糖尿病患者血栓指标的观察

目前,我国糖尿病发病率约为3.21％。糖尿病患者有血栓形成倾向,并由此而并发血管病变。临床研究表明:血管病变是糖尿病患者死亡和致残的主要原因。据国内资料表明,糖尿病并发冠心病者占38％,并发心肌梗死者占7.2％,并发高血压者占28.4％,并发视网膜病变者占32.6％,并发四肢坏疽者占     

血液透析治疗糖尿病肾病终末期

目的 探讨糖尿病肾病终末期的防治方法。方法 观察４６例糖尿病肾病终末期和６８例非糖尿病肾病行血液透析治疗患者的存活率,死亡原因及并发症,并进行对比。结果 糖尿病肾病占４０％,并发高血压占９３％,心血管病变占８４％,视网膜变占８４％,视网膜病变占８９％,感染占６０％,１ａ存活率９１．３％,５ａ存活率１７％,２ａ病死率２４％。     

强化控制血压治疗老年糖尿病合并高血压的疗效观察

高血压是糖尿病常见的并发症，在糖尿病中合并高血压的患病率高达40％～80％，为一般人群中高血压的4～5倍，且其患病率随年龄升高而增加。糖尿病合并高血压时，降低血糖可减少糖尿病微血管并发症，但对大血管病变来说，降压较控制血糖更为重要。降低血流动力学和高血压的负荷，最大限度地减少心血管并发症的发病率和病死率。我们对来院疗养的220例糖尿病合并高血压的患者进行了3～7年的随访治疗观察，结果表明强化控制血压的患者心脑血管病的发病率和病死率较对照组明显降低。     

2型糖尿病合并高血压患者的临床特点及血管并发症分析

目的 探讨2型糖尿病合并高血压患者的临床特点及血管并发症发生情况.方法 选择本院2011年9月至2013年9月收治的174例患者,根据患者的疾病分为A组、B组和C组,A组62例糖尿病合并高血压患者;B组54例单独糖尿病患者;C组58例单独高血压患者.比较三组患者血管并发症的发生情况,并分析其临床特征和危险因素.结果 （1）A组患者冠心病、脑血管病、外周血管病变方面的发生率明显高于B组和C组患者,差异有统计学意义（P＜0.05）;A组患者在神经病变和视网膜病变方面的发生率明显高于B组患者（P＜0.05）.（2）糖化血红蛋白是冠心病和外周血管病变的主要危险因素,甘油三酯是外周血管病变和神经病变的主要危险因素.结论 2型糖尿病合并高血压患者具有并发症复杂、发病率高等临床特点,通过对其血管并发症的相关危险因素分析,可在一定程度上避免血管并发症的发生.     

糖尿病的整体性健康教育

目的探讨糖尿病与高血压、冠心病、脑梗死等大血管病变的关系及遗传与环境因素对它们的影响,并提出合理的健康教育方法。方法对140例糖尿病合并或不合并大血管病变的发病率及其影响因素进行回顾性分析,并施行糖尿病及其并发症的整体性健康教育。结果糖尿病并发高血压、冠心病、脑梗死的发病率分别为30.71％、22.86％、21.43％,且接近一半是以并发症先发病的。糖尿病合并大血管病变组的糖尿病家族史、嗜甜饮食、运动少的发生率分别为46.55％、55.17％、50％,糖尿病无合并大血管病变组的糖尿病家族史、嗜甜饮食、运动少的发生率分别为34.15％、40.24％、34.15％,两组比较有显著性差异。结论糖尿病与高血压、冠心病、脑梗死是一组有内在联系的疾病,发病受遗传因素和外界环境易感因素影响,进行健康教育时应作为一个整体考虑。     

糖尿病乳酸性酸中毒20例临床分析

糖尿病乳酸性酸中毒是糖尿病三大急性并发症之一，临床常见于老年糖尿病患者并发大血管或微血管病变的基础上，病死率50％～80％，现将我院1992～2002年收治20例临床资料分析如下。     

