糖尿病酮症酸中毒23例临床分析

糖尿病酮症酸中毒(Diabetic Ketoacidosis，DKA)是常见的内分泌急症，也是导致糖尿病病人死亡的主要原因。本文对我院收治的23例DKA病人进行分析，现报告如下：     

老年卧床病人的护理体会

老年人随着年龄的增长机体各组织器官都有程度不同的功能性衰退,贮备能力减少,适应能力降低,机体的稳定性较差.……     

加强科学管理 提高保健质量

通过几年的工作实践,我们认识到只有加强科学管理,才能使保健工作制度比、规范化、程序化,才能全面提高医疗保健质量,全心全意为老干部服务。     

低频重复经颅磁刺激对帕金森病运动功能和情感障碍的疗效观察

Objective To investigate the therapeutic effects of low frequency repetitive transcranial magnetic stimulation (rTMS) on motor function and affective disorder in patients with Parkinson's disease (PD). Methods Twenty PD patients were performed by 1 Hz rTMS therapy for 15 days and 10 matched patients were performed sham stimulation. Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA) and Unified Parkinson' s Disease Rating Scale (UPDRS) were assessed before and 15 days after rTMS treatment. Results After treatment with rTMS, the motor function was improved, and UPDRS total score and UPDRS-Ⅰ , UPDRS-Ⅱ, UPDRS-Ⅲ scores were decreased. UPDRS score was decreased from (38.45±17.33) to (30.95± 17.00) (t=6.780,P<0.01). At the same time, HAMD score was decreased from (12.15±7.62) to (8.75±7.31 ) (t = 5.101, P<0.01 ). The scores of somatization, blockage and sleep disorders were lowered after treatment, but the HAMA score had no significant change(t=1.757, P>0.05). The rigidity of PD patients was improved obviously. All indexes had no improvement in sham stimulation group. Conclusions Low frequency rTMS may improve motor dysfunction and affective disorder in PD patients .     

浅析《伤寒论》太阳病"汗不如法"所致诸证

汗法是中医临床常用治法,表证治以发汗已为现代临床所常用,而且患者自行服用发汗解表药物也已司空见惯。但是往往忽略的是,汗法用之不当,往往会导致诸多变证的发生,所以总结《伤寒论》中太阳病误汗致变诸证,对指导当今临床具有一定指导意义。笔者主要从汗出太过、汗出不彻、当汗未汗3个方面阐述《伤寒论》中太阳病“汗不如法”后出现的各种情况。     

1993-2006年中国九省(区)居民酒类消费状况及变化趋势

目的 分析1993-2006年我国9个省(自治区)成年居民的饮酒状况及变化趋势.方法 选取1993、1997、2000、2004和2006年在中国9个省(自治区)开展的中国居民健康与营养调查中18岁以上的成年居民作为研究对象,5轮调查中18岁以上的成年居民分别为7994、8625、9283、9780和9746名.对其饮酒状况、饮酒频率、饮酒类型以及饮酒量进行横断面分析,并分析变化趋势.结果 男性居民平均饮酒率为60.2%(13 201/21 919),女性为9.7%(2269/23 509);男性饮酒者每日酒精摄入量为(32.2 ±35.6)g,女性为(14.0±19.4)g.男性饮酒者中,小学及以下学历者饮酒率最低,5轮调查中分别为59.7%(985/1651)、58.7%(941/1604)、57.0%(889/1560)、55.3%(885/1599)和53.1%(812/1529);但其每日酒精摄入量最高,1997、2000、2004、2006年分别为(31.1±38.2)、(39.8±42.1)、(3 8.9±41.3)和(38.4±43.3)g.大学及以上学历者每日酒精摄入量最低,1997、2000、2004、2006年分别为(21.9±24.5)、(28.8±30.9)、(24.6±22.0)和(25.0±26.4)g.女性饮酒者中,大专及以上学历者饮酒率最高,5轮调查中分别为21.0%(13/62)、24.5%(26/106)、16.6%(27/163)、19.7%(38/193)和18.8%(46/245),但其每日酒精摄入量较低,1997、2000、2004、2006年分别为(4.7±3.3)、(12.5±31.9)、(9.9±18.7)和(8.2 ±8.5)g;女性小学及以下学历者每日酒精摄入量较高,分别为(13.4±16.9)、(16.3±22.4)、(19.9±26.1)和(16.4±18.0)g.从地区分布来看,女性饮酒率以城市女性较高,5轮调查中分别为17.4%(110/631)、19.9%(147/740)、17.4%(129/741)、14.4%(117/814)和11.3%(88/781).男性饮酒频率以几乎每天喝酒的比率最高,占32.6%(3533/10 844);女性饮酒频率以每周1～2次、每月1～2次、每月不多于1次为主,分别占23.0%(410/1786)、24.6%(440/1786)和21.2%(379/1786).男性饮酒者历年均以喝白酒为主(81.8%,8875/10 844),女性饮酒者葡萄酒饮用率22.3%(399/1786)高于男性的9.0%(976/10844)(x2=280.4,P＜0.01).42.0%(4058/9654)的男性饮酒者每日酒精摄入量≥25 g,25.3%(349/1378)的女性饮酒者平均每日酒精摄入量≥15 g.结论我国9个省(自治区)的成年居民饮酒率较高,男性、女性的饮酒率和饮酒量有很大的差别,且存在学历和地区差异.

