胰岛素泵在2型糖尿病强化治疗中的应用和护理体会

目的 观察胰岛素泵持续皮下注射(CSⅡ)胰岛素和传统胰岛素皮下注射(MDⅡ)两种方法对2型糖尿病(DM)患者短期强化治疗中的血糖控制及胰岛素用量情况,探讨胰岛素泵使用过程中的护理问题.方法 148例2型DM患者随机分为CSⅡ组和MDⅡ组,比较两组治疗前后空腹血糖及餐后2 h血糖、胰岛素用量、血糖达标时间及低血糖反应.结果 CSⅡ和MDⅡ患者空腹血糖及餐后2 h血糖均逐渐降低,但CSⅡ胰岛素用量少、达标时间短,且低血糖发生率低.结论 胰岛素泵是2型DM短期强化控制血糖的安全有效、简便可靠的手段.     

胰岛素泵强化治疗对重型颅脑损伤高血糖反应患者的控制效果及护理

将60例颅脑损伤后高血糖反应患者分为胰岛素泵治疗组(胰岛素泵连续皮下输注组,即CSⅡ组)和对照组(每日多次注射胰岛素组,即MSⅡ组)各30例,并实施有效护理.比较观察两组患者治疗前后血糖水平、血糖达标时闻、胰岛素用量及低血糖发生率.结果CSⅡ组血糖控制效果明显优于MSⅡ组,CSⅡ组能明显缩短血糖达标时间,胰岛素用量及低血糖发生率均少于MSⅡ组.提示应在重型颅脑损伤早期,对高血糖反应患者及早应用胰岛素泵治疗并强化胰岛素泵护理措施.     

动态血糖监测联合胰岛素泵强化治疗2型糖尿病疗效及安全性评价

目的分析动态血糖监测联合胰岛素泵强化治疗2型糖尿病（T2DM）的临床疗效及安全性。方法将88例T2DM患者随机分为观察组和对照组,每组44例。观察组采用动态血糖监测系统（CGMS）联合胰岛素泵持续皮下输注（CSII）,即＂双C＂疗法进行治疗,对照组仅采用CSII进行治疗,比较2组患者治疗前后血糖水平的变化、血糖达标时间、胰岛素用量及低血糖事件的发生情况。结果治疗后,2组患者的空腹血糖（FBG）和2h餐后血糖（2hPG）均较治疗前明显降低;观察组患者胰岛素用量及血糖达标时间均显著低于对照组,差异有统计学意义;治疗期间,观察组有8例患者出现低血糖,均无其他伴随症状,对照组有18例患者出现低血糖,均伴有冷汗、心慌等症状,2组低血糖发生率比较差异显著。结论 ＂双C＂疗法可有效降低T2DM患者的血糖水平,减少胰岛素用量及缩短血糖达标时间,降低低血糖发生率,值得在临床推广应用。     

胰岛素泵强化治疗2型糖尿病30例临床护理

目的：探讨胰岛素泵持续皮下胰岛素注射（CSⅡ）和多次皮下胰岛素注射（MDI）对2型糖尿病强化治疗的临床疗效及护理措施。方法：将60例2型糖尿病患者随机分为CSⅡ组和MDI组各30例,CSⅡ组采用胰岛素泵治疗,MDI组采用胰岛素笔治疗。比较两组血糖水平、血糖达标时间、胰岛素用量、低血糖发生率等情况。结果：CSⅡ组在血糖达标时间、胰岛素用量及低血糖发生率方面与MDI组比较差异有显著性（P〈0．05）。结论：CSⅡ更能有效地控制血糖,节省胰岛素用量,降低低血糖的发生率,减少和延缓慢性并发症,提高生活质量。     

胰岛素泵治疗2型糖尿病临床观察

目的:比较胰岛素泵(持续皮下胰岛素注射或CS)与多次皮下注射胰岛素(MS)强化治疗2型糖尿病(T2DM)的疗效,达到血糖控制所用的胰岛素用量及时间、以及低血糖发生率。方法:将400例T2DM患者,随机分为CS组(200例)和传统的多次皮下注射胰岛素(MS)组(200例),进行强化胰岛素治疗。分别比较两组治疗前后的三餐前后及睡前血糖、血糖控制时间(d)、每日胰岛素用量及低血糖发生的次数。统计资料用-x±s表示,并行统计分析。结果:两组均能达到目标血糖值,但CS组血糖控制达标时间、胰岛素用量及低血糖发生率均明显少于MS组(P<0.01)。结论:CS能有效模拟人生理胰岛素分泌,更快、更有效地控制高血糖,减少低血糖的发生率。     