搪尿病的整体性健康教育

目的 探讨糖尿病与高血压、冠心病、脑梗死等大血管病变的关系及遗传与环境因素对它们的影响，并提出合理的健康教育方法。方法 对140例糖尿病合并或不合并大血管病变的发病率及其影响因素进行回顾性分析，并施行糖尿病及其并发症的整体性健康教育。结果 糖尿病并发高血压、冠心病、脑梗死的发病率分别为30．71％、22．86％、21．43％，且接近一半是以并发症先发病的。糖尿病合并大血管病变组的糖尿病家族史、嗜甜饮食、运动少的发生率分别为46．55％、55．17％、50％，糖尿病无合并大血管病变组的糖尿病家族史、嗜甜饮食、运动少的发生率分别为34．15％、40．24％、34．15％，两组比较有显著性差异。结论 糖尿病与高血压、冠心病、脑梗死是一组有内在联系的疾病，发病受遗传因素和外界环境易感因素影响，进行健康教育时应作为一个整体考虑。     

糖尿病并发高血压的护理44例

糖尿病和高血压均被认为是发生大血管和微血管病变的危险因素,可造成多系统血管功能损害.高血压是糖尿病最多见的并发症,也是糖尿病的主要死亡原因之一.糖尿病患者合并高血压,大约为非糖尿病患高血压的1.5～2.0倍,糖尿病高血压者与非糖尿病正常血压者相比,前者心血管事件的危险性增加4倍[1].老年糖尿病患者具有较多的高血压发病率,2007年6月～2008年8月收治糖尿病并发高血压患者44例,根据其临床特点制订护理措施,现报告如下.     

糖尿病性血管病变

本文分析了住院糖尿病患者162例并发血管病变的概况,其中高血压者占29％,其发生率与年龄和病程有关,冠心病和高血压心脏病者占11.7％;视网膜病变者占31.5％;脑血管病变占3.1％;糖尿病肾病者占26.5％,其发生率与病程和糖代谢障碍有关,故有效地控制血糖可以防止肾病的进展。     

糖尿病性血管病变

本文分析了住院糖尿病患者162例并发血管病变的概况,其中高血压者占29％,其发生率与年龄和病程有关,冠心病和高血压心脏病者占11.7％;视网膜病变者占31.5％;脑血管病变占3.1％;糖尿病肾病者占26.5％,其发生率与病程和糖代谢障碍有关,故有效地控制血糖可以防止肾病的进展。     

老年糖尿病住院患者死亡原因分析

OBJECTIVE: To understand the mortality rate and main death causes of aged diabetics in hospital. METHODS: The clinical record of 183 aged diabetic patients, who were hospitalized and died between January, 1995 and December, 2002 in our hospital, were reviewed in comparison with 293 non-diabetic aged patients hospitalized in the same period. RESULTS: The mortality rate of the aged diabetics was 13.11%, far beyond that of the non-diabetics. The main death causes of the diabetic patients were tumor (29.5%), cardiovascular diseases (CVD, 25.7%), pulmonary infections (14.2%), renal dysfunction (9.8%) and cerebral vascular diseases (5.5%). Tumor was the main cause of death in the diabetic patients 60 to 80 years of age, and in those 80-90 years old, CVD accounted for most of the deaths, whereas most patients over 90 years old died of pulmonary infections. When only one of the 3 risk factors, namely hypertension, dyslipidemia and smoking, was present, CVD accounted for 36.8% of all deaths; when all the 3 factors co-existed, CVD accounted for 50% of all deaths. CONCLUSIONS: The mortality rate of aged diabetics is higher than that of the non-diabetics. Tumor and CVD are the main causes of death, but the constituent ratio changes with age. The ratio of CVD in all death causes depends on the number of risk factors present, including hypertension, dyslipidemia and smoking.     

