持续皮下胰岛素输注和胰岛素每日多点注射治疗2型糖尿病的成本效果分析

Objective To observe the cost-effectiveness of using continuous subcutaneous insulin infusion (CS Ⅱ) and multi-point daily insulin injections (MDI) in controlling blood sugar in the newly hospitalized type 2 diabetes patients. Methods Retrospective analysis on 86 cases taking CS Ⅱ and 103 cases using MDI on a 'blood sugar control program' among the newly hospitalized patients with type 2 diabetes. The period for observation was 2 weeks, using cost-effectiveness analysis methods to evaluate the two treatment programs. Results After two weeks of treatment, the effectiveness in the control of blood sugar in CS Ⅱ group was similar to the MDI group, with no significant difference(P<0.05) and the adverse reactions were similar. Costs in the CS Ⅱ program (Yuan/person) was less than in the MDI program (1478.34 vs. 1620.46), with significant differences (P< 0.05). The cost-effectiveness ratios (C/E) were 15.07 in the CS Ⅱ group, and 16.34 in the MDI group, with no significant difference (P>0.05). In order to further reduce the cost of CS Ⅱ group as a reference, the incremental cost-effectiveness ratio (△C/ △E)ofthe MDI group was 129.20. Conclusion Costs-effective of the CS Ⅱ program was better than the MDI one in treating the newly hospitalized patients with type 2 diabetes, suggesting that CS Ⅱ program might be a better choice for hospitals to carry on an intensive insulin therapy program.     

2型糖尿病合并非酒精性脂肪肝与血清尿酸的关系

目的:研究2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFL)的患者的临床特点及其与血清尿酸(SUA)的关系。方法:将113例住院T2DM患者根据有无合并非酒精性脂肪肝分为合并脂肪肝组和非脂肪肝组,记录患者身高、体重、腰围、臀围,进行空腹血糖(FBG)、血总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、血清尿酸(SUA)、空腹胰岛素(FINS)测定,计算体重指数(BMI)、腰臀比(WHR)、胰岛素抵抗指数(HOMA-IR)。对两组的一般临床资料进行统计学分析。结果:2型糖尿病合并脂肪肝组BMI、WHR、FINS、HOMA-IR、LDL-C、TG、SUA较非脂肪肝组升高(P<0.05),而FBG、TC、HDL-C两组差别无显著性(P>0.05)。脂肪肝患者中高尿酸血症患者比例较高,男性脂肪肝患者的尿酸高于女性脂肪肝患者。结论:2型糖尿病合并脂肪肝组血脂异常、胰岛素抵抗更明显,SUA的水平显著升高。     

持续皮下胰岛素输注和胰岛素每日多点注射治疗2型糖尿病的成本效果分析

Objective To observe the cost-effectiveness of using continuous subcutaneous insulin infusion (CS Ⅱ) and multi-point daily insulin injections (MDI) in controlling blood sugar in the newly hospitalized type 2 diabetes patients. Methods Retrospective analysis on 86 cases taking CS Ⅱ and 103 cases using MDI on a 'blood sugar control program' among the newly hospitalized patients with type 2 diabetes. The period for observation was 2 weeks, using cost-effectiveness analysis methods to evaluate the two treatment programs. Results After two weeks of treatment, the effectiveness in the control of blood sugar in CS Ⅱ group was similar to the MDI group, with no significant difference(P<0.05) and the adverse reactions were similar. Costs in the CS Ⅱ program (Yuan/person) was less than in the MDI program (1478.34 vs. 1620.46), with significant differences (P< 0.05). The cost-effectiveness ratios (C/E) were 15.07 in the CS Ⅱ group, and 16.34 in the MDI group, with no significant difference (P>0.05). In order to further reduce the cost of CS Ⅱ group as a reference, the incremental cost-effectiveness ratio (△C/ △E)ofthe MDI group was 129.20. Conclusion Costs-effective of the CS Ⅱ program was better than the MDI one in treating the newly hospitalized patients with type 2 diabetes, suggesting that CS Ⅱ program might be a better choice for hospitals to carry on an intensive insulin therapy program.     