CGMS与CSII联合强化治疗危重症老年2型糖尿病疗效观察

目的：对动态血糖监测系统（continuous glucose monitoringsystem，CGMS）与胰岛素泵持续皮下输注胰岛素（continuous subcutaneous insulininfusion，CSII）联合治疗危重症老年2型糖尿病（T2DM）（联合组）的效果进行观察，并与多次皮下注射胰岛素（multiple daily insulin injection，MDII）组进行比较。方法：合并危重症的老年T2DM患者39例，随机为联合组（n=19）及MDII组（n=20），比较两组每日使用胰岛素量、平均血糖漂移幅度（mean amplitude of glycemic excursions，MAGE）、血糖达标天数、低血糖发生率、多脏器功能不全综合征（MODs）发生率及死亡率的差异。结果：联合组胰岛素用量、低血糖发生率、血糖达标天数、MODs发生率低于MDII组（P〈0．01或P〈0．05）。结论：CGMS与CSII联合治疗相较于MDII，可以更平稳、迅速的控制危重症老年T2DM患者的血糖，降低其并发症发生率。     

胰岛素泵强化治疗2型糖尿病疗效观察

目的观察胰岛素泵（CSⅡ）强化治疗2型糖尿病的临床疗效和不良反应。方法 60例2型糖尿病患者随机分为CSⅡ组和多次皮下注射胰岛素（MDI）组,观察两组患者的血糖、胰岛素用量、血糖达标时间、低血糖发生率及胰岛素抵抗指数（HOMA-IR）、胰岛素敏感指数（IAI）的变化。结果 CSⅡ组的胰岛素用量、HOMA-IR、血糖、低血糖发生率、血糖达标时间明显比MDI组降低,P〈0.05,但IAI明显增加,P〈0.05。结论 CSⅡ强化治疗2型糖尿病临床疗效好于MDI。     

胰岛素泵治疗初发2型糖尿病临床观察

目的:观察胰岛素泵对初发2型糖尿病的疗效.方法:选择2004年6月～2007年6月收治的120例初发2型糖尿病,随机分成胰岛素泵治疗组(CSⅡ组)和皮下注射胰岛素组(MSⅡ组),观察两组治疗前后空腹血糖、餐后血糖、血糖达标天数、平均胰岛素用量及低血糖现象发生率.结果:CSⅡ组治疗后空腹血糖、三餐后2小时血糖均显著低于MSⅡ组(P＜0.01);CSⅡ组血糖达标时间平均(6.6±1.3)天,MSⅡ组平均(10.1±2.3)天,两组比较差异有显著性统计学意义(P＜0.01);CSⅡ组平均胰岛素用量(33.8±7.9)U/d,MSⅡ组平均(44.4±10.8)U/d,两组比较差异有显著性统计学意义(P＜0.05).结论:胰岛素泵对初发非胰岛素抵抗的2型糖尿病可有良好治疗效果,缩短血糖达标天数,减少胰岛素用量,降低低血糖发生率.     

两种不同胰岛素给药方法对糖尿病病人血糖影响的临床观察

[目的]对两种不同的胰岛素给药方法,在胰岛素总用量、血糖达标时间、低血糖发生率方面进行比较。[方法]选择86例住院使用胰岛素治疗的2型糖尿病病人,回顾性分为持续皮下胰岛素泵注射组(CSⅡ组)与静脉输注泵加常规皮下注射胰岛素治疗组,采取不同的给药方法治疗,比较效果。[结果]两种方法均能有效降低血糖,但胰岛素总用量、血糖达标时间、低血糖发生率CSⅡ组显著少于静脉输注泵组。[结论]胰岛素泵强化治疗2型糖尿病更能较快、平稳控制血糖,优于静脉输注泵加常规皮下注射胰岛素治疗,并可减少低血糖发生的危险,缩短住院时间,减少胰岛素用量,减轻病人的负担。     

胰岛素泵治疗2型糖尿病临床观察

目的 观察分析胰岛素泵持续皮下输注胰岛素(CSⅡ)治疗糖尿病的疗效.方法 将68 例2型糖尿病患者随机分为CSⅡ组和常规多次皮下注射组,每组34例,进行胰岛素强化治疗并对结果 进行比较.结果 CSⅡ组血糖控制良好,胰岛素用量较少、低血糖发生次数、血糖达标所需天数短于对照组(P<0.05).结论 胰岛素泵强化治疗能更有效地模拟生理胰岛素的分泌,更快、更有效地控制高血糖,减少低血糖和血糖波动的发生.     