老年糖尿病住院患者死亡原因分析

目的 了解老年糖尿病患者的死亡原因。方法 对1995年1月~2002年12月在我院住院并死亡的老年糖尿病患者183例的临床资料进行回顾性分析,并与同期非糖尿病住院并死亡的老年患者292例相对照。结果 老年糖尿病患者死亡率13.11%,远高于非糖尿病患者的死亡率6.15%(P<0.05)。前5位的死亡原因依次是恶性肿瘤(29.5%)、心血管疾病(25.7%)、肺部感染(14.2%)、肾功能衰竭(9.8%)和脑血管疾病(5.5%)。60~70岁组和70~80岁组首要死因是肿瘤,80~90岁组首要死因为心血管病,而90岁以上组肺部感染占第1位。高血压、高血脂、吸烟3个危险因素只有1个时心血管病死亡所占构成比为36.8%,而同时存在时心血管病死亡占所有死亡的比重增至50.0%。结论 糖尿病患者的死亡率明显高于非糖尿病患者。肿瘤和心血管疾病是老年糖尿病患者的主要死亡原因,但是在不同年龄组的重要性略有不同。心血管病死亡所占构成比与高血压、高血脂、吸烟等危险因素的聚集程度相关。     

一组随访13年的老年人死亡原因与代谢综合征关系分析

目的一组随访13年的老年人死亡原因与代谢综合征之间关系的分析。方法回顾性分析1996年-2009年老年人群查体和病历资料,比较不同代谢性疾病对人群死亡率的影响。结果本组2 160例老年人在13年的随访中共死亡576例,总死亡率26.67%;死亡原因排位前三名的是恶性肿瘤、呼吸系统疾病及心血管疾病,分别占总死亡人数的36.98%、31.42%和18.23%;多因素回归分析显示年龄（OR=1.17,95%CI=1.144-1.193）和高血压（OR=1.39,95%CI=1.078-1.779）为死亡的独立危险因素。单个代谢疾病死亡率比较,仅高血压组死亡率（29.31%）高于非高血压组（19.80%,P〈0.01）,肥胖、糖、脂代谢异常组与对应非肥胖、非糖尿病、非高血压组死亡率相似。随着代谢综合征组分叠加,心、脑血管患病率显著增加,但死亡原因仍以恶性肿瘤及呼吸系统疾病为主。结论本组老年人群恶性肿瘤、呼吸系统疾病及心血管疾病为主要死亡原因,增龄及高血压增加老年人群死亡风险,代谢综合征组分叠加未增加死亡率。     

重庆市住院2型糖尿病患者慢性并发症及相关大血管病变调查

目的了解重庆市住院2型糖尿病患者慢性并发症发病及相关大血管病变状况.方法回顾性分析1991年1月1日～2000年12月31日期间在重庆市住院的2型糖尿病患者960例的临床及实验室资料.结果近10年重庆市住院2型糖尿病患者糖尿病慢性并发症及相关病变患病率分别为:高血压49.1%;脑血管并发症16.9%;心血管并发症12.3%;下肢血管并发症4.7%;眼部并发症40.0%;肾脏并发症36.3%;神经病变41.9%,总患病率为78.8%.其中高血压、眼部并发症和神经并发症患病率男女之间有明显差异.结论重庆市住院2型糖尿病患者慢性并发症患病率较高,其中高血压、糖尿病眼病和神经病变的患病率男女之间有明显差异.     

