老年急性心肌梗死病人并发谵妄的临床分析及护理

[目的]分析老年急性心肌梗死并发谵妄病人的临床特点,并探讨恰当的护理措施。[方法]选取32例并发谵妄的老年急性心肌梗死病人作为观察组、未发生谵妄的老年急性心肌梗死病人33例作为对照组,观察两组病人的致病危险因素、心肌梗死类型、并发症、住院时间及病死率。[结果]观察组高血压、糖尿病、高脂血症、吸烟发生率高于对照组（P〈0．05）;观察组ST段抬高型心肌梗死发生率高于对照组;观察组心力衰竭、心源性休克发生率高于对照组（P〈0．05）;观察组住院时间较对照组长、病死率较对照组高（P〈0．05）。[结论]老年急性心肌梗死并发谵妄病人的危险因素多、并发症发生率高、心肌梗死范围大、住院时间长、痛死率高,应加强此类病人的护理。     

入院血糖水平对急性心肌梗死患者预后的影响与护理

目的 了解急性心肌梗死（AMI）惠者入院血糖水平和预后的相关关系，为护士做好病情观察和准确评估预后提供理论依据。方法 分别以6.1mmol／L、7．0mmol／L和8．0mmol／L作为入院糖水平的切入点，对144例急性心肌梗死患者的预后进行研究，比较2组预后的差异。结果 以6．1mmol／L为切点分组，感染、心功能不全和病死率均无显著性差异；以7．0mmol／L为切点分组，心功能不全的发生率有显著性差异；入院血糖〉8．0mmol／L的患者心功能不全和病死率均较〈8．0mmol／L者高，差异有显著性意义。结论 护士应重视和了解急性心肌梗死者的入院血糖水平，以指导临床评估预后和实施分级护理。     

入院血糖水平对急性心肌梗死患者预后的影响与护理

目的了解急性心肌梗死(AMI)患者入院血糖水平和预后的相关关系,为护士做好病情观察和准确评估预后提供理论依据.方法分别以6.1 mm0l/L、7.0 mmol/L和8.0 mmol/L作为入院糖水平的切入点,对144例急性心肌梗死患者的预后进行研究,比较2组预后的差异.结果以6.1 mmol/L为切点分组,感染、心功能不全和病死率均无显著性差异;以7.0 mmol/L为切点分组,心功能不全的发生率有显著性差异;入院血糖＞8.0 mmol/L的患者心功能不全和病死率均较＜8.0 mmol/L者高,差异有显著性意义.结论护士应重视和了解急性心肌梗死者的入院血糖水平,以指导临床评估预后和实施分级护理.     

急诊护理流程优化在急性心肌梗死病人抢救中的应用分析

[目的]探讨急诊护理流程优化在急性心肌梗死病人抢救中的应用效果。[方法]将120例来急诊科就诊的急性心肌梗死病人按照随机数字表法分为观察组和对照组,每组60例,观察组病人采用优化后的急诊护理流程,对照组病人采用常规急诊护理流程,比较两组病人抢救效果。[结果]观察组病人分诊评估时间、进入急诊室至构建静脉通路时间、至做心电图时间、至实施介入时间及总急救时间均较对照组明显缩短(P0.05),抢救成功率较对照组明显升高(P0.05),院内急性心肌梗死复发率和院内再行经皮冠状动脉介入术(PCI)比例均较对照组明显降低(P0.05),病人家属急诊护理满意度较对照组明显提高(P0.05)。[结论]急诊护理流程优化能够有效提高急性心肌梗死病人抢救成功率,缩短急救接诊各时间窗,改善病人预后,提高病人家属急诊护理满意度。     

