糖尿病患者家庭诊治和护理指导

据WHO统计目前全世界有13亿糖尿病患，到2025年将增加到3亿；献报告我国糖展病患病率在2．0～36％．比十年前增加3～4倍。糖尿病是慢性终身性疾病．其特点是长期性、反复性、预后及疗效不确定性、且影响日常生活。根据我国目前国情．加强对糖尿病患的家庭诊治、护理、管理和教育，以减轻和避免糖尿病患急、慢性多脏器受累及并发症的发生，提高患的生活质量．降低医疗费用是重要环节之一。从改变患生活习惯、控制饮食、合理用药、合理运动、监测血糖着手．开展对病人及家属的培训和指导。现将我们多年来开展家庭诊治糖尿病患体会报告如下。     

高压氧抢救一氧化碳中毒的护理体会

我科自1976年至1978年1月共收住院观察急性一氧化碳中毒病人29例,其中重度中毒17例;中度中毒12例。有较明显脑水肿临床表现者16例,肺水肿5例;14例经一般常规抢救无明显效果或病情加重而转来我院。29例全部治愈,经随访至今尚未发现严重后遗症。一般概念一氧化碳是某些工业部门在生产过程中经常遇到的有害气体,也是民用生活中常见的气体中毒。长时间吸入一定浓度的一氧化碳或短时间内吸入高浓度一氧化碳气体就可以发生中毒。它对人的毒理作用主要是与红细胞中的血红蛋白结合成碳氧血红蛋白。一氧化碳与血红     

碘过量对大鼠甲状腺细胞线粒体超氧化物生成和膜电位的影响

Objective To investigate the effects of iodine excess on mitochondrial superoxide production and mitoehondrial membrane potential(△ψ)changes in Fisher rat thyroid cell line(FRTL)cells.Methods FRTL cells were treated with 10-4mol/L potassium iodine(KI),10 U/L thyrotropin(TSH),10-4 mol/L KI+10 U/L TSH respectively for 24 h.Effects on cell proliferation were assayed by methyl thiazolyl tetrazolium(MTT)colorimetric method.Changes of mitochondrial superoxide production and △ψ were measured by live cell imaging and spectrofluorometer using MitoSOX and rhodamine 123(rh123)respectively.Results Absorbance(A)in the KI group (0.794±0.144)showed a significant decline compared to the control group(1.000 ±0.183,P<0.05),whereas a significant elevation was observed in the TSH group(1.215±0.156,P<0.05).No significant differences was found between the KI+TSH group(1.025±0.254)and the control group(P>0.05),but the former was marked higher than the KI group(P<0.05).Compared to the control group(9.74±3.24).MitoSOX mean fluorescence intensity (MFI)in the KI and KI+TSH groups(18.16±6.57,13.33±2.92)were significantly increased(all P<0.05),which was a significant decline in the TSH group(6.64±2.15,P<0.05).MitoSOX MFI in the KI+TSH group was lower than the KI group(P<0.05).Rh123 MFI in the KI and KI+TSH groups(210 593±31 328,295 525±34 243)showed significant decline than the control group(407 824±37 198,all P<0.05).Compared with the KI group.the KI+TSH group pronouncedly attenuated the reduction of Rh 123 MFI(P<0.05).No significant differences of Rh 123 MFI were found between the TSH group(411 187 ± 72 852) and the control group(P > 0.05). Conclusion Iodine excess (10-4 mol/L KI) may lead to peroxide damage on the mitochondria of FRTL cells, and cell proliferation is inhibited. Combining treatment with 10 U/L TSH may attenuate mitochondrial peroxide damage and inhibition of cell proliferation caused by iodine excess.     

