胰岛素泵治疗糖尿病急性并发症的效果观察

目的观察胰岛素泵治疗糖尿病急性并发症的疗效、副作用、住院时间及费用。方法将我院住院的糖尿病急性并发症患者40例(酮症酸中毒28例,乳酸酸中毒2例,高渗昏迷2例,心衰8例)随机分为胰岛素泵皮下输注组(CSII组,20例)和常规小剂量胰岛素静脉滴注(对照组,20例),两组年龄、血糖和体重指数(BMI)相比无显著差异。观察两组血糖、尿酮体变化,低血糖发生率以及住院时间和费用。结果①两组经治疗后血糖均明显下降,达到目标血糖值的时间(h)相比,CSII组(34.2±10.6)较对照组(52.7±23.5)明显缩短;②CSII组尿酮转阴时间(10.4±4.7)较对照组(49.5±10.2)明显缩短;③CSII组低血糖发生率(2.96%)较对照组(8.68%)明显减少;④CSII组住院时间(96.3±34.5)较对照组(135.7±56.8)明显缩短;以上均有显著性差异(P<0.01);⑤住院费用(元)CSII组(3365±657)较对照组(3100±456)稍多,二者无明显差异(P>0.05)。结论胰岛素泵持续皮下输注胰岛素治疗糖尿病急性并发症患者较常规小剂量静脉注射胰岛素疗效更好,更安全。     

胰岛素泵治疗糖尿病急性并发症的效果观察

目的观察胰岛素泵治疗糖尿病急性并发症的疗效、副作用、住院时间及费用。方法将我院住院的糖尿病急性并发症患者40例（酮症酸中毒28例,乳酸酸中毒2例,高渗昏迷2例,心衰8例）随机分为胰岛素泵皮下榆注组（CSII组,20例）和常规小剂量胰岛素静脉滴注（对照组,20例）,两组年龄、血糖和体重指数（BMI）相比无显著差异。观察两组血糖、尿酮体变化．低血糖发生率以及住院时间和费用。结果①两组经治疗后血糖均明显下降,达到目标血糖值的时间（h）相比,CSII组（34．2±10．6）较对照组（52．7±23．5）明显缩短;②CSII组尿酮转阴时间（10．4±4．7）较对照组（49．5±10．2）明显缩短;CSII组低血糖发生率（2．96％）较对照组（8．68％）明显减少;④CSII组住院时间（96．3±34．5）较对照组（135．7±56．8）明显缩短;以上均有显著性差异（P〈0．01）;⑤住院费用（元）CSII组（3365±657）较对照组（3100±456）稍多,二者无明显差异（P〉0．05）。结论胰岛素泵持续皮下输注胰岛素治疗糖尿病急性并发症患者较常规小剂量静脉注射胰岛素疗效更好,更安全。     

微量泵在糖尿病酮症酸中毒中的临床应用

目的:探索微量注射泵与静脉滴注治疗糖尿病酮症酸中毒的临床疗效.方法:选取2017年9月~2019年11月在本院治疗的糖尿病酮症酸中毒患者72例为观察对象,分为两组.微量注射泵组(实验组)38例患者,采用微量注射泵注射胰岛素方案治疗;静脉滴注组(对照组)34例患者,采取静脉滴注胰岛素方案治疗.比较两组患者的临床疗效以及各项指标的变化情况.结果:①经过治疗发现微量注射泵组患者的总有效率对比静脉滴注组具有明显优势,P<0.05.②经过治疗发现微量注射泵组患者血酮转阴时间短、住院时间少、血糖达标时间短及维持胰岛素量小对比静脉滴注组具有明显优势,P<0.05.结论:采用微量注射泵的方式注射胰岛素治疗糖尿病酮症酸中毒效果确切,对比临床疗效及各项指标等方面有明显的优势.     