急性心肌梗死患者应激性血糖升高的临床研究

目的研究急性心肌梗死时应激性高血糖对患者心功能、心律失常及院内死亡率的影响。方法200例急性心肌梗死患者被分成非糖尿病组及糖尿病组,前者又被分为应激性血糖增高组及血糖正常组,并详细记录三组患者的临床资料。结果非糖尿病血糖增高组心力衰竭、心律失常及院内死亡率均高于血糖正常组,而血糖>10.0 mmol/L组,则上述指标与糖尿病患者相似。结论急性心肌梗死时伴有应激性高血糖可增加患者心力衰竭、心律失常及院内死亡率。     

急性心肌梗死并发心房颤动病人的预后评估

[目的]探讨急性心肌梗死(AMI)并发心房颤动(AF)的危险因素、近期预后及护理对策。[方法]对137例急性心肌梗死合并心房颤动11例病人发生心力衰竭、心室颤动及行气管插管、主动脉内球囊反搏(IABP)事件发生情况进行相关因素研究。[结果]AMI并发AF的病人年龄大、气管插管率高、病死率高,与非AF组比较具有统计学意义(P<0.05)。[结论]高龄AMI并发AF病人气管插管率高、病死率高,预后不良,应做好预见性护理。     

急性心肌梗死并发心房颤动病人的预后评估

[目的] 探讨急性心肌梗死（AMI）并发心房颤动（AF）的危险因素、近期预后及护理对策。[方法] 对137例急性心肌梗死合并心房颤动11例病人发生心力衰竭、心室颤动及行气管插管、主动脉内球囊反搏（IABP）事件发生情况进行相关因素研究。[结果] AMI并发AF的病人年龄大、气管插管率高、病死率高，与非AF组比较具有统计学意义（P〈0.05）。[结论] 高龄AMI并发AF病人气管插管率高、病死率高，预后不良，应做好预见性护理。     

48例急性心肌梗死合并急性左心衰竭病人临床护理分析

[目的]分析急性心肌梗死合并急性左心衰竭病人临床护理特点,探讨护理要点。[方法]回顾性分析48例急性心肌梗死合并急性左心衰竭病人的临床资料。[结果]急性心肌梗死并发急性左心衰竭较多见于前壁梗死;心肌梗死后再梗病人预后差,急性心肌梗死病人并发的其他疾病较易发生心力衰竭;护理难点包括呼吸管理、血压管理及主动脉内球囊反搏护理3个方面。[结论]针对急性心肌梗死合并急性左心衰竭病人临床护理特点及护理难点采取相应的护理措施。     

预警式血糖监测表的设计与应用研究

[目的]评估预警式血糖监测表在血糖控制不佳的非胰岛素治疗2型糖尿病病人护理中的应用效果。[方法]将102例血糖控制不佳的非胰岛素治疗2型糖尿病病人随机分为两组,观察组采用自行设计的预警式血糖监测表,对照组采用常规血糖监测日志,比较两组病人应用前及应用后3个月、6个月糖化血红蛋白(HbA1c)、平均血糖波动幅度(MAGE)及自我管理水平变化。[结果]3个月、6个月后两组病人的HbA1c均较基线下降,但两组结果相近,组间差异无统计学意义(P0.05),观察组MAGE低于对照组(P0.01),观察组自我管理水平优于对照组(P0.01)。[结论]血糖控制不佳的非胰岛素治疗2型糖尿病病人护理过程中应用预警式血糖监测表可提高自我管理能力,帮助病人控制血糖水平。     

糖尿病病人非体外循环冠状动脉搭桥术的护理

[目的]总结糖尿病病人非体外循环冠状动脉搭桥术后的护理方法。[方法]43例冠心病合并糖尿病病人住院期间,密切观察术前术后生命体征及血糖波动情况,对其进行相关护理。[结果]本组43例病人术后并发心律失常6例,切口感染5例,肺部感染2例,均痊愈出院。[结论]加强围术期护理,减少感染及并发症,促使病人尽快康复出院。     

