急诊连续性肾脏替代治疗糖尿病非酮症高渗综合征的体会

糖尿病非酮症高渗综合征(dibetic nonketotic hyperosmolr syndrome,DNHS)病死率高。我科从2010年10月～2011年12月开展了连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)治疗DNHS共20例,均取得了良好的疗效,报道如下。临床资料CRRT组20例(男8,女12),年龄67.5±10.4岁;对照组20例(男10,女10),年龄65.3     

胰腺癌合并糖尿病的有关因素分析

临床上胰腺癌合并糖尿病并不少见,为了解两者的关系,我们对有关因素试作初步分析。 一、临床资料 1. 一般资料;1970～1989年我院内、外科共收治胰腺癌患者75例。其中经尸检证实者7例,手术组织学证实者46例,经各种穿刺细胞学检查者12例,胰胆管造影1例,CT及腹部B型超声波检查9例。 75例中合并糖尿病者25(男14,女11)例(占33.3％,男:女=1.27:1),平均年龄62.96±8.23岁(50～75岁);非糖尿病者50(男38,女12)例(占66.6％,男:女=3.17:1),平均年龄58.10±9.27岁(43～82岁)。     

糖尿病合并急性心肌梗死患者临床特点分析

目的探讨糖尿病合并急性心肌梗死患者的临床特点。方法选取2016年6月—2017年6月黑龙江省齐齐哈尔市甘南县人民医院收治的140例急性心肌梗死患者,其中男84例,女56例,年龄52~86岁,平均年龄(66.25±6.8)岁。根据患者是合并糖尿病分为两组,糖尿病组80例,非糖尿病组60例。采用χ2检验比较两组患者的临床症状,包括患者是否胸痛、呼吸困难、恶心、腹泻;采用t检验比例两组患者的甘油三酯水平。结果急性心肌梗死合并糖尿病患者临床症状与非合并糖尿病患者之间的差异有统计学意义。糖尿病组患者胸痛46例,明显多于非糖尿病组16例,两组比较差异有统计学意义(χ2=13.211,P0.001);糖尿病组患者呼吸困难15例,明显多于非糖尿病组4例,两组比较差异有统计学意义(χ2=4.268,P=0.039);糖尿病组患者恶性、腹泻19例,明显多于非糖尿病组5例,两组比较差异有统计学意义(χ2=5.737,P=0.017);糖尿病组患者甘油三酯(2.51±0.84)mmol/L,明显高于非糖尿病组(2.23±0.85)mmol/L,两组比较差异有统计学意义(t=1.94,P0.05)。结论糖尿病患者当发生胸痛、呼吸困难、腹泻、呕吐症状时,应高度怀疑是否发生了急性心肌梗死,甘油三酯升高后应及时口服他汀类降脂药物,降低患者病死率。     

综合护理干预在62例股骨颈骨折合并糖尿病老年患者中的应用观察

<正>本文通过综合护理干预股骨颈骨折合并糖尿病老年患者治疗中的应用效果。1资料与方法 1)将62例随机平分成对照组男20例和女11例,年龄52～78(62. 36±5. 26)岁,糖尿病病程为2～11(6. 25±2. 87)年;观察组男18例和女13例,年龄51～79(63. 06±5. 22)岁,糖尿病病程区间为1～13(6. 84±2. 19)     

80例肾移植术后泌尿系统感染患者的临床资料分析

目的分析肾移植患者泌尿系统感染(UTI)的相关影响因素及其特点。方法 80例肾移植术后UTI患者,按年龄段分为低龄组(22~40岁)和高龄组(41~69岁),对两组性别、年龄、发生UTI次数、尿液微生物检查、透析类型、血清肌酐、免疫诱导、免疫抑制、发生移植肾急性排斥反应、有无糖尿病史、发生慢性移植肾肾病、发生移植肾失功情况进行比较。结果 80例肾移植术后UTI患者中男35例、女45例,女性患者UTI发病率较男性高(P<0.05);其中75.0%(60/80)患者出现至少2次UTI;45.0%(36/80)患者临床表现不典型,32.5%(26/80)患者无任何症状;尿液微生物检查发现39例份尿标本细菌阳性,大肠埃希菌占41.0%(16/39),30.0%(24/80)患者尿液中未找到任何致病菌。肾移植术前血液透析替代治疗的尿毒症患者术后UTI的发生率为70.0%(56/80)。肾移植术后2例膀胱输尿管反流、3例前列腺增生、5例移植肾结石患者均发生UTI。高龄组(66.3%,53/80)UTI患者的发生率高于低龄组(33.8%,27/80),且有糖尿病史、慢性移植肾肾病发生率、移植肾失功发生率均高于低龄组(P均<0.05)。结论年龄、性别、糖尿病、术后输尿管膀胱反流、前列腺增生、移植肾结石及术前长时间血液透析等都是肾移植患者发生UTI的高危因素,且肾移植患者UTI具有高发性、反复发作性、临床表现不典型性、以大肠埃希菌为主要致病菌等特点。高龄组肾移植UTI患者合并糖尿病易增加慢性移植肾肾病以及移植肾失功发生的风险。     

