高血糖与卒中预后的关系

卒中合并血糖升高是常见的临床现象,约2/3的急性缺血性卒中患者入院时合并高血糖或患有糖尿病。近年来,越来越多的证据支持高血糖或糖尿病是卒中患者预后不良的独立危险因素,且急性卒中时发生高血糖也是患者预后不良的危险因素。令人遗憾的是,目前国际研究表明,急性期应用胰岛素降糖治疗不能改善高血糖卒中患者预后。到底是由于治疗策略的不当还是试验设计的缺陷,目前尚不清楚。不管是什么原因,都意味着我们对于血糖与卒中的理解仍停留在一个非常粗浅的阶段。由此可见,在卒中领域的血糖管理方面存在许多亟需解决的问题：卒中急性期高血糖/糖尿病如何干预？控制血糖的时间窗是多少？血糖升高到什么水平会导致卒中患者预后不良？用什么样的策略进行血糖干预最合适？干预的强度如何？卒中急性期过后的血糖管理又该遵循怎样的原则？诸多问题都需要我们在临床工作中进行观察和总结,更需要利用循征医学的正确方法进行研究和讨论,只有这样,才能更全面的了解血糖与卒中的关系,以期通过合理的血糖管理策略改善卒中患者的预后。     

卒中的血糖管理

<正>卒中的血糖管理要遵循糖尿病治疗指南的一般原则。值得注意的是,临床治疗指南只是临床决策的一个组成部分,临床医生必须依据患者的病情、年龄、运动和饮食习惯、文化     

糖尿病与卒中——已知与未知，机遇与挑战

卒中已成为我国第一大死因及成人致残的主要病因,严重威胁着人类的健康。与此同时,随着经济发展及生活方式的转变,糖尿病的患病率逐年攀升,我国2007 2008年流行病学调查显示,20岁以上人群中糖尿病的总体患病率达9.7%。糖尿病是卒中的重要危险因素之一,如何预防以降低糖尿病患者的卒中风险已成为必须面对的严峻挑战。许多研究表明,糖尿病患者发生卒中的风险较非糖尿病患者显著升高。糖尿病信息研究(Diabetes and Informatics Study,DAI)显示糖尿病组卒中的患病率较非糖尿病组明显升高(6.7%vs2.5%),糖尿病患者的卒中风     

卒中急性期应激性高血糖的甄别与处理

临床流行病学研究已证实,糖代谢异常是缺血性卒中的独立危险因素,高血糖对卒中的预后有显著的不良影响,可使其致残率和死亡率明显上升^[1-2]。数十年来,许多学者对于卒中后高血糖发生及其导致卒中预后不良的机制进行了不懈的探索。2型糖尿病占糖尿病的95％左右,但由于2型糖尿病的高度异质性和隐匿性,     

卒中二级预防中血糖管理的原则

卒中后再次卒中的发生率很高。在美国，每年78万卒中患者中大约有1／4是卒中再发，因此对于卒中或TIA病人管理的首要目标是预防再次脑血管事件的发生^[1]。再次卒中的患者预后更差，常导致严重的致残或死亡，随之带来的认知障碍及抑郁状态，已经成为社会的巨大负担。重视卒中的二级预防，是临床脑血管病工作者的当务之急。     

重视血糖管理，完善卒中治疗

近年来我国脑血管事件的发病率有逐年攀升趋势,每年新发卒中患者约200万例,约150万人死于卒中,是继恶性肿瘤之后第2位的死亡原因。大量临床研究发现,在卒中患者中普遍存在高血糖现象。血糖超过6.0mmol／L即被定义为高血糖,超过2／3的慢性卒中患者和超过1／3的急性卒中患者并发高血糖川。     

缺血性进展性卒中与血压、血糖及梗死部位的关系

目的 探讨缺血性进展性卒中的发生率及影响因素,为临床防治进展性卒中提供依据.方法 我院436例急性脑梗死患者,入院后测血糖、血压,评定神经功能缺损评分.结果 436例患者中,142例发生进展性卒中(32.4％),进展性卒中患者中既往有糖尿病史19例(13.4％),入院发现血糖高者68例(47.89％),既往有高血压病史者90例,首次血压高者79例,影像学检查示梗死灶多位于皮质或皮质下区域,与非进展型者比较差异具有统计学意义.结论 高血压、高血糖可促使缺血性进展性卒中发生,梗死部位多位于皮质或皮质下.     

进展性缺血性卒中相关危险因素临床分析

目的探讨进展性缺血性卒中的临床相关因素。方法分析我院神经内科322例急性脑梗死患者临床资料,将其分为进展性卒中组及非进展性卒中组,对两组患者的高血压病史,糖尿病史,空腹及三餐后2h血糖、入院时收缩压、舒张压、高脂血症、高同型半胱氨酸血症及颅内血管狭窄情况进行比较。结果进展组患者中有高血压、糖尿病史及高脂血症、高同型半胱氨酸血症者较非进展组多见(P<0.05),进展组患者空腹及餐后2h血糖水平较非进展组高(P<0.05),进展组与非进展组患者入院时收缩压及舒张压水平未见显著差异(P>0.05),进展组患者颅内主要供血动脉狭窄较非进展组多见(P<0.05)。结论高血压、糖尿病史、血糖水平、高脂血症、高同型半胱氨酸血症及颅内血管狭窄与进展性卒中的发生相关。     