206例急性脑梗死并发肺部感染危险因素分析及气道护理

【】目的 研究急性脑梗死并发肺部感染的危险因素,探讨有效的护理对策。方法 对我科2009年1月～11月住院治疗的206例急性脑梗死患者回顾性分析肺部感染的危险因素。 结果 急性脑梗死并发肺部感染35例,感染发生率16.99%;肺部感染组病死率37.14%,较无肺部感染组病死率(9.36%)有显著差异;老年,有吸烟史,有意识障碍,吞咽困难,有侵入性操作,合并有慢性阻塞性肺病(COPD)、心功能不全、高血糖等基础疾病是并发肺部感染的重要影响因素。 结论 急性脑梗死并发肺部感染发生率高,影响因素多,预后差。及时评估病情,去除诱因,加强基础护理和气道护理,严格无菌操作,合理使用抗生素,掌握侵入性操作适应证等护理对策可有效减少肺部感染发生率。     

糖尿病合并急性脑梗死患者血糖水平对预后的影响

目的 探讨糖尿病血糖水平对脑梗死患者的影响。方法 将２６０例老年急性脑梗死患者分为两组：糖尿病组１２８例,非糖尿病组１３２例,对照分析了糖尿病伴急性脑梗死患者血糖水平与临床表现,急性期脑缺血损害程度,好转率和死亡的关系。结果 急性脑梗死患者高血糖水平不仅使脑缺血损害范围增大,且对短期预后有不良影响,血糖水平愈高,病情愈重,病死率愈高。结论 血糖水平的高低,可作为估计脑梗死范围的重要参数,也是老年糖     

Stroke in diabetic and non-diabetic patients: course and prognostic value of admission serum glucose

BACKGROUND, AIMS: Whether diabetes mellitus affects the prognosis of stroke patients, and whether admission hyperglycemia influences prognosis similarly in diabetic as in non-diabetic patients is assessed controversially. The aims of the study were: 1) to compare the course of diabetic and non-diabetic acute stroke patients, and 2) to assess the influence of admission serum glucose levels on case fatality. METHODS: In 57 Austrian medical departments the hospital course of consecutive stroke patients was documented prospectively between June 1999 and October 2000. RESULTS: Two hundred and ninety-six (30%) of 992 patients had a history of diabetes mellitus. Intracerebral hemorrhage was more frequent in non-diabetic patients than diabetic (13% versus 5%, P=0.0001). Coronary heart disease was more frequent in diabetic than in non-diabetic patients (35% versus 24%, P=0.0003). The case fatality was 18% among non-diabetic and 16% among diabetic patients (P=0.3559). Among patients who were discharged alive, the Barthel Index increased from 50 to 90 in non-diabetic and from 45 to 75 in diabetic patients (P=0.0403). In non-diabetic patients, admission serum glucose>9.2 mmol/L was associated with a more than 4-fold increase in case fatality, compared with patients with serum glucose<5.7 mmol/L (P<0.0001). CONCLUSIONS: Diabetic stroke patients need special care since they tend to have a poorer recovery than non-diabetic patients. Admission hyperglycemia in non-diabetic acute stroke patients predicts a poor prognosis.     

In-hospital prognosis of patients with fasting hyperglycemia after first myocardial infarction

OBJECTIVE: To investigate the incidence and prognostic significance of fasting hyperglycemia in a large group of patients with a first myocardial infarction. RESEARCH DESIGN AND METHODS: Blood glucose was measured after an 8-h overnight fast in 752 patients with a first myocardial infarction. Three groups of patients were identified: patients with normal fasting blood glucose (92.5%), patients with fasting hyperglycemia but no prior history of glucose intolerance (3%), and patients previously known to have diabetes mellitus (4.5%). RESULTS: The fasting hyperglycemic patients were significantly older and had significantly more in-hospital complications than the normal blood glucose group. Previously known diabetic subjects tended to be older and had more mechanical complications postinfarction than the group with normal blood glucose but the difference did not reach statistical significance. There was no significant difference between the diabetic subjects and patients with fasting hyperglycemia in mean age and in-hospital prognosis. CONCLUSIONS: Fasting hyperglycemia detected after a first myocardial infarction is associated with a poor in-hospital prognosis that was not due to larger infarct size, as reflected in peak levels of cardiac enzymes. The measurement of a fasting blood glucose level provides additional information in identifying high-risk groups of patients postinfarction.     

