老年腹腔镜胆囊切除围手术期处理

目的总结55例老年病人行腹腔镜胆囊切除围手术期的处理经验。方法回顾该院60岁以上老年胆囊良性疾病患者行腹腔镜胆囊切除术，术中心电监护和监测血氧饱和度，术后重点观察心肺功能和血糖变化并及时治疗。结果52例完成腹腔镜胆囊切除术，3例中转开腹；术后24h胃肠道功能恢复，均顺利出院，平均住院5．5d。结论老年胆囊良性疾病患者行腹腔镜胆囊切除术，必须注重围手术期的综合处理。     

老年腹腔镜胆囊切除术围手术期护理

报告82例老年患者行腹腔镜胆囊切除术围手术期护理，并总结出行之有效的方法，确保老年患者术后顺利康复。     

安装胰岛素泵患者行腹腔镜胆总管结石手术的围手术期护理

目的:探讨安装胰岛素泵糖尿病患者行腹腔镜胆总管结石手术的围手术期护理方法。方法:对14例安装胰岛素泵胆总管结石合并糖尿病患者进行围手术期的系统护理。结果:14例患者均未发生并发症。结论:安装胰岛素泵患者行腹腔镜胆总管结石手术的围手术期护理至关重要。术前合理准备,术后正确配合治疗为手术成功奠定了基础、保证了安全。     

行腹腔镜胆囊切除术的维吾尔族糖尿病患者的护理体会

总结了55例维吾尔族糖尿病患者行腹腔镜胆囊切除术围手术期的护理经验。主要包括:术前建立良好的护患关系,指导疾病相关知识,遵重患者的个人隐私,加强术前饮食指导,加强血糖监测与控制;术后加强基础护理,密切观察病情,加强饮食护理等。认为加强围手术期的观察和护理,对维吾尔族糖尿病患者行腹腔镜胆囊切除术的治疗起着重要作用。     

腹腔镜胆囊切除术围手术期护理体会

腹腔镜胆囊切除术，是指在电视腹腔镜窥视下，通过腹壁的34个小戳孔，将腹腔镜手术器械插入腹腔行胆囊切除术。该术式为微创手术，具有创伤小、恢复快、瘢痕小等优点，已成为胆囊炎、胆石症的首选手术方式。做好腹腔镜胆囊切除术围手术期的护理，防止并发症的发生，是促进患者康复的关键。为此，作者对在我院行胆囊切除术患者的围手术期护理体会进行了总结，现介绍如下，旨在为促进患者的全面康复提供依据。     

腹腔镜胆囊切除合并糖尿病147例围手术期的护理

目的探讨胆囊切除术合并糖尿病患者行腹腔镜胆囊切除术围手术期的护理。方法针对147例合并糖尿病的患者的术前、术中、术后的护理,对高血糖的患者采取了有效的护理实施。结果本组患者在术中及术后均无明显并发症的发生,术后痊愈率100%。结论针对术前、术后及围手术期的观察护理,对合并糖尿病患者手术治疗有着重要作用。     

胆囊结石合并糖尿病病人行腹腔镜胆囊切除术的围术期护理

[目的]总结胆囊结石合并糖尿病病人行腹腔镜胆囊切除术的围术期护理措施.[方法]回顾性分析66例胆囊结石合并糖尿病病人行腹腔镜胆囊切除术的临床资料.[结果]本组病人腹腔镜胆囊切除术均顺利完成,术后无一例并发症发生.[结论]加强围术期的整体护理是胆囊结石合并糖尿病病人成功进行腹腔镜胆囊切除术的重要保证.     

胆囊结石合并糖尿病病人行腹腔镜胆囊切除术的围术期护理

[目的]总结胆囊结石合并糖尿病病人行腹腔镜胆囊切除术的围术期护理措施。[方法]回顾性分析66例胆囊结石合并糖尿病病人行腹腔镜胆囊切除术的临床资料。[结果]本组病人腹腔镜胆囊切除术均顺利完成,术后无一例并发症发生。[结论]加强围术期的整体护理是胆囊结石合并糖尿病病人成功进行腹腔镜胆囊切除术的重要保证。     

老年人腹腔镜胆囊切除围手术期处理(附386例报告)