持续静脉应用胰岛素、胰岛素泵用于治疗糖尿病酮症酸中毒病患的临床效果分析

目的:调研和分析持续静脉应用胰岛素和胰岛素泵用于治疗糖尿病酮症酸中毒患者的临床效果。方法:选择2017年1月~2019年1月到本院糖尿病科接受治疗糖尿病酮症酸中毒的68例患者作为调研对象,以随机法分为对照组(34例)和观察组(34例)。其中,对照组患者接持续静脉应用胰岛素治疗,观察组患者接受胰岛素泵应用胰岛素治疗。观察并对比两组患者相关指标情况以及低血糖发生情况。结果:观察组患者的尿酮转阴时间、血糖达标时间、尿酮体消失时间、血浆pH值恢复正常时间明显短于对照组,胰岛素应用剂量少于对照组(P<0.05);观察组患者的低血糖发生率2.94%明显低于对照组14.71%(P<0.05)。结论:在糖尿病酮症酸中毒患者接受治疗的过程中,相比较于持续静脉应用胰岛素,胰岛素泵应用胰岛素的临床治疗效果较好。     

儿童糖尿病30例临床分析

目的提高对儿童糖尿病的临床认识和诊治水平。方法对2003年1月～2007年11月间30例确诊为糖尿病住院患儿的临床特点进行总结和分析。结果发病年龄多为学龄儿童，10～15岁16例，占53％；男（17例），女（13例）；并发糖尿病酮症酸中毒（diabetic ketoacidosis，DKA）者22例，达73％；合并感染者23人；所有病例均用胰岛素治疗，效果良好。结论儿童糖尿病以学龄儿童多发，易合并糖尿病酮症酸中毒，感染可能是患儿糖尿病临床症状出现的重要诱因之一。了解儿童2型DM临床特点，对其进行早期干预，将会延缓其发生和发展。     

Antihypertensive drug therapy and hypoglycemia in elderly diabetic patients treated with insulin and/or sulfonylureas

We performed this case–control study to evaluate the risk of hypoglycemia associated with the use of antihypertensive drugs in older hospitalized diabetic patients treated with sulfonylureas and/or insulin. All diabetic patients admitted during 4 months in 1988, 1 month in 1991, 4 months in 1993 and 4 months in 1995 (n = 3477, mean age 71.4 ± 0.2 years, 1542 males and 1935 females) were enrolled in the study. During the four annual surveys 86 patients (mean age 71.1 ± 1.4 years, 33 males and 53 females) presented hypoglycemia during hospital stay. The patients who presented hypoglycemia were less frequently users of sulfonylureas and more frequently users of a combination of insulin and sulfonylureas. Use of antihypertensive drugs was similar in the two groups studied, and among potentially interacting drugs considered in the analysis, sulfonamides were more frequently used in patients who experienced hypoglycemia. Moreover, patients with hypoglycemia used a higher number of drugs, had a longer length of stay and had a greater prevalence of hypoglycemia as admission problem. Finally, although not significant, liver and renal diseases were more frequent among patients with hypoglycemia. In the multivariate analysis, contemporary use of insulin and sulfonylureas, liver disease and length of stay were significantly associated with hypoglycemia, while none of the antihypertensive drugs showed a significant association with the occurrence of hypoglycemia during hospital stay. Our results indicate that antihypertensive drugs do not increase the risk of hypoglycemia in elderly diabetic patients.     

Vomiting: not a benign symptom in children with diabetes

Two girls, 14 and 15 years old and known for several years with diabetes, came to the paediatric outpatients' clinic because they had been vomiting for 1-2 days. Laboratory tests revealed diabetic ketoacidosis. After administration of fluids and short-acting insulin, and sodium bicarbonate in one of the girls, the patients recovered, although one of them continued to have fluctuating glucose values. In most children, vomiting indicates benign gastro-enteritis and is therefore self-limiting. But in children with diabetes mellitus, vomiting can be more sinister because it could lead to, or be a symptom of, diabetic ketoacidosis. Even with normal blood glucose levels, severe metabolic disturbances are possible, and tests diagnosing diabetic ketoacidosis are recommended.     