不同等级医院血液透析患者原发病及死因的差异性分析

目的  回顾性分析不同等级医院血液透析（血透）患者原发病及死因的构成比。方法  从中国知网、万方、维普数据库搜集1986～2013年有关血透原发病及死因的文献,共搜集3 601例维持性血透患者,死亡2 432例,按文献数据来源,分为二甲医院、三乙医院、三甲医院,纳入的研究血透原发病的例数分别为871、723和1 523例;纳入研究血透死因的例数分别为312、429和1 207例,分析其原发病及死因构成比。结果  血透患者原发病为慢性肾小球肾炎占49.32%,糖尿病占18.24%,高血压占14.22%;不同时期不同等级医院血透患者原发病构成比比较,差异有统计学意义（P <0.05）,其中糖尿病及高血压构成比呈上升趋势,尤以糖尿病为甚。血透患者主要死因为：心血管疾病（42.35%）、脑血管疾病（21.5%）、感染（11.76%）;2000年前二甲医院血透患者主要死因为脑血管疾病、心血管疾病、感染、高钾,2000年后相应为心血管疾病、脑血管疾病、感染、多器官功能障碍综合征（MODS）,三级医院血透患者主要死因为心血管疾病、脑血管疾病、感染,且心血管疾病构成比呈上升趋势。二甲医院血透患者主要死因与三甲医院比较,差异有统计学意义,但三乙医院与三甲医院比较,差异无统计学意义。结论  血透患者主要原发病为慢性肾小球肾炎、糖尿病、高血压,其中糖尿病构成比呈上升趋势;同一时期三级医院血透患者中糖尿病、高血压构成比更高。血透患者主要死因为心血管疾病、脑血管疾病、感染,且心血管疾病构成比呈上升趋势。

     

影响糖尿病终末期肾病血液透析患者长期生存率的危险因素分析

目的探讨影响糖尿病终末期肾病（ESDN）血液透析患者长期生存率的危险因素,以提高ESDN血液透析患者的长期生存率。方法31例ESDN血液透析患者和同期透析的42例非糖尿病终末期肾病（non-ESDN）血液透析惠者相比较,回顾性分析了死亡率、死亡原因、并发症、营养状态及血生化改变。结果ESDN组1、3年死亡率分别为19．3％和41．9％,3年死亡率明显高于non-ESDN组。主要死因为心血管病变（47,4％）和感染性疾病（26,3％）。主要并发症是心血管病变（94％）。两组营养状态评估（SGA）均差。但ESDN组的血浆清蛋白明显低于non—ESDN组。结论ESDN组并发症发生率及死亡率均比non—ESDN组高。积极治疗并发症,改善营养状态是提高生存率的关键。     

Deaths associated with diabetic ketoacidosis and hyperosmolar coma. 1973-1988

We assessed the possibility of improvements in the management of the potentially fatal acute hyperglycaemic complications of diabetes by a review of all deaths in patients who presented to the Alfred Hospital, Melbourne, with diabetic ketoacidosis or hyperosmolar coma during the 16 years, 1973-1988. All late deaths of patients during hospitalization were included in the mortality data. In the 610 episodes of diabetic ketoacidosis (pH, 7.30 or lower) or hyperosmolar coma (osmolality, 350 mOsmol/kg or greater), only one death occurred as a result of the acute metabolic disturbance--in a patient who had suffered a cardiac arrest before admission to hospital. The over-all mortality rate was 6.2% (38 deaths). The mortality rate was 4.9% (26 deaths) for 528 episodes of diabetic ketoacidosis and 14.6% (12 deaths) for 82 episodes of hyperosmolar coma. Patients with diabetic ketoacidosis who died were older than were those who survived (64 +/- 13 years compared with 40 +/- 21 years, respectively; P less than 0.001). Mortality in patients with hyperosmolar coma did not relate to age, initial blood-glucose level or osmolality. Twelve deaths resulted from bacterial pneumonia and two deaths resulted from aspiration pneumonia. Other major causes of death were mesenteric and iliac thromboses (six cases), myocardial infarction (eight cases) and cerebral haemorrhage (two cases). Of the 26 deaths that were associated with diabetic ketoacidosis, only two deaths--as a result of aspiration pneumonia and bowel infarction, respectively--were assessed as potentially avoidable after the patient's admission to hospital. Eight of the 12 hyperosmolar-coma-associated deaths occurred in newly recognized diabetic patients in whom there were avoidable delays in diagnosis. We conclude that further improvements in outcome will be difficult to achieve, but that efforts should be directed towards the earlier diagnosis of diabetes and the earlier recognition and treatment of associated acute pulmonary and vascular complications.     