超声评分对膝骨性关节炎患者病变特点的评估价值

目的 探讨超声评分对膝骨性关节炎患者病情严重度的诊断价值。方法 回顾性收集我院收治的膝骨性关节炎患者52例,同期收集50例健康成人,分析超声评分与膝骨性关节炎患者病情严重度的相关性。结果 膝骨性关节炎患者超声评分显著高于健康成人(6.93±1.76 vs. 1.73±0.56,P=0.000)。膝骨性关节炎患者超声评分与髌上囊液体深度、髌下囊液体深度、关节腔液体深度、滑膜厚度显著正相关(r=0.265、0.216、0.310和0.255,P=0.004、0.035、0.000和0.012),与Lyshsolm显著负相关(r=-0.381,P=0.000)。与增生滑膜内血管阴性的患者相比,增生滑膜内血管阳性的患者超声评分显著增加(7.43±1.61 vs. 5.58±1.42, P=0.000)。结论 超声评分与膝骨性关节炎患者病情严重度相关。     

Use of the Role Checklist with the patient with multiple personality disorder

A paucity of occupational therapy evaluation tools exists for use with patients with multiple personality disorder. The Model of Human Occupation (Kielhofner & Burke, 1980), particularly the volition and habituation subsystems within this model, proved useful for the identification of the many facets of patients with multiple personality disorder on a short-term treatment unit. The Role Checklist (Oakley, Kielhofner, Barris, & Richler, 1986), a tool derived from the Model of Human Occupation, was adapted for use with this population and was found to be beneficial in the identification of common goals held by most of the personalities of each patient with multiple personality disorder. The use of the Role Checklist is illustrated with a case example.     

Living with a woman with fibromyalgia from the perspective of the husband

BACKGROUND: Fibromyalgia (FM) is a chronic pain syndrome, which affects mostly middle-aged women. The syndrome is poorly understood and treatment is mainly palliative. The diagnosis is established from diagnostic criteria. Living with FM means living a life greatly influenced by the illness in various ways for people affected. Aim of the study. The aim of this study was to describe the experiences of living with a woman with FM from the husbands' perspective. METHODS: Five men married to women with FM were interviewed using a narrative approach. The interviews were analysed using qualitative thematic content analysis. FINDINGS: The analysis resulted in the following seven themes: increasing responsibility and work in the home; being an advocate for and supporting the wife; learning to see the woman's changing needs; changing relationship between spouses; changing relationship with friends and relatives; deepening relationship with the children and lacking information and knowledge about FM. The findings show that the women's illness had a great impact on husbands' lives, and that husbands lacked information about the woman's illness. CONCLUSION: This study shows that it is not only the women with FM who experience a changed life; the whole family life is influenced and limited by FM. The husband's role in the family changes, first and foremost concerning responsibility and workload within the family. This must be taken into consideration in care planning. This study also highlighted the need of information and knowledge about FM expressed by the participants, information that health care personnel have a great responsibility to give.     

Experience with the use of plasmapheresis in the combined treatment of children with the crush syndrome

Plasmapheresis (PP) was applied to the treatment of 5 children aged 6-14 years with the crush syndrome. The multimodality treatment using antibiotics, erythrocytic mass, rheologically active preparations, hemodialysis and blood rheologically active preparations, hemodialysis and hemoperfusion carried out for 6-7 days before PP did not bring about any appreciable improvement of the patients' status. The patients failed to get rid of anuria and manifested the signs of increasing intoxication. The treatment with PP consisted of 1 to 6 procedures, in the course of which 70 to 85 of the design volume of the circulating plasma was removed. The use of PP resulted in the disappearance of myoglobin from the patients' blood and urine, in the normalization of the coagulogram, a considerable decrease of the content of medium molecules, and in the appearance of the first urine towards the end of the procedure. Thus, the introduction of PP into multimodality treatment of the crush syndrome made it possible to eliminate anuria, disseminated intravascular coagulation, and to noticeably reduce intoxication and to clear the blood off myoglobin.