Low-dose intravenous insulin: treatment of diabetic ketoacidosis in children (suitability for use in community hospitals).

A regimen is described to simplify current methods of ketoacidosis therapy by using only standard intravenous equipment and without requiring albumin administration. After an initial intravenous insulin bolus of 2 units, a dose of up to 3 units per hour was sufficient to bring patients out of ketoacidosis. No hypoglycemia, significant hypokalemia, or rapid fall in serum osmolality was detected. Patients showed steady increases in endogenous bicarbonate and were out of metabolic acidosis in 8.4 hours. This modified regimen appears to be a safe and easy method of treating diabetic ketoacidosis in children and is suited for use in community hospitals. Since the method is described for children over the age of three or those not in severe coma, consultation should be sought for any infant and for any child in severe coma or with a significant complication, such as severe infection.     

Diabetic ketoacidosis and pregnancy

This paper describes the clinical course of a young diabetic primigravida who presented to her physician with vomiting and abdominal pain. Despite the conventional doses of intravenous fluid and insulin that were used to treat her suspected diabetic ketoacidosis, she remained severely acidotic and developed increasing abdominal pain. Two hundred twenty units of regular insulin over a 5-hour period were required to reverse the lipolysis, acidemia, and abdominal pain, which characterized her severe episode of diabetic ketoacidosis. This discussion emphasizes the importance of insulin in the reversal of the hyperglycemia and acidosis that accompany a diabetic crisis. The roles of bicarbonate, phosphorous, magnesium, insulin, potassium, and fluids are discussed along with conditions such as pregnancy, infection, pancreatitis, and abdominal pain, which can complicate the management of diabetic ketoacidosis.     

Feeding practices of severely ill intensive care unit patients: an evaluation of energy sources and clinical outcomes

OBJECTIVE: The quantity of nutrition that is provided to intensive care unit (ICU) patients has recently come under more scrutiny in relation to clinical outcomes. The primary objective of this study was to assess energy intake in severely ill ICU patients and to evaluate the relationship of energy intake with clinical outcomes. DESIGN: Prospective cohort study. SUBJECTS/SETTINGS: Seventy-seven adult surgery and medical ICU patients with length of ICU stay of at least 5 days. STATISTICAL ANALYSES PERFORMED: Student's t test and chi2 tests were used to examine ICU populations. To determine the relationship of patient variables to hospital length of stay and ICU, length of stay regression trees were calculated. RESULTS: Both groups were underfed with 50% of goal met in surgical ICU and 56% of goal met in medical ICU. Medical ICU patients received less propofol and significantly less dextrose-containing intravenous fluids when compared to surgical ICU patients (P=0.013). From regression analysis, approaching full nutrient requirements during ICU stay was associated with greater hospital length of stay and ICU length of stay. For combined groups, if % goal was > or =82%, the estimated average value for ICU length of stay was 24 days; whereas, if the % goal was <82%, the average ICU length of stay was 12 days. This relationship held true for hospital length of stay. CONCLUSIONS: Medical and surgical ICU patients were insufficiently fed during their ICU stay when compared with registered dietitian recommendations. Medical ICU patients received earlier nutrition support, on average more enteral nutrition, with fewer kilocalories supplied from lipid-based sedatives and intravenous fluid relative to surgical ICU patients. Based upon length of stay, the data suggest that the most severely ill patient may not benefit from delivery of full nutrient needs in the ICU.     

