小剂量胰岛素加胃管补液治疗糖尿病高渗性昏迷

糖尿病高渗性昏迷属内科急症，多发生于非胰岛素依赖型老年糖尿病患者。临床表现为严重高血糖及严重脱水，并伴有神经系统症状，有高血浆渗透压。治疗重点在于积极纠正高渗脱水状态，恢复血容量，并合理使用胰岛素，使血糖降至最佳水平。我院近年收治39例糖尿病高渗性昏迷患者。经抗感染、静脉与鼻饲联合补液、持续滴注小剂量胰岛素，取得较好疗效，报告如下。     

腹部重症感染并发高渗高血糖非酮症性昏迷(附7例报告)

高渗高血糖非酮症性昏迷(ＨＨＮＣ)是糖尿病的严重并发症。在外科严重感染时亦可发现。我院自1985年1月至1997年12月共收治此类病人7例,均发生在严重腹部感染时。经积极救治,4例治愈,3例因感染性休克及继发多器官功能衰竭而死亡。现报告如下。1　临床资料1·1　一般资料　7例中男5例,女2例,年龄47岁～78岁,平均64岁。经Ｂ超、ＣＴ、腹腔穿刺及血、尿、腹水淀粉酶测定确诊,4例为急性重症胰腺炎;2例为急性重症胆管炎;1例是胃次全切除术后吻合口瘘引起的弥漫性腹膜炎。7例均无糖尿病病史。分别于入院后1～7ｄ先表现躁动不安、烦渴、神志恍惚,谵…     

TPN期间高糖高渗非酮症性昏迷防治体会(附1例报告)

全肠外营养(TPN)在外科危重疾病的治疗中具有十分重要的作用.随着TPN在临床广泛应用,与TPN相关的并发症也相应增加.其中,高糖高渗非酮症性昏迷是一种严重并发症,现报告1例.     

非酮症高渗性昏迷心肌酶学分析

目的 探讨糖尿病非酮症高渗性昏迷患者心肌酶学变化的临床意义。方法 对1994-2004年51例高渗性昏迷患者入院后作心肌酶学动态现察并结合临床资料进行分析。结果 51例高渗性昏迷病人的心肌酶学均有不同程度的变化。结论 高渗性昏迷患者的心肌酶学明显升高。有显著性差异。     

神经外科高渗高血糖非酮症性昏迷7例临床分析

目的对7例神经外科高渗高血糖非酮症性昏迷(hyporosmolar hyperglycemia nonketotic coma HHNC)病人进行临床分析,探讨HHNC的发病原因及预防治疗措施.方法回顾治疗方法,对过去3年内神经外科发生7例HHNC病人进行调查研究.结果7例HHNC患者均有蛛网膜下腔出血(subarachnoid haemorrhage SAH),发病后1例呈嗜睡,6例昏迷程度加深,采用监测中心静脉压(ccntral venous pressure,CVP)调整补液量、微量泵泵入胰岛素控制血糖治疗4人,存活3人,所有病人均死于并发症.结论监测CVP调整补液量纠正高渗状态,微量泵泵入胰岛素控制血糖,预防和控制并发症是成功治疗HHNC的关键.     

小剂量胰岛素治疗糖尿病酮症酸中毒2例报告

1 病历摘要例1,男,45岁。因烦渴、多饮、多尿、多食、消瘦半个月,加重伴有恶心、疲乏3天,于1995年6月入院。既往无糖尿病史,无类似疾病的家族遗传史。入院体检:T36.5℃,P94次/分,R29次/分,BP18/     

TPN并发高糖高渗性非酮症性昏迷

近年来,完全胃肠外营养（ＴＰＮ）在临床中广泛应用,偶有高糖高渗性非酮性昏迷（ｈｙｐｅｒｇｌｙｃｅｍｉｃｈｙｐｅｒｌｓｍｌｌａｒｎｏｎｋｅｔｉｏｎｉｃｃｏｍａ,ＨＨＮＣ）发生。现就我们遇到的３例报告如下：１　临床资料例１,女,３４岁,５０ｋｇ,车祸伤,行十二肠断裂吻合、胰腺破裂修补术后外院转入。否认糖尿病史,查血糖不高。经中心静脉应用ＴＰＮ,其中给葡萄糖２２５ｇ／ｄ,浓度为１０．５％,第３天输液速度失控,１５ｍｉｎ内输入高渗营养液３００ｍｌ,病人出现抽搐,逐渐进入昏迷状态,经等渗盐水、５％葡萄糖液…     

糖尿病非酮症高渗性昏迷的抢救和护理

糖尿病非酮症高渗性昏迷为糖尿病严重的并发症之一,死亡率高达40%以上[1],主要表现为严重的高血糖、尿糖,而尿酮体阴性,血浆渗透压明显升高,引起身体严重脱水而导致意识障碍、循环衰竭等严重情况危及生命,因此及时、合理、准确地抢救至关重要。1抢救措施1.1合理安排输液补液和应用胰岛素是抢救高渗性昏迷的同步措施,应专用一条静脉通道补液。1.1.1补液途径病情较轻者,鼓励自己饮水;不能进食者,给予插胃管经胃肠道补液,尤其是年龄较大者,胃管补液量应占总补液量的2/3。1.1.2补液种类目前认为如无休克而渗透压明显增高者,应给0.6%低渗NaCl液;…     

