用基于IMB模型的延续性健康教育干预。比较两组干预前后血糖控制情况(包括空腹血糖(FBG)、餐后2 h血糖(2 hPG))、疾病感知控制水平[采用简易疾病感知问卷(BIPQ)]、饮食治疗依从性、自我管理能力[采用糖尿病自我管理量表(SDSCA)]及生活质量[采用糖尿病特异性生活质量测定量表(DSQL)]。结果:干预3个月后,观察组FBG、2 hPG水平均低于对照组(P0.05);观察组BIPQ评分、治疗依从性均高于对照组(P0.01);干预3个月后,两组SDSCA评分高于干预前(P0.05),且观察组高于对照组(P0.05);干预3个月后,两组DSQL评分高于干预前(P0.05),且观察组低于对照组(P0.05)。结论:基于IMB模型的延续性健康教育有助于T2DM患者血糖水平的控制,可提升患者的疾病感知控制及饮食、运动、用药等方面的治疗依从性,提高其自我管理能力、生活质量。     

C反应蛋白与2型糖尿病血管并发症的临床关系

目的 探讨C反应蛋白(CRP)与2型糖尿病(T2DM)血管并发症的临床关系.方法 2型糖尿病患者36例,有血管并发症的T2DM患者36例,血糖正常健康者38例,采用免疫透射比浊法测定血清C反应蛋白浓度.结果 糖尿病组、并发症组与对照组的C反应蛋白浓度差异有统计学意义(P＜0.01);糖尿病组与并发症组比较,差异有统计学意义(P＜0.05).结论 C反应蛋白和2型糖尿病及糖尿病的进程有显著相关性.     

App平台结合精准护理干预模式对2型糖尿病患者的影响

目的:探讨App平台结合精准护理干预模式对2型糖尿病(T2DM)患者的影响。方法:将2017年1月1日～2019年1月1日收治的120例T2DM患者随机分为对照组和研究组各60例,对照组给予常规护理,研究组在常规护理基础上给予App平台结合精准护理;比较两组糖尿病知识掌握情况、自我管理能力[采用中文版糖尿病自护行为量表(SDSCA)]、血糖控制情况及生活质量[采用糖尿病生存质量特异性量表(DSQL)]。结果:护理后,两组糖尿病基础知识、饮食知识、运动知识、治疗知识及运动监测知识水平显著高于护理前(P0.05),且研究组显著高于对照组(P0.05);护理后,两组SDSCA中健康饮食、规律运动、血糖监测、足部护理评分及总分显著高于护理前(P0.05),且研究组显著高于对照组(P0.05);两组空腹血糖、餐后2 h血糖、糖化血红蛋白水平显著低于护理前(P0.01,P0.05),且研究组显著低于对照组(P0.05);两组DSQL中生理维度、心理/精神维度、社会关系维度、治疗维度评分均显著低于护理前(P0.05),且研究组(除社会关系维度外)均显著低于对照组(P0.05)。结论:App平台结合精准护理干预模式应用于T2DM患者护理中,可有效提高患者疾病认知水平与遵医行为,进而有利于血糖控制,改善患者生活质量,值得临床推广。     

血清空腹C肽水平与2型糖尿病周围血管并发症相关性

目的:探讨血清空腹C肽与2型糖尿病周围血管并发症的关系.方法:糖耐量异常患者(IGT组)72例,2型糖尿病患者(T2DM组)140例,同期健康体检者50名为对照组(NC组).T2DM组根据有无冠心痛再分为糖尿病合并周围血管并发症组(T2DM合并PVD组)68例,糖尿病无周围血管并发症组(T2DM无PVD组)72例,比较各组血清空腹C肽、血脂、空腹血糖等指标.结果:T2DM组血清空腹C肽高于IGT组、NC组(P＜0.05);T2DM合并PVD组血清空腹C肽水平低于T2DM无PVD组(P＜0.05);IGT组血清空腹C肽水平高于NC组,但差异无统计学意义(P＞0.05).T2DM合并PVD与空腹C肽、年龄、糖尿病病程、空腹血糖相关(P＜0.01).结论:糖尿病合并周围血管并发症的发生与发展除与年龄、糖尿病痛程、空腹血糖等有关外,还可能与空腹C肽水平有关,血清空腹C肽可能成为糖尿病周围血管痛变的早期预测指标.     

饮食疗法对2型糖尿病的疗效

目的:观察饮食疗法对2型糖尿病(DM)患者的干预效果.方法:2型DM住院患者80例随机分为观察组和对照组各40例,2组均进行常规药物治疗,观察组在此基础上进行系统的饮食疗法.结果:观察组患者出院后3及6个月时空腹血糖、餐后2h血糖及糖化血红蛋白均低于对照组(P＜0.01);观察组住院时间及观察期间相对性低血糖及低血糖发生率均低于对照组(P＜0.01).结论:有计划、系统的饮食疗法能提高2型DM患者治疗的依从性,降糖效果显著.     

强化糖尿病教育对不稳定心绞痛合并2型糖尿病患者的影响

目的:探讨强化糖尿病教育对不稳定心绞痛(UA)合并2型糖尿病(T2DM)患者的影响。方法:将78例UA合并T2DM患者随机分为观察组和对照组各39例,对照组给予UA及T2DM常规护理,观察组在此基础上给予强化糖尿病教育,比较两组血糖、血压控制情况及预后。结果:观察组治疗4周后空腹血糖(FPG)、餐后2 h血糖(2 h PG)、收缩压(SBP)及舒张压(DBP)均低于对照组(P0.05),两组血糖达标率及心血管意外事件发生率比较差异有统计学意义(P0.05)。结论:强化糖尿病教育能改善UA合并T2DM患者血糖及血压控制水平,降低心血管意外发生率。     

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.