25 years experiences on diabetic ketoacidotic patients

INTRODUCTION: In the past 25 years the authors regularly assessed the clinical characteristics of patients with diabetic ketoacidosis who were admitted to their diabetes unit. AIM: The aim was to examine the possible changes in the incidence, causes, treatment and mortality of diabetic metabolic disorders. METHODS: Retrospective analysis of the data obtained by the assessment of case histories. RESULTS: Between 1981 and 2005, 288 patients were admitted with 364 ketoacidotic episodes. The mean age of the patients was 42 +/-16.9 -- 53.2 +/- 12.6 years. Approximately 60% of them had type 1 diabetes and the proportion of the male patients was almost the same. The mean duration of diabetes was 7.8 +/- 8.1 -- 10 +/- 7.1 years. The ratio of manifest comas was approximately 10%. Among the precipitating factors the dominance of infections decreased (from 77.3% to 50.4%). During the treatment the aim of the authors was to supply fluids and electrolytes properly and to administer insulin for a prolonged period of time and in a dose as small as possible. The dose of the insulin bolus significantly decreased in the last period (8.29 +/- 4.31 U; p < 0.05). In the observed period 43 patients died (14.93% of the patients), the mortality rate decreased to 7.2% during the last period. CONCLUSIONS: Despite the intensive education, care and treatment of diabetic patients, the number of hospitalizations due to diabetic ketoacidosis has not decreased. In order to prevent ketoacidotic episodes proper team work is needed in the management of diabetic patients.     

胰岛素泵治疗糖尿病酮症酸中毒患者疗效观察

目的比较不同胰岛素给药方法对糖尿病酮症酸中毒患者的疗效差异。方法选择糖尿病酮症酸中毒患者75例,分别采用胰岛素泵（CSII）和胰岛素静脉滴注治疗,对胰岛素用量、血糖控制达标、尿酮转阴和血pH值恢复时间及低血糖发生情况进行对比分析。结果胰岛素泵（CSII）和持续胰岛素静脉滴注方法均能有效控制糖尿病酮症酸中毒。但本研究显示,两组患者胰岛素用量、血糖达标时间、尿酮转阴和pH值恢复时间、低血糖发生率,胰岛素泵（CSII）均较胰岛素静脉滴注治疗效果显著。结论与常规小剂量胰岛素持续静滴相比,胰岛素泵（CSII）对糖尿病酮症酸中毒的治疗是更为安全、有效的。     

Juvenile diabetes mellitus in Ethiopians.

The clinical features seen in 27 Ethiopian juvenile diabetics, which were similar to those of juvenile diabetics elsewhere, are summarized in this first published report from an African country of childhood diabetes. Control was difficult and admission to hospital frequent because of poverty, uncontrolled diets and irregular supplies of insulin. This group of childhood diabetics represents 9.8% of patients attending a diabetic clinic in Addis Ababa. Survey of the published information on diabetes mellitus in African populations reveals that most series do contain several children and a significant number of teenagers. It is concluded that juvenile diabetes mellitus is not rare in African countries.     

480例烧伤科手术患者医院感染危险因素调查

目的了解烧伤科手术患者医院感染的危险因素,为有效降低患者医院感染发病率提供理论依据。方法采用回顾性调查的方法,对某三级甲等综合医院2015年1—12月烧伤科收治的480例手术患者进行调查,分析其发生医院感染的相关危险因素。结果 480例烧伤手术患者,发生医院感染38例、44例次,医院感染发病率为7.92%,医院感染例次发病率为9.17%。感染部位以手术部位(19例,占43.18%)、血液(8例,占18.18%)和下呼吸道(5例,占11.36%)为主。单因素分析结果显示:合并糖尿病、手术时机、手术持续时间、入住重症监护病房(ICU)、住院日数、使用有创呼吸机、中心静脉置管、留置导尿管与医院感染的发生有关(均P0.05);多因素logistic回归分析结果显示:手术持续时间≥3 h(OR=4.455,P0.001)、住院日数30 d(OR=4.417,P0.001)和留置导尿管(OR=4.215,P0.001)是烧伤科手术患者发生医院感染的危险因素。结论加强围手术期管理,缩短手术时间,避免不必要的留置导尿以及缩短患者住院日数,有助于减少烧伤科手术患者医院感染的发生。     