Abstract：

Objective To understand the status and trend of alcohol consumption among adult people living in 9 provinces(autonomous region)of China from 1993 to 2006.Methods The data was collected at the China Health and Nutrition Survey in 1993,1997,2000,2004 and 2006,the subjects with complete drinking data of adult residents were involved.The sample of subjects were 7994,8625,9283,9780 and 9746 among 5 round surveys respectively.Alcohol intake,drinking frequency,drinking type,drinkingamount and trends of changing was analyzed.Results The average drinking rates were 60.2% (13 201/21 919)and 9.7%(2269/23 509)among male and female respectively.The average alcohol intake was(32.2 ±35.6)g in male and(14.0 ± 19.4)g in female drinkers.Male drinkers with primary and secondary schools or below education had the lowest level of drinking rate,which was 59.7%(985/1651),58.7%(941/1604),57.0%(889/1560),55.4%(885/1599)and 53.1%(812/1529)in the 5 round surveys respectively.However,the average daily alcohol intake was the highest ,which was(31.1 ± 38.2)g,(39.8±42.1)g,(38.9 ±41.3)g and(38.4 ±43.3)g at 1997,2000,2004,2006 respectively.The male drinkers with college or above education had the lowest alcohol intake,which was(21.9 ± 24.5)g,(28.8 ±30.9)g,(24.6 ± 22.0)g and(25.0 ± 26.4)g in 1997,2000,2004 and 2006 respectively.Female drinkers with college or above education had the highest drinking rate,which was 21.0%(13/62),24.5% (26/106),16.6%(27/163),19.7%(38/193)and 18.8%(46/245)at 5 round surveys respectively.But their average daily alcohol intake was lowest,which was(4.7 ± 3.3)g,(12.5 ± 31.9)g,(9.9 ± 18.7)g and (8.2 ±8.5)g at 1997,2000,2004,2006 respectively.And the average daily alcohol intake was the highest among female drinkers with primary and secondary schools or below education,which was(13.4 ± 16.9)g,(16.3 ± 22.4)g,(19.9 ± 26.1)g and(16.4 ± 18.0)g respectively.According to the regional distribution,the highest drinking rate of female drinker was occurred at urban female,which was 17.4%(110/631),19.9%(147/740),17.4%(129/741),14.4%(117/814)and 11.3%(88/781)at 5 round surveys.Drinking every day was most popular in male drinkers,the proportion was 32.6%(3533/10 844).Drinking 1 to 2 times per week,1 to 2 times per month,no more than 1 time per month was most popular in female drinkers,the proportion was 23.0%(410/1786),24.6%(440/1786)and 21.2%(379/1786)respectively.Male drinkers liked liquor more(drinking rate was 81.8% ,8875/10 844).The wine drinking rate of female(22.3% ,399/1786)is far higher than that of male's(9.0% ,976/10 844)(x2 = 280.4 ,P ＜0.01).The daily alcohol intake equal to or greater than 25 g of male drinkers was 42.0%(4058/9654),and the daily alcohol intake equal to or greater than 15 g of female drinkers was 25.3% (349/1378).Conclusion The drinking rate of adults among 9 provinces(autonomous region)was higher than that of national average level.The drinking rate and the average alcohol consumption among male and female was significantly different.Same differences was observed among education level and different regions.     