目的：总结老年人胆囊良性病变386例行腹腔镜胆囊切除术围手术期的处理经验。方法：为386例60岁以上的老年胆囊疾病患者行腹腔镜胆囊切除术。术前除常规检查外，特别注意心，肺功能和血糖的检查；术中心电监护及监测血氧饱和度；术后侧重观察心肺功能和测定血糖。结果：380例完成腹腔镜胆囊切除术，6例中转开腹，腹腔镜胆囊切除术后24h均恢复胃肠功能，术后平均住院4.2d。结论：合理且周密的围手术期处理是保证老年患者耐受腹腔镜胆囊切除术的重要环节。     

腹腔镜胆囊切除术128例围术期护理

目的:探讨腹腔镜胆囊切除术围术期护理方法和效果。方法:对128例接受腹腔镜胆囊切除术患者的围术期护理工作进行总结、分析。结果:128例患者手术顺利,术后发生皮下气肿3例,恶心、呕吐6例,无其他并发症发生,全部治愈出院,平均住院时间3.23 d。结论:周密、有效的腹腔镜胆囊切除术围术期护理工作对预防手术并发症、保证手术成功起到重要的作用。     

The experiences of school nurses caring for students receiving continuous subcutaneous insulin infusion therapy.

Diabetes mellitus is the most common metabolic disorder in childhood. Today, children with diabetes are receiving new technologically advanced treatment options, such as continuous subcutaneous insulin infusion (CSII) therapy. School nurses are the primary health caregivers of children with diabetes during school hours. Therefore, it is important to determine their perceptions, resources, and resource needs when caring for students with continuous subcutaneous insulin infusion or insulin pump therapy. This study uses a phenomenological approach to examine the experiences of school nurses caring for students receiving insulin pump therapy. Eleven school nurses were interviewed using semistructured taped interviews. The nurses' responses indicated that they were "scared" when first caring for students with continuous subcutaneous insulin infusion therapy. However, they were able to work through their fear by using their resources and gaining more knowledge and hands-on experience with insulin pumps. The data also revealed that school nurses who were able to learn the language of continuous subcutaneous insulin infusion therapy and successfully deal with pump problems developed trusting and knowing relationships with students, teachers, and parents.     

胰岛素泵持续皮下输注胰岛素法在妊娠期糖尿病治疗中的应用价值

目的:比较分析胰岛素泵持续皮下输注胰岛素法与传统皮下注射胰岛素法在妊娠期糖尿病治疗中的疗效,评价胰岛素泵持续皮下输注胰岛素法的临床应用价值。方法:将60例妊娠期糖尿病患者随机分为两组:胰岛素泵组(CSII组)30例和皮下注射组(MDSI组)30例。胰岛素泵组通过胰岛素泵给予持续皮下输注胰岛素进行治疗,皮下注射组给予每日2次皮下注射治疗。治疗两周后,比较分析两组治疗前、后的血糖控制情况;比较两组治疗后妊娠并发症、胎儿患病率及产后低血糖发生次数、产后3年内糖尿病患病率。结果:两种方法均能有效控制血糖水平;与传统皮下注射胰岛素组比较,胰岛素泵持续皮下输注胰岛素组治疗后的妊娠并发症、胎儿患病率、产后低血糖发生及产后3年内糖尿病患病率明显下降(P<0.05)。结论:胰岛素泵持续皮下输注胰岛素法治疗妊娠期糖尿病能稳定、有效地控制血糖水平;显著降低母婴并发症、产后低血糖的发生率和产后3年内糖尿病患病率。避免多次皮下注射的痛苦以及心理压力,改善患者生活质量,提高患者依从性。     

Insulin pump therapy (continuous subcutaneous insulin infusion)

Continuous subcutaneous insulin infusion has provided patients who have diabetes with a system for achieving treatment targets with a lower incidence of severe hypoglycemia. Patients prefer the flexibility, convenience, and physiologic glycemic control of continuous subcutaneous insulin infusion. Future insulin pumps will be implanted within the body and the "loop" will be closed, providing a physiologic insulin delivery system. This system will provide the means for achieving near-normal glycemia, limit episodes of severe hypoglycemia, and prevent long-term complications of diabetes mellitus.     