The relationship of hospital stay and readmission with employment status

The Inpatient Clinico-Occupational Survey collected data from 3.76 million patients, showing that the average length of stay declined by 16.1 d in FY2008 and by 14.1 d in FY2015. In this study, we assessed the length of hospital stay and readmission, stratified by ICD-10 and employment status. A cross-sectional study was conducted on data from FY2008, including those from 65,806 first hospitalizations and 16,653 readmissions in FY2008, where 62,260 first admissions and 29,242 readmissions in FY 2015. The length of hospital stay was longest in those admitted due to external influences (24.8 d), followed by musculoskeletal disorders (22.5 d). This remained unchanged in FY2015, however, lengths of stay of those were reduced by 20.1 and 20.0 d, respectively. The length of hospital stay for most diseases was longer upon readmission than on first admission, and longer for those who were unemployed. It is necessary to give attention to patients who need to be discharged early due to work, or plan for frequent hospitalization in order to reduce the length of each hospital stay because of the expected increase in the number of elderly workers brought on by a declining birth rate and an aging population.     

An early switch from intravenous to oral antibiotics is equally effective as the standard intravenous therapy in severe community acquired pneumonia

OBJECTIVE: To compare an early switch from intravenous to oral antibiotics with the standard intravenous therapy in patients admitted to hospital with severe community acquired pneumonia. DESIGN: Multicentre randomised prospective trial with follow-up at 28 days. METHOD: Patients with severe pneumonia who were admitted to hospital were randomised for 7 days intravenous antibiotic therapy (control group) or for an early switch to oral antibiotic therapy after 3 days of intravenous antibiotic therapy (intervention group). An intention-to-treat analysis was performed. The primary outcome measure was clinical cure. The length of hospital stay was a secondary outcome measure. RESULTS: Out of the 302 patients included in the trial, data was analysed from 265 patients. The mortality rate in the intervention group did not differ significantly from that of the control group (mean difference: 2%; 95% CI: -3-8). After 28 days, 83% of the patients in the intervention group and 85% in the control group were clinically cured (mean difference: 2%; 95% CI: -7-10). The length of hospital stay was 1.9 days shorter in the intervention group (95% CI: 0.6-3.2 days). CONCLUSION: An early switch from intravenous to oral antibiotics in patients admitted to hospital for severe community acquired pneumonia is safe and reduces the length of hospital stay by approximately 2 days.     

胰岛素泵治疗糖尿病酮症酸中毒的疗效

目的：研究胰岛素泵治疗糖尿病酮症酸中毒（Diabetic ketoacidosis,DKA）患者的治疗效果。方法：此次研究中所入选的研究对象为糖尿病酮症酸中毒患者,均于2018年7月～2019年7月收入本院治疗,共90例,将其随机分为观察组及对照组,每组各45例。其中观察组采取胰岛素泵治疗,对照组接受常规输注治疗,患者治疗后观察其空腹血糖、饭后2h血糖等血糖指标,在血酮体、尿酮体转阴所用时间,以及在休克、心绞痛、肾功能衰竭等方面的并发症发生率,并比较两组患者的生活质量以及治疗满意度。结果：由血糖指标数据方面上可见,观察组患者相比较对照组较低（P<0.05),观察组患者恢复所用时间短于对照组（P<0.05),由并发症发生率数据方面上可见,观察组相比较对照组较低（P<0.05)。由生活质量数据方面上可见,治疗前,两组数据对比差异不满足统计学含义（P>0.05),治疗后,观察组相比较对照组较高（P<0.05)。观察组治疗满意度为95.56%(43/45);对照组治疗满意度为80.00%(36/45);由治疗满意度数据方面上可见,观察组相比较对照组较高（P<...     

The spectrum of brittle diabetes.