终末期肾病血液透析患者危险因素分析

目的：探讨影响终末期肾病（ESRD）血液透析患者生活质量及长期存活的各种危险因素及防治方法。方法：选择42例终末期糖尿病肾病血透患者和同期50例相同年龄段非糖尿病血透患者,分别观察死亡原因、存活率、并发症及血生化改变。结果：①糖尿病肾病组1年和2年存活率分别为81％和71％。主要死因是心血管病变,其次是感染。②首次透析时的肌酐值与病死率成正比。③影响透析效果的主要并发症是心血管病变（86％）、高血压（88％）、透析低血压（31％）、感染（50％）,与非糖尿病肾病组比较有显著性差异。结论：糖尿病肾病终末期患者较非糖尿病患者应更早进行血透,控制两次透析期间的体重增加〈2．5kg,减少透析时血糖波动,防治并发症是减少危险因素,提高存活率及生活质量的关键。     

Comparative evaluation of diabetic and non-diabetic stroke--effect of glycaemia on outcome

Though there are extensive data on diabetic retinopathy, neuropathy and peripheral vascular disease, there are not enough data on diabetic stroke. Present study was carried out to evaluate distinctive feature of diabetic and non-diabetic stroke and to compare early mortality between two groups. Four hundred and fifty consecutive stroke cases categorised into group I of 171 known diabetic and 279 non-diabetics. Reactive hyperglycaemia seen in cases with HbA1c below 7.0% were put into group II. Patients were evaluated clinically. Evidence of peripheral vascular disease, retinopathy and other target organ damage were assessed. Glycaemic parameters monitored include fasting plasma glucose (FPG), random plasma glucose (RPG) and HbA1c. Total serum cholesterol was taken as the main risk factor in both groups though lipid profile was done in all cases. CT scan was done in all cases and a repeat one when needed. Out of 450 cases 171 were diabetic and 279 cases were non-diabetic. There was female preponderance in diabetic. Average age of diabetic stroke was lower than non-diabetic, 51.2 years as against 67 years. History of previous stroke was higher in diabetic (15.8%) than non-diabetic (5.7%). There was higher incidence of transient ischaemic attack in diabetic (22.8%) than non-diabetic (7.5%), which was highly significant (p<0.001). Hypertension and hypercholesterolaemia (> 175 mg/dl) were two important risk factors in 70.9% and 30.9% respectively in group I compared to 47.6% and 21.1 % respectively in group II, both of which are significant (p<0.001). Ischaemic stroke were higher in group I(69%) as compared to group II (45.8%) which was significant (p<0.001). Lacunar infarct were more in group I (73.7%) than group II (61.7%). Haemorrhagic stroke was higher in group II (52.7%) than in group I (30.4%). Apart from recent event CT scan showed evidence of old lacunar infarct in 36.8% cases of group I compared to 21.1% of group II. During follow-up mortality within 4 weeks was higher in haemorrhagic stroke of group I (55.8%) compared to 49.6% in group II which is significant (p<0.05). For ischaemic stroke mortality in group I was 26.3% compared to 14.8% in group II which is very significant (p<0.001). Out of total mortality in group I, 35.08% had high HbA1c. Increased risk of stroke in diabetic is probably related to hypertension and lipid abnormalities. Increased mortality from abnormal glycaemic control needs to be evaluated further.     

住院糖尿病患者死因分析

目的:了解住院糖尿病患者的病死率及死因,并探讨其主要死因与年龄和病程的关系。方法:回顾分析95例住院死亡的糖尿病患者的资料,并分析不同年龄和病程的死因构成。结果:糖尿病患者病死率为4.17%,远高于非糖尿病患者的病死率1.52%(P<0.01)。其前五位的死因依次是,心血管疾病(24.2%)、脑血管疾病(22.1%)、肿瘤(21.1%)、肾衰尿毒症(12.6%)、和其它(12.6%)。结论:糖尿病患者的病死率明显高于非糖尿病患者,心脑血管疾病和肿瘤是糖尿病患者的主要死亡原因。