腺苷后适应对糖尿病急性心肌梗死再灌注的保护作用

目的:观察经皮冠状动脉介入治疗(PCI)术中腺苷后适应对糖尿病急性心肌梗死(AMI)再灌注的保护作用。方法:将84例AMI患者按入选条件分为非糖尿病再灌注组(IR),非糖尿病腺苷后处理组(POST),糖尿病再灌注组(DIR),糖尿病腺苷后处理组(DPOST),糖尿病组按入院时所测糖化血红蛋白(HbA1c)值再分为DIR1(HbA1c<7%)、DIR2(HbA1c≥7%)、DPOST1(HbA1c<7%)、DPOST2(HbA1c≥7%)。POST及DPOST组于支架植入前静滴腺苷,IR及DIR组于支架植入前静滴等量生理盐水。检测PCI术前及术后30min冠脉血浆中的MDA、SOD及PCI术后6、12、24及48h静脉血CM-MB水平。结果:6组患者术后MDA值均较术前升高(P﹤0.01),SOD值均较术前降低(P﹤0.01);POST及DPOST组MDA值比IR及DIR组升高较少(P﹤0.05),SOD值比IR及DIR降低较少(P﹤0.05)。术后POST及DPOST组CK-MB峰值较IR及DIR组降低(P﹤0.05)。结论:糖尿病急性心肌梗死PCI治疗时应用腺苷后处理可以减轻心肌缺血再灌注损伤,起到心肌保护的作用。     

糖尿病在急性心肌梗死危险评估中地位的探讨

目的 观察血糖升高对急性心肌梗死(AMI)患者预后的影响,探讨糖尿病在AMI危险评估中的地位.方法 回顾性选择解放军第八一医院2000年1月至2010年5月收治的AMI患者.将无糖尿病史、空腹血糖(FBG)≥7.0 mmol/L,而后又恢复正常定义为非糖尿病AMI患者的应激性高血糖.根据FBG水平将糖尿病和非糖尿病患者分为<7.0、7.0～7.9、8.0～11.0及≥11.1 mmol/L 4组,观察院内病死率、并发症发生率及降糖治疗情况;并对AMI预后危险因素进行Logistic回归分析.结果 共入选AMI患者152例,糖尿病组45例,其中FBG≥8.0 mmol/L者占73.3%(33例),FBG≥11.1 mmol/L者占46.7%(21例);非糖尿病组107例,发生应激性高血糖者(47例,占43.9%)中有91.5%的患者(43例)FBG为7.0～11.0 mmol/L.糖尿病组院内病死率较非糖尿病组显著增高(35.6%比15.9%,P=0.007),且两组病死率均随FBG升高呈上升趋势.多因素Logistic回归分析显示,FBG≥8.0 mmol/L糖尿病患者死亡风险是FBG<8.0 mmol/L者的12.28倍,FBG≥7.0 mmol/L非糖尿病患者死亡风险是FBG<7.0 mmol/L者的4.81倍.FBG是AMI死亡的独立危险因素,糖尿病组相对比值比(OR)为1.03,95%可信区间(95%CI)为1.01～1.16,P=0.012;非糖尿病组OR为1.56,95%CI为1.09～2.23,P=0.015.糖尿病组充血性心力衰竭发生率较非糖尿病组显著增高(40.0H比22.4%,P=0.027);其中非糖尿病组FBG≥7.0 mmol/L者肺部感染、充血性心力衰竭、严重心律失常及急性脑血管事件发生率(分别为51.1%、34.0%、27.7%、14.9%)均较FBG<7.0 mmol/L者(分别为18.3%、13.3%、10.0%、0)显著增高(P<0.05或P<0.01),而在糖尿病组中未观察到该现象.糖尿病组中有80.0%(36例)的患者接受降糖治疗,其中23例(占63.9%)应用胰岛素;而非糖尿病组应激性高血糖者无一例进行降血糖治疗.结论 糖尿病AMI患者及伴应激性高血糖的非糖尿病AMI患者院内病死率和并发症发生率增加,糖尿病史和血糖都是影响AMI预后的危险因素,将二者结合起来对AMI进行危险分层更为合理.

