糖尿病与非糖尿病患者散瞳后瞳孔直径的观察

目的比较糖尿病与非糖尿病患者散瞳后瞳孔直径的大小。方法将门诊散瞳患者分为糖尿病组和非糖尿病组。每组60例（60只眼）,共120例（120只眼）。均采用复方托品酰胺眼药水散瞳,30min时测量瞳孔直径,两组进行比较。结果糖尿病组散瞳时间明显长于非糖尿病组（t=2．563）,其散瞳直径明显小于非糖尿病组（t=3．669）,差异均有显著性（P〈0．01）。结论糖尿病患者散瞳后瞳孔直径明显小于非糖尿病患者,提示应重视糖尿病患者术前散瞳,以确保医师按时进行手术。     

糖尿病与非糖尿病白内障患者散瞳后瞳孔直径的比较

目的:比较糖尿病与非糖尿病患者散瞳后瞳孔直径的大小。方法:将门诊患者分为糖尿病组和非糖尿病组,每组60例共120例。均采用美多丽眼药水给患者散瞳,30min时测量瞳孔直径,两组进行比较。结果:两组瞳孔直径大小有差异。结论:糖尿病患者散瞳后瞳孔直径明显小于非糖尿病患者。提示应重视糖尿病患者术前散瞳,确保医师按时进行手术。     

糖尿病与非糖尿病白内障患者散瞳后瞳孔直径的比较

目的：比较糖尿病与非糖尿病患者散瞳后瞳孔直径的大小。方法：将门诊患者分为糖尿病组和非糖尿病组，每组60例共120例。均采用美多丽眼药水给患者散瞳，30min时测量瞳孔直径。两组进行比较。结果：两组瞳孔直径大小有差异。结论：糖尿病患者散瞳后瞳孔直径明显小于非糖尿病患者。提示应重视糖尿病患者术前散瞳，确保医师按时进行手术。     

美多丽对糖尿病性和非糖尿病性白内障散瞳效果的比较

目的：探讨使用美多丽对糖尿病性和非糖尿性白内障病人散瞳的效果，以及糖尿病性与非糖尿病性白内障病人散瞳后瞳孔直径大小的对比。方法：随机抽取40例（40只眼）糖尿病性白内障患者和40例（40只眼）非糖尿病性白内障患者，均给予患者采用美多丽散瞳，散瞳后分别在30分钟和45分钟时测量瞳孔直径大小，并进行两组比较。结果：两组散瞳后瞳孔直径大小有差异有统计学意义（T=3．621，P〈0．01）。结论：提示糖尿病性白内障患者散瞳后瞳孔直径明显小于非糖尿性白内障病患者，提示为确保手术的顺利进行，应根据糖尿病性白内障的特点进行术前散瞳。     

2型糖尿病患者散瞳结果的临床观察

目的 观察2型糖尿病患者与非糖尿病患者散瞳后瞳孔直径的大小（以下糖尿病均指2型糖尿病）。 方法 将2009年10月－2011年12月在眼科门诊就诊及因糖尿病性视网膜病变行激光治疗的住院患者30例（60只眼）纳入糖尿病组,另将因视网膜静脉阻塞、视网膜坏死综合征、视网膜裂孔等需要行视网膜激光光凝治疗的50例（61只眼）患者纳入对照组,两组均用复方托吡卡胺滴眼液散瞳,每5分钟1次,共4次,30 min后用瞳孔尺测量自然光线下瞳孔直径的大小并进行比较。 结果 在相同药物、相同时间、相同剂量的作用下,糖尿病组患者瞳孔直径变化差值较对照组小,两组比较差异有统计学意义（P＜0. 01）。 结论 糖尿病患者散瞳后瞳孔直径明显小于非糖尿病患者,在临床工作中应考虑瞳孔不易散大带来的不利因素。     

高龄糖尿病与非糖尿病患者眼科手术前散瞳效果的比较

目的探讨美多丽滴眼液在高龄糖尿病与高龄非糖尿病患者散瞳后效果。方法将53例高龄糖尿病患者与53例非糖尿病患者比较,共106例（106只眼）,均采用美多丽滴眼液给患者散瞳,30 min时测量瞳孔的直径。结果2组瞳孔直径大小差异有统计学意义（P〈0.01）,显示高龄糖尿病患者散瞳后瞳孔直径明显小于高龄非糖尿病患者。结论应重视高龄糖尿病患者术前的散瞳,按时手术有重要的意义。     