糖尿病和非糖尿病患者心肌梗塞和临床特征之关系

糖尿病病人的急性心梗死亡率高于非糖尿病患者。本文比较两者急性心梗院内并发症。方法 A组130(男90,女40)例糖尿病患者,年龄41～79(64.2±12.5)岁。B组455     

糖尿病合并急性心肌梗塞的临床及预后分析

糖尿病合并急性心肌梗塞发病率高，其临床表现、并发症及预后亦明显不同于非糖尿病合并心肌梗塞病人，本文就此进行讨论。豆材料与方法1.1诊断标准所有糖尿病、急性心肌梗塞病的诊断均符合WHO标准诊断。1.2．病例选择100例糖尿病合并急性心肌梗塞病例（以下简称糖尿病组，DMG）为1988～1994年间住院确诊病人，男26、女74例，年龄39～70岁（平均42士5岁）；另设同期住院的100例无糖尿病的急性心肌梗塞病人（以下简称为非糖尿病组，NDMG）作对照，男52、女48例，年龄41～80岁（平均62±9岁）。2结果2．1主要症状、体征见表1。糖尿病组较非…     

丹红注射液治疗老年不稳定性心绞痛疗效观察

2007年2月～2008年2月,我们在常规治疗的基础上加用丹红注射液治疗老年不稳定性心绞痛,取得较好的效果.现报告如下. 临床资料:将72例老年不稳定性心绞痛患者随机分为治疗组和对照组,治疗组37例,男27例、女10例,年龄(75.4±8.1)岁,其中合并高血压病25例、高脂血症28例、糖尿病8例;对照组35例,男26例、女9例,年龄(73.8±9.2)岁,其中合并高血压病22例、高脂血症25例、糖尿病7例.     

老年静止性脑梗死的CT表现与影像分类及临床分析

本研究对在我院接受诊断与治疗的老年静止性脑梗死(SCI)患者进行CT检查,进行影像学分类,并对危险因素与无症状脑梗死(ACI)患者进行对比分析. 1 资料与方法 1.1 一般资料 选择2009年9月至2012年12月在我院接受诊断与治疗的SCI患者62例(SCI组),入选的患者临床上无明确卒中病史,而影像学检查发现梗死病灶[1];其中男41例,女21例;年龄60 ～82[平均(70.21±8.02)]岁;其中合并高血压42例,糖尿病26例,高脂血症26例,心脏病31例,吸烟38例,酗酒15例;按照影像学检查将SCI患者分为:腔隙性脑梗死42例,非腔隙性脑梗死15例,分水岭梗死5例.另外,选择同期在我院接受诊断与治疗的SCI老年患者50例(非SCI组),其中男32例,女18例;年龄60 ～80[平均(71.02±8.12)]岁;其中合并高血压11例,糖尿病5例,高脂血症12例,心脏病14例,吸烟20例,酗酒14例.入选的患者均自愿参加本次研究,且签订知情同意书.SCI组与非SCI组患者的年龄、性别比较无明显差异(P＞0.05).     

老年糖尿病患者并发脑梗死与血脂水平的关系

糖尿病和脑梗死均为临床老年患者常见病,其中脑梗死是糖尿病的严重并发症,病死率、致残率极高[1].本文通过回顾性分析老年糖尿病患者的血脂水平,对老年糖尿病患者并发脑梗死与血脂水平的相关性进行评估. 1资料与方法 1.1一般资料所选病例均为2010年5月至2012年3月我院收治的老年糖尿病患者,均为2型糖尿病.其中观察组30例,男19例,女11例,年龄63 ～ 87[平均(71.2±7.2)]岁,头颅CT确诊为脑梗死;对照组30例,男16例,女14例,年龄61～ 86[平均(70.5 ±7.9)]岁,头颅CT检查无异常.     

多重耐药铜绿假单胞菌耐药状况分析

目的 了解医院铜绿假单胞菌对常用抗菌药物的耐药谱动态变化,为临床合理选用抗菌药物提供依据.方法 应用回顾性调查方法,对本院从2005年1月至2009年6月间临床样本分离的铜绿假单胞菌的药敏试验进行对比统计分析.结果 所分离出的1125株铜绿假单胞菌对常用抗菌药物的耐药率总体呈上升趋势.耐药率最低的是美罗培南（33%）.铜绿假单胞菌对常见抗菌药物的耐药性均有显著性变化.结论 本地区铜绿假单胞菌耐药率有显著性变化,多重耐药现象严重,动态监测其耐药谱变化是防止铜绿假单胞菌的感染率攀升的重要措施.     