Abstract：

Objective To determine the impact of elevated in-hospital glucose level on outcome of patients with acute myocardial infarction (AMI),and evaluate the role of diabetes mellitus as a risk factor of AMI.Methods The study included a retrospective analysis of AMI patients who were admitted to No.81 Hospital of PLA from January 2000 to May 2010.In patients without a history of diabetes,and those with fasting blood glucose(FBG)≥7.0 mmol/L at admission but returned to normal range soon after admission were defined as stress hyperglycemia of non-diabetic AMI patients.Both diabetic patients and non-diabetic patients were stratified into four mutually exclusive groups according to FBG levels:<7.0,7.0-7.9,8.0-11.0 and≥11.1 mmol/L.The in-hospital mortality,incidence of complications,and treatment to lower glucose level were analyzed.Logistic regression analysis was conducted on risk factors of outcome of AMI patients.Results One hundred and fifty-two AMI patients were enrolled with 45 diabetic patients and 107 patients without previous diabetes.In diabetic group patients with FBG≥8.0 mmol/L and those with FBG≥11.1 mmol/L accounted for 73.3%(33 cases)and 46.7%(21 cases),respectively.In non-diabetic group patients with stress hyperglycemia accounted for 43.9%(47 cases),among which patients with FBG levels of 7.0-11.0 mmol/L accounted for 91.5%(43 cases).Compared with the non-diabetic group,the in-hospital mortality was significantly higher in diabetic group(35.6%vs.1 5.9%,P=0.007).In both groups,the in-hospital mortality presented an elevating tendency with an increasing FBG level.Multivariate Logistic regression analysis demonstrated that in diabetic group patients with FBG≥8.0 mmol/L had 12.28-fold higher risk of death than patients with FBG<8.0 mmol/L,and that in non-diabetic group patients with FBG≥7.0 mmol/L had 4.81-fold higher risk of death than patients with FBG<7.0 mmol/L.FBG was an independent risk factor of death with relative odds ratio(OR)1.03,with 95% confidence interval(95% CI)1.01-1.16,P=0.012,and OR 1.56,95% CI 1.09-2.23,P=0.015 in diabetic group and non-diabetic group,respectively.The incidence of congestive heart failure in diabetic group was significantly higher than that in non-diabetic group (40.0% vs.22.4%,P=0.027).In non-diabetic group,the incidence of lung infection,congestive heart failure,serious arrhythmias and acute cerebrovascular events(51.1%,34.0%,27.7%,14.9%,respectively) was increased significantly in patients with FBG≥7.0 mmol/L than that in patients with FBG<7.0mmol/L(18.3%,13.3%,10.0%,0,respectively,P<0.05 or P<0.01).This association was not seen in diabetic group.80.0%of patients(36 cases)in diabetic group received anti-hyperglycemia treatments in which insulin therapy accounted for 63.9%(23 cases),while there was not even 1 patient who needed insulin therapy in non-diabetic patients with stress hyperglycemia.Conclusion In-hospital mortality and complications were significantly increased in diabetic AMI patients and in non-diabetic AMI patients with stress hyperglycemia.Both a history of diabetes mellitus and stress hyperglycemia have strong influence on AMI prognosis.It seems to be more plausible to collaborate blood glucose level with history of diabetes in considering risk factors in AMI patients.     