高龄糖尿病与非糖尿病患者眼科手术前散瞳效果的比较

目的探讨美多丽滴眼液在高龄糖尿病与高龄非糖尿病患者散瞳后效果。方法将53例高龄糖尿病患者与53例非糖尿病患者比较,共106例（106只眼）,均采用美多丽滴眼液给患者散瞳,30 min时测量瞳孔的直径。结果2组瞳孔直径大小差异有统计学意义（P〈0.01）,显示高龄糖尿病患者散瞳后瞳孔直径明显小于高龄非糖尿病患者。结论应重视高龄糖尿病患者术前的散瞳,按时手术有重要的意义。     

术前不同体位滴入散瞳药对老年性白内障患者散瞳效果的影响

目的 观察术前采取仰卧位、坐位滴入散瞳药对老年性白内障患者散瞳效果的影响.方法 将需行术前散瞳的老年性白内障患者240例随机分为两组,观察组和对照组各120例.观察组术前滴入散瞳药时取仰卧位,对照组取坐位头向后仰位.测量、记录患者的基线瞳孔直径、首次滴眼散瞳后30min的瞳孔直径及晶体植入前的瞳孔直径,并计算散瞳前后瞳孔直径差值、术中瞳孔达标率,进行两组间的比较.结果 最终完成本次研究的患者中,观察组102例,对照组116例.观察组首次滴入散瞳药后30min的瞳孔直径、晶体植入前的瞳孔直径及散瞳前后瞳孔直径差值均明显大于对照组(P＜0.01).观察组术中瞳孔理想达标率78.43％,基本达标率21.57％,未达标率0％;对照组术中瞳孔理想达标率56.90％,基本这标率40.52％,未达标率2.58％;两组比较,差异有统计学意义(P＜0.01).结论 老年性白内障患者术前滴入散瞳药时取仰卧位的散瞳效果优于坐位.     

糖尿病自主神经病变病人眼底照相散瞳效果观察与意外伤害防范

目的:探讨糖尿病并发自主神经病变病人在眼底照相中的散瞳效果以及在散瞳恢复过程中减少发生意外伤害的方法。方法:将糖尿病无并发症病人与糖尿病并发自主神经病变的病人各50例进行组间比较,两组均采用复方托品酰胺眼药水给予散瞳。同时将糖尿病并发自主神经病变病人的双眼按左右眼进行自身对照,左眼1次1滴,右眼1次2滴,每5 m in 1次,共3次。从第一次给药开始计时,分别在20 m in,40 m in时用测瞳尺由同一护士测量瞳孔直径大小,并记录瞳孔散大及恢复的时间。结果:糖尿病无并发症病人与糖尿病并发自主神经病变病人瞳孔直径在散瞳后20 m in大小差异有统计学意义(P<0.01),40 m in大小差异无统计学意义(P>0.05)。加大剂量与常规剂量的瞳孔直径差异无显著性(P>0.05),而恢复时间差异性显著(P<0.01)。结论:糖尿病并发自主神经病变病人散瞳效果不佳,延长散瞳时间可增加散瞳效果。增加药物剂量对瞳孔的恢复时间影响有显著性差异,在护理上要对病人进行特别的关注。     

60例糖尿病病人散瞳后瞳孔直径的观察

散瞳是眼科白内障、视网膜脱离等手术前的重要准备工作。眼科的内眼手术要求瞳孔直径达到6mm~8mm,并能在术中维持散大状态。术中最理想的瞳孔直径应>7mm。但临床工作中发现,糖尿病病人的瞳孔直径在散瞳30min时往往不能达到理想状态[1]。为探讨糖尿病对瞳孔的影响程度,我们对60例内眼手术的糖尿病病人进行观察,现报告如下。1对象与方法1.1对象样本来源于中日友好医院眼科2003年11月—2004年3月门诊糖尿病病人,共60例(60眼)。病史在1年~病人22例(22眼);病史在10年~的病人20例(20眼);病史在20年~30年病人18例(18眼)。病人的疾病诊断:白内障(无…     

Clinical diagnosis of diabetic polyneuropathy with the diabetic neuropathy symptom and diabetic neuropathy examination scores