冠心病运动处方的最新研究进展

冠心病是目前中国成人心脏病住院和死亡第一位原因,其发病率和病死率呈逐年上升趋势。随着医疗条件的发展,心脏康复知识的普及,冠心病患者康复意识逐渐提高,人们也越来越重视运动锻炼。     

Influence of Repeated Measurement on One Occasion,on Successive Days,and on Workdays on Home Blood Pressure Values

Few reports provide clear guidelines on how home blood pressure (HBP) should be measured in practice. In this study, we evaluated the influence of repeated HBP measurements on one occasion, and the difference between the 1st and 2nd day and between workdays and nonworkdays. The subjects (468 male, 232 female; mean age 41 years) were recruited from one company. HBP was measured with a semiautomatic device (Omron HEM-759P). Subjects were instructed to perform triplicate morning (m) and evening (e) measurements on 7 consecutive days. HBP tended to decrease during repeated measurements: systolic blood pressure (SBP) was significantly higher the 1st time than the 2nd time and 3rd time. There was no difference in diastolic blood pressure (DBP) between the 1st and 2nd time, but the value the 3rd time was significantly lower than the 1st and 2nd time. Both mHBP and eHBP on the 1st day were significantly higher than those on the 2nd day. mHBP was higher on the 1st workday than on nonworkdays, but the difference was less than 1 mmHg and there was no significant difference. Since there were significant differences in HBP during repeated measurements and between the 1st and 2nd day, which value to adopt as HBP needs to be discussed. Whether HBP was measured on a workday or a nonworkday seemed to have little influence on the HBP values obtained.     

Effects on the diet on brain neurotransmitters.

The synthesis of neurotransmitters in mammalian brain responds rapidly to changes in precursor availability. Serotonin synthesis depends largely on the brain concentrations of L-tryptophan, its precursor amino aicd. This relationship appears to be physiologic: when brain tryptophan levels vary because of insulin secretion or meal ingestion, corresponding alterations occur in the rate of serotonin formation. The ability of any food to modify brain tryptophan (and serotonin) depends on how its ingestion changes the serum concentration of not only tryptophan, but also several other large neutral amino acids that compete with tryptophan for uptake into the brain. Such precursor-induced changes in brain serotonin appear to be functionally important: animals having a reduced level of brain serotonin (caused by the chronic ingestion of a naturally tryptophan-poor diet, such as corn) demonstrate a heightened sensitivity to painful stimuli; this pain sensitivity can be acutely restored to normal values by a single injection of L-tryptophan, which rapidly elevates brain serotonin. The synthesis of catecholamines (e.g., dopamine, norepinephrine) in the brain also varies with the availability of the precursor amino acid L-tyrosine. Single injections of this amino acid increase brain tyrosine levels and accelerate brain catechol synthesis, while injections of a competing neutral amino acid (e.g., leucine, tryptophan) reduce brain tyrosine and its rate of conversion to dopa. The rate of catecholamine synthesis, however, appears to be influenced less by precursor levels than is serotonin formation: tyrosine hydroxylase, whcih catalyzes the rate-limiting step in catecholamine synthesis, responds strongly to end-product inhibition and to other controls that reflect variations in neuronal activity. The synthesis of acetylcholine in brain responds to substrate (choline) availability much like serotonin synthesis. Short-term alterations in brain choline levels are mirrored by similar changes in brain acetylcholine concentration. Variations in the daily dietary intake of choline also modify brain choline and acetylcholine. The relationship between choline availability and acetylchyoline synthesis has already foudn a cletween choline availability and acetylchyoline synthesis has already found a clinical application: choline has been used successfully in the treatment of tardive dyskinesia, a disorder of the central nervous system thought to reflect a deficiency in cholinergic transmission. These relationships between precursor availability from the periphery and brain neurotransmitter synthesis may ultimately provide the brain with information about peripheral metabolic state.     

地方性氟中毒防制对策新思考——读李广生《营养因素对地方性氟中毒的影响》一文有感

阅读李广生教授的《营养因素对地氟病的影响》一文受到启发,联系到三次流行病学调查中的矛盾现象进行分析。认为,在地氟病流行因素中,除日摄氟量外,还与营养因素有关,尤其是膳食中的钙。据此,对地氟病防制对策进行了讨论。