瑞格列奈联合罗格列酮治疗糖尿病效果观察

目的探讨分析瑞格列奈联合罗格列酮治疗糖尿病的临床疗效。方法选取82例2型糖尿病患者,将其随机分为观察组和对照组,分别给予瑞格列奈联合罗格列酮治疗和单纯瑞格列奈治疗,比较两组患者临床疗效,治疗前后空腹血糖、餐后2 h血糖、糖化血红蛋白、三酰甘油及胆固醇水平,同时观察患者治疗过程中的不良反应发生率。结果观察组临床疗效总有效率为95.12%,较对照组(80.49%)显著提高,治疗后观察组空腹血糖、餐后2 h血糖、糖化血红蛋白、三酰甘油及胆固醇水平较对照组显著下降;观察组不良反应发生率为7.32%,显著低于对照组的24.39%,差异有统计学意义(P0.05)。结论瑞格列奈联合罗格列酮治疗2型糖尿病患者可显著提高临床疗效,尤其是改善患者临床症状疗效显著,空腹血糖、餐后2 h血糖、糖化血红蛋白、三酰甘油及胆固醇水平均显著改善,且降低不良反应发生情况,值得进一步在临床上推广。     

甘精胰岛素联合瑞格列奈治疗非肥胖2型糖尿病临床观察

目的:观察甘精胰岛素联合瑞格列奈治疗非肥胖2型糖尿病的疗效及低血糖发生情况.方法:非肥胖2型糖尿病患者64例,随机分为治疗组(32例)和对照组(32例).治疗组给予甘精胰岛素联合瑞格列奈,对照组给予精蛋白锌重组人胰岛素混合注射液,2组疗程均为12周.观察2组治疗前、后空腹血糖,餐后2 h血糖、糖化血红蛋白、体质量指数、胰岛素用量及低血糖事件发生情况.结果:53例患者完成治疗.治疗后2组空腹血糖、餐后2 h血糖、糖化血红蛋白均较治疗前降低(P<0.05);治疗组治疗后空腹血糖、胰岛素用量及低血糖发生率低于对照组(P<0.05).餐后2 h血糖,搪化血红蛋白及体质量指数比较差异无统计学意义(P>0.05).结论:甘精胰岛素联合瑞格列奈可有效控制非肥胖2型糖尿病患者血糖水平,且安全方便,初使剂量宜偏小.     

瑞格列奈治疗2型糖尿病肾病氮质血症期32例疗效分析

目的：观察瑞格列奈治疗2型糖尿病肾病氮质血症期的疗效。方法：糖尿病肾病氮质血症期患者32例,瑞格列奈三餐前口服0.5~1.0 mg,观察12周。停用其他降糖药。治疗前后观测：空腹血糖、餐后2 h血糖、糖化血红蛋白、尿素氮、血肌酐及不良反应。结果：空腹血糖、餐后2 h血糖、糖化血红蛋白较治疗前明显下降（P〈0.01）,尿素氮及血肌酐无明显变化（P〉0.05）,无明显不良反应。结论：瑞格列奈能很好降低血糖,不损害肾功能。     

国产瑞格列奈治疗老年2型糖尿病的疗效观察

目的探讨国产瑞格列奈治疗老年2型糖尿病的临床疗效。方法回顾性分析2010年1月至2013年1月收治入院的高龄2型糖尿病患者200例临床资料,随机将患者分为两组,每组100例,观察组采用国产瑞格列奈进行治疗,对照组患者采用进口瑞格列奈进行治疗,采用平行对照、多中心研究设计,整个试验过程历时4周,药物观察期4周。比较治疗前后空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbAlc)的变化。评价两组用药后不良反应发生情况。结果两组患者治疗前血糖及体质指标差异无显著性(P0.05);治疗前FPG、2hPG及HbAlc水平均明显高于正常,治疗4周后两组血糖及体质指标均明显下降,与治疗前比较差异均有统计学意义(P0.05);但观察组更为明显;两组患者血糖达标时间差异无显著性(P0.05);观察组胰岛素用量、低血糖发生人数明显低于对照组,且差异有统计学意义(P0.05)。结论国产瑞格列奈治疗老年2型糖尿病安全有效。     

瑞格列奈联合二甲双胍治疗2型糖尿病的临床观察

探讨瑞格列奈联合二甲双胍治疗2型糖尿病的临床效果。将收治的2型糖尿病患者90例随机分为观察组和对照组,对照组45例给予瑞格列奈,观察组45例在对照组的基础上给予二甲双胍,观察两组患者的临床效果。观察组餐后血糖、空腹血糖及糖化血红蛋白明显低于对照组,差异有统计学意义(P0.05)。瑞格列奈与二甲双胍联合用药,能显著降低患者餐后血糖、空腹血糖及糖化血红蛋白水平,临床效果明显,值得临床推广。     