TOAST分型的急性缺血性脑卒中患者血糖变异性及其和预后的关系研究

目的 研究TOAST分型的急性缺血性脑卒中患者血糖变异性及其和预后的关系。方法 选取本院2014年2月～2015年2月接诊的112例急性缺血性脑卒中患者作为研究对象,据血糖监测将其分为血糖变异组和非血糖变异组,对所有患者的TOAST分型各亚型血糖变异性、TOAST分型各亚型血糖变异性两两比较情况、NIHSS评分以及Barthel指数、患者预后的多因素进行分析。结果 2组患者的年龄、糖尿病史以及NIHSS评分患者例数具有明显差异(P<0.05)。血糖变异组患者的LAA患者例数明显多于非血糖变异组(P<0.05),LAA组血糖变异性与SAO组和CE组比较有明显差异(P<0.05),而SAO组和CE组的血糖变异性没有明显差异(P>0.05)。入院半个月后血糖变异组患者的NIHSS评分以及Barthel指数没有明显差异(P>0.05),而非血糖变异组患者的NIHSS评分以及Barthel指数均有明显的变化,且2组患者在入院半个月后的NIHSS评分以及Barthel指数有明显差异(P<0.05)。年龄、NIHSS评分以及血糖变异等因素与急性缺血性脑卒中患者预后有关。结论 年龄、糖尿病史、LAA患者等均是影响患者血糖变异性的相关因素,且血糖变异性对急性缺血性脑卒中患者的预后具有一定的影响,是其独立的危险因素,即血糖变异性异常的急性缺血性脑卒中患者的恢复较缓慢,预后情况不良。     

The Fear of Doing Nothing

Through a personal account of the first year-and-a-half of conducting psychotherapy with a patient with borderline and narcissistic features, the author argues that current trainees in psychotherapy might be in a state of “choice overload,” i.e., having too many choices of theoretical and clinical approaches. It is argued that this overload, although at times helpful, is mostly confusing and detrimental, and that it covers the most basic fear of therapists in training: the fear of doing nothing. The importance of achieving a theoretical core to guide treatment and the difficulty of doing so in the current training climate, as experienced by the author, are discussed.     

Intolerance of Uncertainty and Mental Wellbeing: Serial Mediation by Rumination and Fear of COVID-19

International Journal of Mental Health and Addiction - The novel coronavirus-2019 (COVID-19) pandemic has become globally widespread with millions of confirmed cases and many countries implementing...     

Your Fear is My Fear: The Relationship Between Parental and Offspring Anxieties

Child Psychiatry & Human Development - Contrary to the well-documented link between parental and offspring clinical anxiety, little is known about the relationship between parental...     

The non-standardization of the Fear Survey Schedule.

The Fear Survey Schedule-III was administered to 860 college students. The results are presented in the form of frequencies, in deliberate contrast to previous work which present results in the form of z-scores. The argument is made that these z-scores do not normalize the original item distributions and thus provide no opportunity for normative comparisons. Data are provided allowing the researcher to assess the characteristics of FSS-III item distributions and make limited normative comparisons.     

Fear of dogs

Adults living in a mental handicap hospital, for whom fear of dogs was a problem, were included in a group treatment programme. Treatment involved gradual desensitisation over a period of 21 weekly sessions, making use of video and modelling procedures, and exposure to four different dogs. At the end of treatment, the majority showed an increased ability to cope with dogs. This improvement was maintained after nine months in those who had the opportunity to practise.     

Fear of AIDS

A specter is haunting our streets--the specter of AIDS, a remorseless and incurable disease whose nature, transmission and effects still contain elements of mystery. The fear of AIDS is pervasive. Most of us experience this fear as an uneasy but usually abstract awareness of its presence in the society. This awareness, however, may be jolted into something more concrete and immediate when we need to make or react to such decisions as whether our children should attend school with an AIDS victim or whether to require tests for the presence of AIDS antibodies (ELISA test) in food handlers and health workers. But populations at risk of infection with AIDS face a fear of a different quality. For hemophiliacs requiring the transfusion of blood products, for users of contaminated needles, even under certain circumstances for those who engage in heterosexual intercourse, infection with AIDS has to be a real issue. For homosexuals with an active sex life the fear is constant; ways must be found to come to terms with it. In this presentation I shall offer a series of vignettes illustrating reactions to the threat of AIDS that range from the distinctly maladaptive to the appropriately adaptive. I shall discuss some of the psychodynamic mechanisms operative in these cases and make general observations about the fear of AIDS in target populations.     

Fear of COVID-19 and Positivity: Mediating Role of Intolerance of Uncertainty,Depression, Anxiety,and Stress

This study aimed to investigate the mediating role of intolerance of uncertainty, depression, anxiety, and stress in the relationship between the fear of COVID-19 and positivity. The participants consisted of 960 individuals, including 663 females (69.1%) and 297 males (30.9%). The age of the participants ranged between 18 and 76 (29.74 ± 9.64). As a result of the correlation analysis, a positive relationship was found between fear of COVID-19 and intolerance of uncertainty, depression, anxiety, and stress, and a negative relationship was determined between the fear of COVID-19 and positivity. The result of the analysis for the study model indicated that there was a mediating role of intolerance of uncertainty, depression, anxiety, and stress in the relationship between the fear of COVID-19 and positivity. Eliminating uncertainty from the fear of COVID-19 will contribute to reducing depression, anxiety and stress, and increasing positivity.

     

Correction to: Your Fear is My Fear: The Relationship Between Parental and Offspring Anxieties

Child Psychiatry & Human Development -