Patient management of long-term continuous subcutaneous insulin infusion

AIM: This paper reports a study of patients' current practice with continuous subcutaneous insulin infusions, particularly with respect to the management of the pump. BACKGROUND: Successful implementation of continuous subcutaneous insulin infusion requires a motivated patient with a range of technical skills and self-management capabilities. The therapy should be prescribed, implemented and monitored by a skilled professional team familiar with it and capable of supporting the patient. METHODS: A questionnaire was mailed to 102 continuous subcutaneous insulin infusion treated patients at a Swedish university hospital with experience of pump treatment for at least 6 months. RESULTS: The questionnaire was answered by 88% of the patients, 53 women and 37 men, aged 22-71 years with a duration of continuous subcutaneous insulin infusion use of between 7 months and 19 years. The changing interval for soft infusion set ranged from 2.0 to 10.0 days (mean 4.8) and for metal needles from 1.5 to 7.5 days (mean 3.8), P = 0.001. Catheter occlusions were significantly more often reported in patients with presence of bleeding at the infusion site (P = 0.011) and among those using insulin lispro (P = 0.032). CONCLUSIONS: Patients having long-term continuous subcutaneous insulin infusion should be carefully audited with respect to the management of the insulin pump and its accessories. In patients who frequently experience problems, shorter intervals between changes of infusion sets are strongly advocated and type of insulin preparation may be of importance in some cases.     

Optimizing pumped insulin delivery

The use of portable devices for the subcutaneous infusion of insulin may facilitate the attainment of improved glycemic control in selected patients with insulin-dependent diabetes mellitus. Successful use of a program of continuous subcutaneous insulin infusion requires patient cooperation and motivation, routine monitoring of glycemia, and attention to food intake and activity. This article describes an approach by which patients may optimize glycemic control utilizing a set of algorithms based on patient-determined blood glucose measurements. The algorithms permit programming the insulin infusion device to achieve the desired control.     

Malfunction of continuous subcutaneous insulin infusion systems: a one-year prospective study of 127 patients

Malfunction of portable continuous subcutaneous insulin infusion (CSII) systems may result in either ketoacidosis or serious hypoglycemia. To determine the types and frequencies of infusion system failure and the resulting clinical consequences, we recorded their occurrences in a 1-yr prospective study of 127 patients who were using insulin infusion pumps in a clinical practice setting. Of the 127 patients, 109 (86%) experienced at least one infusion system failure during the study. Most of the infusion system failures (96%) occurred in the syringe, infusion tube and connections, or subcutaneous infusion site. Virtually all malfunctions resulted in interruption of insulin flow, and most were associated with temporary loss of diabetes control. Equipment malfunction was documented in 6 of 7 patients who used insulin pumps and were treated in our hospital for diabetic ketoacidosis during the study. Pump "runaway" was not observed. We conclude that infusion system malfunction resulting in interruption of insulin flow is a common occurrence, is often associated with temporary hyperglycemia, and may account for some of the increased incidence of diabetic ketoacidosis previously described in these patients.     

胰岛素泵强化治疗在初发2型糖尿病患者血糖控制中的应用

目的探讨胰岛素泵强化治疗对初发2型糖尿病患者血糖控制的作用。方法将60例初发2型糖尿病患者随机分为观察组和对照组,每组各30例。观察组患者采用胰岛素泵强化治疗,对照组患者采用皮下注射胰岛素治疗。比较两组治疗前后血糖控制水平、血糖达标时间、低血糖发生率、胰岛素总用量的差异。结果两组患者血糖控制均达标,但观察组能更快更稳地控制血糖水平,同时减少胰岛素用量,低血糖发生率低于对照组,两组比较,P〈0.01或P〈0.05,差异具有统计学意义。结论胰岛素泵强化治疗可较好控制初发2型糖尿病患者的血糖,减轻患者多次注射的痛苦。     

胰岛素泵治疗初诊2型糖尿病的疗效评价

目的:观察胰岛素泵对初诊2型糖尿病的疗效。方法:选取80例初诊2型糖尿病随机分为短期持续皮下注射胰岛素泵(CSII)组及皮下注射胰岛素(MSII)组。结果:提示CSII组及MSII组治疗均可有效降低血糖,但前者显著优于MSII组(P<0.01),两组均可改善初诊2型糖尿病患者胰岛β细胞功能,减轻胰岛素抵抗,CSII组较MSII组效果好(P<0.01)。结论:胰岛素泵可迅速有效使初诊2型糖尿病患者血糖达标,消除高血糖的毒性作用,缩短血糖达标天数,减少胰岛素用量,降低低血糖发生率,可延缓胰岛β细胞功能的衰退。     