糖尿病非酮症高渗性昏迷的抢救与护理

非酮症高渗性昏迷为糖尿病严重的并发症之一 ,死亡率高达 40 %以上 ,主要表现为严重的高血糖、尿糖 ,而尿酮体阴性 ,血浆渗透压明显升高 ,引起身体严重脱水、脑脱水而导致意识障碍、循环衰竭等严重情况危及生命 ,因此及时、合理、准确的抢救至关重要。现将我科 2 0 0 0年 1月～ 2 0 0 2年10月收住抢救 16例糖尿病非酮症高渗性昏迷患者抢救护理体会报告如下 :1　临床资料1 1　一般资料16例患者中 ,年龄 3 5～ 74岁 ,平均 5 5岁。既往明确糖尿病病史者 13例 ,以昏迷发病后确诊者 13例。其中嗜睡 3例 ,重度脱水 13例 ,中度脱水 3例。检验结果 :…     

A review of fluid replacement for workers in hot jobs

Prolonged work in hot environments leads to progressive water and electrolyte loss from the body. The rate of sweating varies among individuals and depends on the environmental conditions, but in protective clothing and very hot environments rates can reach 2.25 L/hour. Because hypohydration will impair work performance and increases the risk of heat injury, consumption of fluids is necessary to prevent dehydration and enhance performance. Much of the research on rehydration has been conducted in athletic settings. The purpose of this review is to interpret the existing research literature on hydration in a way that is useful to industrial hygienists and safety experts. The authors hope to provide industrial hygienists and safety professionals with scientific bases for making recommendations regarding beverage availability and hydration practices. Although water is a very common beverage, some previous research has reported that drinks containing low to moderate levels of electrolytes and carbohydrates may provide some significant advantages in industrial situations. In general these studies seem to support the use of electrolyte-carbohydrate beverages as a supplement to water or as a replacement for water.     

应用Excel精确计算连续性肾脏替代治疗置换液电解质浓度

目的 设计一款简单而精确的连续性肾脏替代治疗（CRRT）置换液电解质浓度的计算工具.方法 以南京军区总院置换液配方为基础,查列所需药物的分子式和分子量,利用Excel工作表制作一个带自动计算功能的表格,只需输入药物的剂量,即可得出置换液相关电解质的浓度.选取20例患者治疗时已配好的置换液送检,查钾、钠、氯、碳酸氢根、钙等离子和葡萄糖的浓度,分析其检验结果与计算结果.再选取一重度低钠血症患者和一代谢性碱中毒患者为实例,了解治疗结束时目标离子的变化情况.结果 20份标本的钾、钠、氯、碳酸氢根、钙等离子和葡萄糖浓度的检验结果与计算结果近似.重度低钠血症患者治疗结束时抽血查钠离子浓度接近计算结果,同样,代谢性碱中毒患者治疗结束时抽血查碳酸氢根浓度也接近计算结果.结论 利用笔者所在科室设计的EXCEL工作表可精确计算CRRT置换液的电解质浓度,只需调整药物的剂量,即可得出临床所需的置换液的相关电解质浓度.     

Influence of dietary fat quantity and composition on insulin binding to rat intestine.

It is presently recommended that the general US population reduce the consumption of dietary lipid in order to reduce the risk of several chronic diseases, although the mechanism(s) through which dietary factors alter cellular function remain unclear. Dietary lipid composition has been shown to alter the plasma membrane lipid composition of adipocytes, muscle and other tissues. These changes in membrane lipid composition have been correlated with altered insulin receptor binding and signal transduction. Insulin receptors are present on mucosal cells of the intestinal tract, although their role in this tissue is not fully understood. We have fed rats diets containing 6, 31.4 or 76% of calories from lard (Protocol 1) and found insulin binding to be increased in the duodenum and decreased in the colon of rats fed the high-fat diet. Additionally, we compared diets containing either 12 or 37.6% of calories from beef tallow (saturated fatty acids or SFA) or corn oil (polyunsaturated fatty acids or PUFA; Protocol 2) and found insulin binding in the jejunum to be significantly decreased by a low SFA or high PUFA diet relative to the low PUFA diet. These results suggest that intestinal insulin receptors are responsive to dietary lipid quantity and quality which may have implications as to the role of dietary factors in modifying nutrient transport and/or risk of intestinal disease.     

An insulin protocol for management of hyperglycemia in patients receiving parenteral nutrition is superior to ad hoc management

Background: The authors investigated whether an insulin protocol for parenteral nutrition (PN)–induced hyperglycemia is superior to conventional management relying primarily on sliding‐scale insulin at a large county hospital. Methods: A prospective cohort study with historical controls was completed. Adult patients receiving PN were managed with a protocol that determined insulin doses based on carbohydrate delivery and capillary blood glucose (CBG) if half or more of CBG measurements in the first 24 hours after initiation of PN exceeded 140 mg/dL. Control data were obtained from records of patients who met study eligibility criteria but had been managed before implementation of the insulin protocol. Results: Mean CBG after the start of insulin therapy was 138 ± 37 mg/dL for protocol patients and 159 ± 46 mg/dL for controls (P < .0001). Proportion of CBG values in the target range of 80–140 mg/dL was 60% in the protocol group and 35% in the control group (P < .0001). Hypoglycemia, defined as CBG <80 mg/dL, occurred infrequently but more often in the protocol group (3% vs 1%, P = .012). There was no difference in total daily insulin between groups, although protocol patients received mostly scheduled insulin (93% total daily dose), whereas control patients received predominantly supplemental insulin (66% total daily dose). Conclusions: Protocol‐directed management of PN‐induced hyperglycemia is superior to ad hoc insulin dosing. Linking insulin to carbohydrate in PN leads to improved glycemic control with a low rate of hypoglycemia.     

腰穿脑脊液置换疗法治疗蛛网膜下腔出血的临床探讨

2005年4月～2008年3月份,我们采用腰穿脑脊液(CSF)置换疗法治疗蛛网膜下腔出血(SAH)43例,故SAH的诊断及治疗备受到医务人员的重视.因此找到一个更有效的治疗方法为当务之急,腰穿脑脊液置换治疗SAH的开展可为是治疗SAH的一个新方法.