2型糖尿病肾病36例临床分析

现将我院11年来(1988～1998年)收治2型糖尿病肾病患者共36例,报道分析如下。1　临床资料1.1　诊断标准　本组36例患者均符合1985年WHO2型糖尿病诊断标准,并有间歇性或持续性蛋白尿2次以上或24小时尿蛋白定量>50mg,并且除外糖尿病酮症酸中毒及泌尿系统感染等因素者。1.2　一般资料1.2.1　性别与年龄　36例2型糖尿病肾病患者中男14例,女22例。年龄38～73岁,平均58.5岁;50岁以上27例,占75%。1.2.2　病程　2型糖尿病病程≤1年2例,占5.6%;1年<病程≤5年13例,占36.1%;病程>5年21例,占58.3%,平均病程6.2年。1.2.3　血糖　空腹血糖<8mmol/L3例,占8…     

糖尿病肾病42例临床分析

糖尿病肾病(DN)是糖尿病严重的微血管并发症之一。本院于2001年1月至2005年7月收治糖尿病患者286例,其中并发糖尿病肾病(DN)者42例,占14.7%,现就其临床特征分析并报道如下。1　临床资料1.1　一般资料　286例糖尿病病人中,1型糖尿病(T1DM)35例,并发DN16例,占45.7%;2型糖尿病(T2DM)251例,并,占发DN26例,占10.4%。42例DN患者中,男性20例,女性22例;年龄<30岁2例,年龄30~49岁6例,50~60岁15例,>60岁19例。1.2　糖尿病病程、血糖水平与糖尿病肾病的关系　病程<5年的168例中并发DN2例(1.2%),2例病程均>3年;病程5~10年的94例中有15例(16.…     

2型糖尿病合并糖尿病性和非糖尿病性肾病的临床、病理特点

目的:了解2型糖尿病合并糖尿病肾病与非糖尿病肾病的发病率、临床特点及病理的异同.方法:对肾活检确诊的19例2型糖尿病的临床、病理资料进行回顾性分析.结果:糖尿病肾病8例(42.1%);非糖尿病肾病11例(57.9%),其中免疫球蛋白A肾病 4例(36.4%),其他系膜增生性肾炎、膜性病各2例,局灶节段性肾小球硬化、狼疮性肾炎合并糖尿病肾小球硬化症、原发性高血压肾损害各1例.非糖尿病肾病血清总胆固醇、甘油三酯明显高于糖尿病肾病(P＜0.05),而蛋白尿发现日期、尿蛋白量、肾小球滤过率两病差异不大.糖尿病肾病出现糖尿病视网膜病变2例,动脉硬化眼底改变 1例 ;非糖尿病肾病仅1例出现动脉硬化眼底改变.结论:2型糖尿病患者出现肾脏病变,应警惕伴发非糖尿病肾病的可能,宜积极行肾活检,视网膜病变对糖尿病诊断有较高特异性.     

2型糖尿病合并胆结石47例分析

糖尿病是一种常见的代谢障碍性疾病,呈慢性过程,并发症多。2型糖尿病合并胆结石已被大多数学者所认同。有资料报道,糖尿病患者胆结石的发病率为30·2%,远高于人群中11·6%的胆结石发病率[1]。我院2003年1月~2006年5月内科收治2型糖尿病891例,合并胆结石47例,占5·28%。现分析临床资料如下。1临床资料1·1一般资料47例中,男15例,女32例;年龄41~82岁;糖尿病病程1个月~20年。合并原发性高血压40例,糖尿病肾病12例,糖尿病视网膜病变10例,糖尿病自主神经病变38例。肥胖体型36例。1·2临床表现47例均有口渴、多饮、多尿、消瘦、乏力等糖尿病症状,…     

初诊2型糖尿病患者尿微量白蛋白的排泄率观察

目的：观察初诊2型糖尿病患者有无早期肾病，方法：观察住院165例2型糖尿病患者晨尿微量白蛋白，分初诊组，复诊组，对照组以t检验比较，结果：初诊2型糖尿病组有20％尿微量白蛋白增高，可能诊为早期肾病，但无临床肾病发现，糖尿病病程愈长，尿微量白蛋白愈高，直到临床肾病期，结论：初诊2型糖尿病实际病程已数年，尽早诊断糖尿病并干预治疗对糖尿病患者预防十分重要。     