胰岛素泵治疗对初诊2型糖尿病患者血糖血脂及纤溶酶原活性的影响

目的观察胰岛素泵治疗初诊2型糖尿病患者2周前后血糖、糖化血红蛋白、血脂、纤溶活性和胰岛素抵抗改善的情况。方法初诊2型糖尿病患者33例,入院后治疗前行口服葡萄糖耐量试验,测空腹血糖和餐后2h血糖,及糖化血红蛋白、血脂、胰岛素水平、组织型纤溶酶原激活物和纤溶酶原激活物抑制剂-1水平,胰岛素抵抗用Homa—IR表示。予胰岛素泵治疗两周后停止胰岛素泵,第2天行OGTT实验测血糖、糖化血红蛋白、血脂、胰岛素、组织型纤溶酶原激活物和纤溶酶原激活物抑制剂-1水平。结果胰岛素泵治疗后患者空腹及餐后血糖达到良好控制（P〈0．01）,糖化血红蛋白从治疗前（8．6±3．1）％降至（7．1±1．6）％,且未见明显低血糖。治疗后血清总胆固醇、低密度脂蛋白胆固醇、三酰甘油均较治疗前明显降低,高密度脂蛋白胆固醇有升高,低密度脂蛋白胆固醇治疗前为3．26±0．85mmoL／L,治疗后为1.81±0．78mmoL／L（P〈0．05）,三酰甘油治疗前2．86±0．85mmoL／L,治疗后1．92±0．64mmoL／L（P〈0．01）。纤溶活性在治疗后获得显著改善,组织型纤溶酶原激活物从治疗前0．225±0．113IU／ml升高至0．457±0．177IU／ml（P〈0．01）,纤溶酶原激活物抑制剂-1从治疗前0．898±0．168AU／ml／L降至0．533±0．215AU／ml（P〈0．05）。胰岛素抵抗指标Homa-IR也较治疗前明显降低,治疗前为4．11±0．85,治疗后为2．42±0．91（P〈0．01）。结论对初诊2型糖尿病患者,胰岛素泵治疗具有快速稳定控制血糖,显著减轻胰岛素抵抗的作用,改善脂质代谢和组织型纤溶酶原活性的作用。     

初诊2型糖尿病患者疾病态度对短期胰岛素泵强化治疗后血糖控制的影响

目的：探讨初诊2型糖尿病患者对疾病的态度对短期胰岛素泵强化治疗后血糖控制的影响。方法：118例持续皮下胰岛素输注（CSII）治疗后获得临床缓解的初诊2型糖尿病患者完成1年随访,分别于基线期、出院后3个月、6个月、1年使用密西根糖尿病管理评定量表（DCP）评价患者对糖尿病的态度（包括积极态度、消极态度、自我护理能力、自我管理重要性认识、自我管理坚持性认识）,并检测患者糖化血红蛋白水平（HbA1c）水平,采用Spearman相关分析探讨患者对疾病态度与HbA1c水平的相关性。结果：65例缓解期≥1年患者为缓解组,53例缓解期〈1年患者为治疗失效组;缓解组患者初中文化的比例明显低于治疗失效组,大学或以上文化的比例明显高于治疗失效组（P〈0.05）。经过2周CSII治疗后两组患者血糖指标均明显改善,缓解组患者CSII治疗后的空腹血糖（FPG）和餐后2 h血糖（2 hPG）低于治疗失效组,伴随胰岛素第一时相分泌（AIR）值高于治疗失效组（P〈0.05）。随访期内缓解组患者积极态度、自我护理能力、自我管理重要性认识和坚持性认识得分较基线升高,并高于同时期的治疗失效组（P〈0.05）,消极态度得分逐渐降低,并低于同时期的治疗失效组（P〈0.05）,而治疗失效组患者积极态度、自我护理能力、自我管理重要性认识和坚持性认识得分较基线下降,消极态度得分则始终维持较高的水平;Spearmen相关分析显示,除0个月外,各随访期HbA1c水平与积极态度、自我护理能力、自我管理重要性认识和坚持性认识得分呈显著负相关,与消极态度得分呈正相关。结论：糖尿病患者对疾病的态度对初诊糖尿病患者CSII后血糖控制具有重要影响,因此应重视对初诊2型糖尿病患者进行心理教育,使患者形成良好的管理疾病的态度,进而更好的控制病情,维持理想的生存质量。