糖尿病及其控制程度与心力衰竭预后的相关性分析

目的 评价糖尿病与糖尿病血糖控制程度对慢性心力衰竭患者5年预后的影响.方法 回顾分析139例住院的慢性心力衰竭患者临床资料,根据是否合并糖尿病,分成糖尿病组(n=64)和非糖尿病组(n=75例);再以血糖控制是否满意,将糖尿病组患者分为血糖控制满意组(n=39)和不满意组(n=25);于首次住院后第5年对所有患者进行临床随访,记录临床情况、生化指标、治疗及不良事件(全因死亡、心肌梗死、心绞痛、心力衰竭再住院、脑血管事件)发生情况.结果 糖尿病组冠心痛患者所占比例高于非糖尿组(73.4%vs 53.3%,P=0.036),而两组患者在年龄,性别,高血压病史,入院时美国纽约心脏病学会(NYHA)心功能分级,心力衰竭治疗药物和治疗依从性等方面均无明显差异(P＞0.05).随访主要不良事件中,糖尿病组心绞痛发病率明显高于非糖尿病组(15.6%vs 2.7%,P=0.016),其他不良事件和总事件发生率在两组间差异无统计学意义.糖尿病患者血糖控制满意组病死率显著低于血糖控制不满意组(35.9%vs 64.0%,P=0.043).多因素logistic回归分析显示,糖尿病控制程度是心力衰竭死亡的独立预测因素(OR=0.342,95% CI0.119～0.981,P=0.046).结论 糖尿病血糖控制程度是慢性心力衰竭合并糖尿病患者死亡的独立预测因素,而糖尿病对慢性心力衰竭预后的影响尚不能肯定.     

Prognostic importance of admission plasma glucose in diabetic and non-diabetic patients with acute myocardial infarction

We assessed the relationship of plasma glucose concentrations measured on admission to mortality during the acute phase of myocardial infarction in 143 diabetic patients and 277 patients without a previous history of diabetes. Mortality in hospital in patients not known to have diabetes increased significantly from 4 per cent in patients with admission plasma glucose below 8 mmol/l to 35 per cent in patients with admission plasma glucose above 11 mmol/l. In diabetic patients the mortality increased with increasing admission plasma glucose but the difference was not significant. In patients with diabetes mean admission plasma glucose levels of the survivors and those who died were similar, whilst in the non-diabetic group the mean plasma glucose levels of the patients who did not survive were significantly higher than those of the survivors. Stepwise logistic regression analyses identified admission plasma glucose level as an important predictor of mortality in the non-diabetic group but not in the diabetic patients. Plasma glucose level on admission is an important prognostic indicator in non-diabetic patients, in that hyperglycaemia is associated with a higher mortality. In diabetic patients a clear relationship between admission plasma glucose and mortality was not demonstrated.     

高血糖水平对老年糖尿病合并急性脑梗死的影响

探讨老年糖尿病患者合并急性脑梗死时血糖水平与病情严重程度及预后关系。方法 对住院老年糖尿病患者６００例进行分析，其中１２８例合并急性脑梗死（２１．３％），按脑梗死严重程度发轻，中，重３组，并按入院时血糖水平分成高血糖Ａ组，高血糖Ｂ组和高血糖Ｃ组，并对３组进行分析。结果 老年糖尿病合并急性脑梗死者以多发脑梗死及椎基底动脉梗视为主（８１．３％）；入院时血糖水平愈高，病情愈重，死亡率愈高（Ｐ〈０．０１）     

糖尿病合并肺结核的CT表现及其预后的影响因素

目的:总结糖尿病合并肺结核的临床特点及CT表现,探讨影响其预后的相关因素.方法:回顾性分析2019年1月至2020年12月我院收治的肺结核初治患者的临床及CT资料.将患者分为糖尿病组和非糖尿病组,比较两组患者的肺部CT表现(实变、树芽征、空洞、干酪灶)及支气管结核的差异.对糖尿病组患者治疗6个月后患者的预后情况进行观察...