1989-2009年中国九省区居民膳食营养素摄入状况及变化趋势(二)18-49岁成年居民膳食能量摄入状况及变化趋势

目的分析九省区18-49岁居民能量摄入状况及其变化趋势,为中国居民能量参考摄入量修订和相应的膳食指导提供依据。方法以"中国健康与营养调查"项目1989-2009年间8次调查中有膳食调查资料的18-49岁调查对象作为研究对象。使用SAS9.2软件对数据库资料进行统计分析。结果 2009年九省区18-49岁男女性成年居民的能量摄入[kJ/d(kcal/d)]分别为10277.6(2456.4)和8539.1(2040.9)。其中城市、郊区、县城和农村男性成年居民的能量摄入[kJ/d(kcal/d)]分别为9707.3(2320.1),10022.8(2395.5),9876.3(2360.5)和10632.8(2541.3);女性分别为7923.7(1893.8),8120.7(1940.9),8340.0(1993.3)和8909.0(2129.3)。能量的食物来源以谷类食物为主,尤其是农村成年居民,约占总能量的57.7%。蛋白质、脂肪和碳水化合物供能比分别为15.1%、31.4%和53.5%。其中,城市、郊区、县城和农村成年居民的脂肪供能比分别为36.0%、33.7%、32.19%和29.2%,1989-2009年我国成年居民能量摄入呈现出总体下降的趋势,能量摄入从高到低依次为农村、郊区、县城、城市,以郊区降低最明显,20年间减少1966.1 kJ/d(469.9 kcal/d)。结论 2009年我国九省区18-49岁成年居民能量摄入较前有较大幅度减少,脂肪供能比显著增加,使肥胖及膳食相关慢性病的高危人群增加。其原因可能在于动物性食物和食用油摄入的增加,值得重点关注。在修订能量参考摄入量和制订膳食指导原则时,应充分考虑我国的经济发展水平及不同地区的人群膳食消费特点。     

美国营养法规和政策综述

公众营养状况是一个国家社会事业发展和文明进步程度的重要标志。美国是世界上经济最发达的国家之一,美国政府对公众营养状况非常重视,在不同历史阶段面对各种营养问题采取了一些切实有效的措施。     

中国育龄女性腹型肥胖相关因素的纵向多水平分析

目的纵向分析身体活动、静坐时间和膳食摄入水平对中国育龄女性腰围、腹型肥胖的影响。方法在"中国健康与营养调查"于2004、2006、2009、2011、2015年的五轮调查中,选择至少参加过两轮调查的2951名15~49岁的育龄女性为研究对象,采用问卷调查收集身体活动和静坐时间数据、采用连续3天24小时回顾法收集食物消费数据。采用方差分析对连续性变量的时间差异进行分析,采用卡方检验对分类变量的时间分布差异进行分析,采用线性多水平模型分析不同身体活动、静坐时间和膳食摄入水平与腰围的关系,采用Logistic多水平模型分析不同身体活动、静坐时间和膳食摄入水平与腹型肥胖的患病风险。结果将身体活动、静坐时间和膳食摄入水平分别纳入多水平模型后,与低水平休闲身体活动相比,中等水平休闲身体活动组的腰围增加了0.47 cm(P=0.025);与低水平电视时间相比,中、高水平电视时间组的腰围分别增加0.49 cm(P=0.033)和0.58 cm(P=0.013),发生腹型肥胖的相对危险度分别是1.13(P=0.049)和1.17(P=0.010);与深色蔬菜摄入不足组相比,摄入充足组的腰围减少0.82 cm(P<0.001),发生腹型肥胖的相对危险度是0.87(P=0.028);与低水平糕点摄入组相比,高水平摄入组的腰围增加1.16 cm(P<0.001),发生腹型肥胖的相对危险度是1.33(P<0.001)。将身体活动、静坐时间和膳食摄入水平同时纳入多水平模型后,电视时间和膳食摄入水平与腰围及腹型肥胖仍然存在统计学意义,且统计值相差不大。与低水平电视时间相比,中、高水平电视时间组的腰围分别增加0.54 cm (P=0.028)和0.58 cm (P=0.025),发生腹型肥胖的相对危险度为1.15(P=0.034)和1.18(P=0.011);与深色蔬菜摄入不足组相比,摄入充足组的腰围减少0.80 cm(P<0.001),发生腹型肥胖的相对危险度是0.87(P=0.027);与低水平糕点摄入组相比,高水平摄入组的腰围增加1.13 cm(P<0.001),发生腹型肥胖的相对危险度是1.32(P<0.001)。身体活动水平与腰围及腹型肥胖无统计学意义。结论电视时间、膳食因素(深色蔬菜摄入不足、糕点摄入过多)是影响中国育龄女性腹型肥胖的独立危险因素。除了加强体育活动外,预防育龄女性腹型肥胖还应该加强减少电视时间、推广适当膳食行为(增加深色蔬菜摄入、减少糕点摄入)的干预措施。