A group of 42 severely brittle insulin dependent diabetic patients were studied, and compared with a similar number of 'stable' diabetic patients. Brittle diabetics were predominantly female (86% v 45%, P < 0.01), were of younger age (mean +/- SD 27.9 +/- 12.8 years v 40.1 +/- 13.6 years, P < 0.001), and of shorter duration of diabetes (13.7 +/- 9.4 years v 19.6 +/- 11.2 years, P < 0.01). Control as measured by glycosylated haemoglobin (HbA1) was poorer (13.7 +/- 3.1% v 10.1 +/- 1.5%, P < 0.001), and daily insulin dose higher (98 +/- 81 u v 47 +/- 14 u, P < 0.001). There was no difference in diabetic complication rates, but psychosocial disturbances (74% v 17%) and factitious instability (40% v 2%) were highly significantly more common amongst brittle patients. Examination of patterns of admission revealed most brittle diabetics to have hyperglycaemic problems (70%), mainly due to recurrent ketoacidosis (52%). Recurrent hypoglycaemia accounted for 12% of the group, and only 5/42 patients (12%) had mixed forms of instability. Brittle diabetes is thus characterized by young age and female sex, and usually manifests itself as recurrent ketoacidosis or other forms of hyperglycaemic instability. Psychosocial problems and factitious metabolic decompensation are common.     

Brittle diabetes in the elderly

Severely unstable, or brittle, diabetes can be disruptive to patients, carers and diabetes care teams. The peak age-group for brittle diabetes is 15-30, but there are reports of its occurrence in much older patients. To explore the characteristics and cause of brittle instability perceived by diabetologists in elderly patients we circulated a questionnaire to all UK hospital diabetic clinics for adults. 130 (56%) of 231 replied. Reports were obtained on 55 patients fulfilling our criteria for 'elderly brittle diabetes'--namely, age > or =60 years, on insulin treatment, and experiencing life-disrupting glycaemic instability of any kind associated with frequent or long admissions to hospital. Further information was obtained by a research nurse who visited the relevant clinics. The mean age of patients was 74 years (range 60-89) and 71% were female. The brittleness was classed as mixed glycaemic instability in 22 (44%), recurrent ketoacidosis in 16 (29%) and recurrent hypoglycaemia in 15 (27%). In 2 cases there was insufficient information for classification. The diabetes care team judged the brittleness to have multiple origins in two-thirds of the cases: problems with memory or behaviour were rare, and in only 4 cases was deliberate manipulation of therapy considered a possibility. 84% of the patients were living independently. In younger patients the principal manifestation of brittle diabetes is recurrent ketoacidosis. The present survey, though possibly subject to ascertainment bias, indicates that the patterns of instability and their causation may be different in elderly patients. With the growing use of insulin in the elderly, brittle diabetes is likely to be encountered increasingly often in this age-group.     

Epidemiology of multi-drug-resistant gram-negative bacteria: data from an university hospital over a 36-month period

Multi-drug-resistant gram-negative rods (MRGN) are associated with increased morbidity and mortality. Little is known about the epidemiology of this group of pathogens in endemic situations. The aim of this study was to determine the epidemiology of MRGN in our facility during a 3-year period. Prospective surveillance of any patient colonized or infected with a MRGN during hospital stay from 2002 to 2004 was performed. Patients proven to harbour extended beta-lactamase (ESBL)-producing bacteria as well as cystic fibrosis (CF) patients were excluded. After culture of MRGN, patients were considered positive until three consecutive samples from all previously affected locations had been tested negative. Five hundred and three case-patients were enrolled accounting for 8081 isolation days and an incidence of 0.43 per 1000 patient days with an average length of stay of 37.5 days (average duration of isolation: 22.6 days). Sixty-six percent of case-patients were known to be positive at the time of admission. Fifty-one percent of MRGN were acquired within the hospital. The most frequently detected species was Pseudomonas aeruginosa. There were 108 case-patients with pan-resistant pathogens. Eight of 169 (4.7%) screened contact patients were found to be MRGN positive. In our hospital cross-transmission of MRGN seems to occur less frequently than cross-transmission of MRSA (9.0%) or ESBL (11.1%). To prevent nosocomial transmission it is recommended to isolate patients colonized or infected with MRGN in our hospital in single rooms. Because there are many immunocompromised patients in our facility we will continue our current infection control management until more data concerning MRGN are available.