老年2型糖尿病肾病52例临床分析

目的探讨2型糖尿病肾病（DN）的临床特点,以更好的预防和治疗此病。方法收集52例2型糖尿病肾病患者的资料进行临床分析。结果DN发病率与高血糖关系密切,与高血压、脑梗死、视网膜病变密切相关。结论DN是渐进性的,高血糖是DN发生的主要原因。发病率与病程呈正相关。在DN早期阶段,严格控制血糖和血压能降低蛋白尿。     

2型糖尿病肾病危险因素临床分析

目的：分析糖尿病肾病（DN）与各相关因素的关系以指导临床及早期防治。方法：对196例2型糖尿病患者（其中56例合并DN）相关指标进行统计分析。结果：DN发生率为28.6%,DN与患者的年龄、糖尿病病程、体重指数、高血压、血脂异常、血糖、尿白蛋白及治疗情况等指标密切相关。结论：多因素影响DN的发生,积极地控制各种危险因素对预防和延缓DN的发生与发展有重要的意义。     

糖尿病肾病53例临床分析

目的观察2型糖尿病肾病的临床治疗效果。方法选择2型糖尿病发展为肾病患者共53例,分为两组。对A组2型糖尿病肾病32例采用饮食控制、体育锻炼及口服降糖药治疗,积极治疗各种并发症,并加服卡托普利及阿司匹林抗凝。对B组2型糖尿病肾病患者21例采用控制饮食及胰岛素治疗,并加用小剂量阿司匹林抗凝治疗,以及服用卡托普利改善肾脏血供,血糖控制在正常范围内。结果A组中20例出现蛋白转阴,占62.50%,9例尿蛋白持续阳性,3例死于肾功能衰蝎,占9.38%。B组中15例出现尿蛋白转阴,占71.43%,2例仍有蛋白尿,4例死于肾功能衰竭,占19.05%。结论防治糖尿病肾病应从早期抓起,早期应严格控制血糖代谢,监测血糖血脂,可长期使用血管紧张素转化酶抑制剂。有高血压者控制血压,注意防治肾功能减退的危险因素,延长患者寿命,提高生活质量。     

2型糖尿病早期肾病临床特点分析

目的 观察2型糖尿病肾病早期的临床特点.方法 调查2型糖尿病患者微量蛋白尿组(MAU组)与正常蛋白尿组(NAU组)患者的年龄、病程及高血压病史、体质指数、腰围、血脂、糖化血红蛋白、C肽.结果 MAU组腰围、2h CP,TG、CH、LDL,高血压病史较NAU组长,以TG增高明显.MAU组中尿微量白蛋白与体质指数及腰围相关,腰围相关性为显著(P＜0.05);腰围与C肽、TG呈正相关,与HDL呈负相关(P＜0.01).结论 肥胖尤其是腹型肥胖与2型糖尿病早期肾病的发生发展关系密切.     

2型糖尿病患者发生糖尿病肾病的相关因素分析

目的探讨2型糖尿病患者糖尿病肾病发生的相关因素。方法采取回顾性分析方法选取2008年1月1日至2012年12月31日间门诊的868例2型糖尿病患者,按尿微量白蛋白(MAU)水平分成两组:无糖尿病肾病组和糖尿病肾病组,对两组患者的临床数据进行比较。结果①868例2型糖尿病患者中糖尿病肾病250例,占28.8%。②两组间年龄、病程、体重指数(BMI)、收缩压、舒张压、空腹血糖、餐后2小时血糖、糖化血红蛋白(HbA1c)、空腹胰岛素、胰岛素抵抗指数,胆固醇(TC)、甘油三酯(TG)、尿酸(UA)差异具有统计学意义。③Logistic回归分析结果提示:糖尿病肾病与BMI、收缩压、空腹血糖、HbA1c、TG、UA相关。结论 2型糖尿病患者应综合控制体重、血压、血糖、血脂、UA,改善代谢紊乱情况,利于糖尿病肾病的防治。     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.