PBL在内分泌科见习教学中的应用

医学见习是医学教育中一个重要的阶段.2006年11月至2008年6月在内分泌科见习带教中试行PBL教学法:先进行资料准备和教师培训,接着在带教中按课前预习一分组讨论一学生发言一教师总结4个步骤进行.结果显示采用PBL教学课堂气氛更为活跃,师生反应良好,学生的考试成绩较高.     

与国家执业医师考试接轨的毕业考试实施与体会

医学毕业考试是医学生在校期间的最后一次考试.和国家执业医师考试组织毕业考试能更好地规范医学生技能培训,促使学生更加积极主动地完成实习任务;考官和考核标准相对统一,具有更强的客观性;并且节约人力物力.但也存在一些不足:临床场景模拟不够真实,记忆性知识比重增加,综合能力比重相对较少等.如何在保证客观性的基础上,尽可能模拟真实临床情景,拓宽考核面是今后在组织毕业考试时应不断思考的问题.     

不要让心灵的窗户模糊

老张多年前就发现有糖尿病,一直也没有什么特别不舒服,对于治疗,想起了就吃药,忙起来就忘了服药,更不用说检查了。可这几天老张有点烦,老觉得眼前有     

大疱性类天疱疮并巨淀粉酶血症一例

淀粉酶升高是诊断急性胰腺炎的重要血清学指标,但淀粉酶升高不应只考虑胰腺疾病。该文报道一例淀粉酶持续升高1年余的66岁男性患者,大疱性类天疱疮并糖尿病3年,8个月前因治疗大疱性类天疱疮时发现血清淀粉酶升高,波动于556~1106 U/L。血脂肪酶波动于62~73 U/L,尿淀粉酶波动于553~1162 U/L。计算肾淀粉酶清除率/肌酐清除率为0.8% （<1%）。该例无胃肠道症状,腹部彩色多普勒超声（彩超）和CT增强显示胰腺未见异常,甲状腺和唾液腺彩超未见异常,口腔科会诊排除唾液腺疾病,最后确诊为巨淀粉酶血症。随访8个月,患者一直无腹部不适,淀粉酶呈现下降趋势,但仍高于正常水平。该病例提示如果患者血淀粉酶持续升高,无动态变化特征,且不伴腹部不适和脂肪酶升高时,要警惕巨淀粉酶血症。     

临床教学管理中应用链式管理理念的总结分析

目的 总结在临床教学管理中应用链式管理的体会.方法 介绍2018—2019年我院试行对临床教学进行网络支持下链式管理的实施过程,并分析其效果.结果 链式管理能够强化纪律性,更好地体现以学生为主体的教学理念,更好地协调各部门工作,充分发挥教学督导的作用.结论 链式管理有利于提高临床教学的质量.     

慢性粒细胞白血病患者血脂变化的初步研究

目的：了解慢性粒细胞白血病（CML）患者的血脂变化规律。方法：收集中山医科大一院1997年9月－2000年6月的初治CML病例，共127例。检测TC、TG、HDL、LDL、apoA1、apoB和apoA1/apoB。结果：CML加速期和急变期患者的TC、TG、HDL、LDL、apoA1、apoB较正常或CML慢性期患者明显降低（P＜0．05），TG和apoA1/apoB则明显升高（P＜0．05）,若经治疗达到完全缓解（CR）则各指标恢复正常水平（P＞0．05）。加速期和急变期之间、慢性期与正常对照之间各指标无明显区别（P＞0．05），急性变中急淋变与急粒变无明显差异（P＞0．05）。结论：检测血脂有可能成为慢性粒细胞白血病患者病情监测、追踪随访，特别是加速期和急变期患者疗效判断的一项有重要意义的敏感指标。     

糖尿病口服降糖药的治疗进展

随着经济的增长，人们生活水平的提高与生活方式的改变，我国糖尿病的患病率不断增加。虽然目前暂时还看不到根治糖尿病的时间，但可喜的是随着研究的深入，越来越多的手段可以用于治疗糖尿病。本文试对口服降糖药的进展做一简要的介绍。