OBJECTIVE: To evaluate the discriminative power of the Diabetic Neuropathy Symptom (DNS) and Diabetic Neuropathy Examination (DNE) scores for diagnosing diabetic polyneuropathy (PNP), as well as their relation with cardiovascular autonomic function testing (cAFT) and electro-diagnostic studies (EDS). RESEARCH DESIGN AND METHODS: Three groups (matched for age and sex) were selected: 24 diabetic patients with neuropathic foot ulcers (DU), 24 diabetic patients without clinical neuropathy or ulcers (DC), and 21 control subjects without diabetes (C). In all participants, the DNS and DNE scores were assessed and cAFT (heart rate variability [HRV], baroreflex sensitivity [BRS]), and EDS were performed (Nerve Conduction Sum [NCS] score; muscle fiber conduction velocity: fastest/slowest ratio [F/S ratio]). RESULTS: Both the DNS and the DNE scores discriminated between the DU and DC groups significantly (P < 0.001). The DNE score even discriminated between DC and C (P < 0.05). Spearman's correlation coefficients between both DNS and DNE scores and cAFT (HRV -0.42 and -0.44; BRS -0.30 and -0.29, respectively) and EDS (NCS 0.51 and 0.62; F/S ratio 0.44 and 0.62, respectively) were high. Odds ratios were calculated for both DNS and DNE scores with cAFT (HRV 4.4 and 5.7; BRS 20.7 and 14.2, respectively) and EDS (NCS 5.6 and 16.8; F/S ratio 7.2 and 18.8, respectively). CONCLUSIONS: The DNS and DNE scores are able to discriminate between patients with and without PNP and are strongly related to cAFT and EDS. This further confirms the strength of the DNS and DNE scores in diagnosing diabetic PNP in daily clinical practice.     

金属锌对2型糖尿病大鼠模型视网膜病变的作用

目的研究金属锌对2型糖尿病大鼠视网膜病变(diabetic retinopathy,DR)的防治作用。方法38只Wistar大鼠随机分成4组:基础饲料喂养的正常对照组,补锌高脂饲料喂养的高脂+锌组,建立糖尿病性视网膜病变模型高脂饲料喂养的高糖高脂组、建立糖尿病性视网膜病变模型高脂饲料喂养补锌的高糖高脂+锌组;4W后轻摘眼球,在透射电镜下分别观察各组视网膜超微结构。结果正常对照组透射电镜下视网膜毛细血管内皮细胞位于管腔内面,外侧有连续的基底膜和周细胞包绕,内皮细胞核形态正常,异染色质分布均匀,细胞器形态正常;高脂+锌组透射电镜下毛细血管内皮细胞核周可见少量异染色质、核内可见散在分布的异染色质,管壁厚基本正常,有管腔内突起物,线粒体基本正常,基底膜无增厚;高糖高脂组透射电镜下视网膜毛细血管基底膜增厚,断裂缺失,内皮细胞肿胀变形,核形态不规则,异染色质靠边聚集,线粒体空化、脊断裂,周细胞线粒体肿胀变形、空化,管壁增厚,管腔明显狭窄;高糖高脂+锌组透射电镜下视网膜毛细血管内皮细胞可见核周边异染色质聚集,核内亦可见异染色质,线粒体正常,管壁厚基本正常,管腔内可见少量突起物,周细胞核及线粒体内偶见空化。结论我们认为补充金属锌能对大鼠2型糖尿病视网膜病变微血管病变有防治作用。     

The diabetic foot

Diabetes is reaching epidemic proportions and with it carries the risk of complications. Disease of the foot is among one of the most feared complications of diabetes. The ultimate endpoint of diabetic foot disease is amputation, which is associated with significant morbidity and mortality, besides having immense social, psychological and financial consequences. As the majority of amputations are preceded by foot ulceration, it is crucial to identify those at an increased risk. Diabetic foot ulcers may develop as a result of neuropathy, ischaemia or both and when infection complicates a foot ulcer, the combination can become limb and life threatening. Structural abnormalities such as calluses, bunions, hammer toes, claw toes, flat foot and rocker bottom foot need to be identified and managed.     

The diabetic foot

Diabetic foot lesions most commonly result from a combination of neuropathy and vascular disease in the lower extremity, and may be the presenting feature of diabetes in the older patient. Insufficient attention previously has been given to the careful clinical assessment of the foot, which enables the physician to recognize those patients who are at particular risk of ulceration. The high-risk patient requires education and frequent follow up to reduce the risk of lesions developing. If ulceration develops, healing is likely to occur if the vascular supply is adequate, infection and the blood glucose are controlled, and pressures that may have caused the ulcer are relieved. The ischemic foot requires full vascular assessment, involving colleagues from vascular surgery. The key to a future reduction in the incidence of diabetic foot ulceration is the setting up of a foot care team in which the skills of nurses, podiatrists, orthotists, physicians, and surgeons are combined. The most important members of the team, however, are the patients, who must be convinced that regular foot care will reduce their chances of developing ulceration and other catastrophic consequences, such as amputation.