瑞格列奈治疗2型糖尿病临床观察

目的观察瑞格列奈治疗2型糖尿病的疗效及安全性。方法应用瑞格列奈治疗107例2型糖尿病患者，疗程为12周，观察并记录患者治疗前后的空腹血糖（FPG）、餐后2h血糖（PPG2h）、糖化血红蛋白（HbA1C）、肝。肾功能情况及副作用。结果经治疗12周后，患者空腹糖（FPG），餐后2h血糖（PPG2h），糖化血红蛋白（HbA1C）都显著降低（P〈0．05）。结论瑞格列奈可有效降低血糖，尤其是餐后血糖控制更好     

瑞格列奈改善2型糖尿病患者胰岛β细胞功能的临床观察

目的：观察瑞格列奈对2型糖尿病患者胰岛β细胞功能的影响。方法：选择58例初诊未经降糖药物治疗的2型糖尿病患者．口服瑞格列奈（诺和龙）0．5～1.0mg／次，3次／d．共16周。测定治疗前后空腹血糖，餐后2h血糖，糖化血红蛋白及空腹血清胰岛素、计算胰岛β细胞功能指数及胰岛素抵抗指数。结果：58例经瑞格列奈治疗的患者其空腹血糖、餐后2h血糖、糖化血红蛋白均降低（P〈0.05）．空腹胰岛素水平亦略有降低．胰岛β细胞功能指数明显增加，胰岛素抵抗指数明显下降（P〈0.05）。结论：瑞格列奈可显著降低血糖．改善2型糖尿病患者胰岛β细胞功能，缓解胰岛素抵抗。     

瑞格列奈治疗2型糖尿病疗效观察

目的:对新型口服抗糖尿病药物瑞格列奈(Repagllnldc,诺和龙)的疗效进行评价。方法:2型糖尿病患者34例,瑞格列奈治疗前一月内测定对照空腹血糖、餐后2小时血糖、糖化血红蛋白(HbA_1c)、血脂、体重、身高,观察过程中,饮食及运动量同前不变,经其它降糖药物治疗血糖3个月控制不佳者,改服或加服瑞格列奈0.5mg,2次/日,如2周后餐后2小时血糖≥11.1mmol/L,则加至0.5mg.3次/日,疗程8周,治疗8周后复查空腹血糖、餐后2小时血糖、HbA_1C、血脂、体重。结果:与治疗前比较,空腹血糖、餐后2小时血糖、HbA_1C均有显著下降,空腹血糖下降0.9mmol/L(P<0.05),餐后2小时血糖下降5.68mmol/L(P<0.05),HbA_2C下降1.54%(P<0.05);而体重指数、血脂治疗前后无显著性差异。瑞格列奈治疗中出现较轻的腹胀、头痛、低血糖等副作用,其中低血糖发生率12%。结论:在为期8周的治疗中,瑞格列奈对2型糖尿病患者的空腹血糖、餐后2小时血糖、HbA_1C均有明显下降,能模拟生理性胰岛素分泌,起到“餐时血糖调节剂”作用,发生低血糖频率低,副作用轻微,患者顺应性、安全性较好。     

甘精胰岛素联合瑞格列奈治疗2型糖尿病合并慢性肾功能不全的疗效

目的:观察甘精胰岛素联合瑞格列奈在2型糖尿病合并慢性肾功能不全患者中的降糖作用和安全性.方法:选择血糖控制欠佳[糖化血红蛋白(HbAlc)>7.5%]的2型糖尿病并慢性肾功能不全患者31例,分为治疗组(甘精胰岛素+瑞格列奈,16例)和对照组(诺和灵30R+瑞格列奈,15例),疗程12周,以糖化血红蛋白、空腹血糖及餐后2h血糖评价其有效性;根据低血糖反应及血生化指标的变化,评价其安全性;比较两种治疗方法在安全性、疗效方面有无差异.结果:两组患者的空腹血糖、餐后2h血糖较治疗前显著降低,差异有统计学意义(P＜0.05),且低血糖发生率治疗组较对照组低(P＜0.05).结论:甘精胰岛素联合瑞格列奈能有效、平稳地控制24h血糖,低血糖反应少,有利于全天血糖控制.     

瑞格列奈联合二甲双胍治疗2型糖尿病的疗效观察

[目的]探讨瑞格列奈联合二甲双胍对2型糖尿病病人的疗效及安全性.[方法]选取2型糖尿病病人54例,分成三组,分别给予单用瑞格列奈、二甲双胍及瑞格列奈联用二甲双胍进行口服.治疗前后饮食习惯及生活方式不变,治疗12周后观察前后空腹血糖(FPG)、餐后2 h血糖(2hPG)和糖化血红蛋白(HbA1C),并了解其有无不良反应.[结果]治疗12周后FPG,2hPG、HbA1C均有明显下降,且瑞格列奈联合二甲双胍组疗效明显优于单独用药组(P＜0.05).[结论]瑞格列奈联合二甲双胍有协同控制血糖的作用,且不良反应轻微,安全性、依从性良好.     

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.     

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.     

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.     

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.