碘过量和多聚肌苷酸-聚胞苷酸及甲状腺球蛋白诱发小鼠甲状腺炎对Toll样受体3表达的影响

Objective To observe the effect of iodine excess(HI),polyinosinic-polycytidylic acid[Poly(I:C),Poly]and thyroglobulin(TG)on the thyroid of mice by the expression of Toll-like receptor 3(TLR3)to reveal the functional role of TLR3 in autoimmune thyroiditis.Methods Forty-two non-obese diabetic mice,body weight (20±3)g,were divided into six groups:control group,HI group,Poly group,TG group,HI+TG group,HI+Poly group. Fed with deionized water and injected intraperitoneally with physiological saline 0.1 ml each day for a week, the mice in control group were injected with physiological saline every other day at the same dose for 1 week before they were sacrificed; HI group drank 0.05% NaI water and were injected intraperitoneally with physiological saline same as control group; Poly group drank deionized water and were injected intraperitoneally with poly 0.1 ml (1 g/L)each day of the week, then the mice were injected with Poly every other day at the same dose for 1 week before they were sacrificed; TG group drank deionized water and were injected intraperitoneally with physiological saline same as control group, immunized with 0.1 mg TG by subcutaneously injecting and the immunization was enhanced after they were fed half dose for 4 and 8 weeks separately. In HI + Poly group, the treatment was the same as HI group and Poly group; HI + TG group: the treatment was the same as HI group and TG group. Eight weeks later, mice were sacrificed and thyroids were taken to make frozen sections, Hematoxylin-Eosin (HE) staining was employed to observe the morphological change of the thyroids. The expression of TLR3 of thyroids was observed under fluorescence microscope after Immumofluorescence using TLR3 antibody and TR3-positive cells were analyzed in the thyroid density. Results HE staining showed thyroids of Poly group had no inflammation under microscope.There were different degrees of inflammatory cell infiltration in HI group and TG group. The inflammatory cell infiltration and the damage of follicular thyroid of HI + TG group and HI + Poly group were serious, and the degrees of inflammation were higher over "++". Thyroid follicular epithelial cell with TLR3 expression could be seen in Poly group and HI group, meanwhile, there were TLR3 strong positive inflammatory cells in HI group under fluorescent microscope. Using stereological analysis of TLR3-positive cell density in the thyroid, the difference between groups was statistically significant(F=7.870, P<0.01 ). TLR3-positive cell density in the thyroid of HI + Poly group was higher[ (9.287 ± 0.522)mm2] than control group[ (0.062 ± 0.025)mm2, P < 0.01] significantly, meanwhile, the density in HI + Poly group was higher than HI group [ (2.574 ± 0.257 )mm2] and Poly group[ (1.361 ± 0.148 )mm2, all P < 0.01]. The density in HI + TG group[ (4.843±0.405)mm2] was higher than HI group and TG group[(1.601 ±0.268)mm2, all P < 0.01 )]. Conclusions Excessive iodine and thyroglobulin can induce thyroiditis, and stimulate the expression of TLR3 in the thyroid follicular epithelial, Poly aggravated thyroiditis induced by iodine excess in NOD mice; TLR3 positive inflammatory cells also appeared in inflammatory region, suggesting that TLR3 is involved in the pathogenesis of autoimmune thyroiditis     

如何提高纤维支气管镜检查的病理诊断阳性率的探讨

<正>纤维支气管镜(简称纤支镜)检查是属微创检查,以其创伤小、简单、易行、可重复检查的特点,成为诊断肺癌极为重要的手段,如何提高其病理诊断阳性率就显得至关重要,在检查中如何做才能减轻患者的痛苦、损伤小、成功率高,是每位医师须思考的问题,对操作     

胃镜辅助下放置空肠营养管的方法

目的:探讨内镜下放置空肠营养管的方法.方法:给148例病人放置空肠营养管,116例病人在胃镜下用异物钳钳夹胃腔内空肠营养管,推送胃镜将其送至Treitz韧带以下.32例经鼻超细胃镜放置导丝后,再经导丝放入空肠营养管.结果:两种空肠营养管放置成功率均为100%,其中鼻肠管126例,三腔鼻肠管22例.两组均无严重并发症,1例病人置管后出现血淀粉酶升高.结论:两种空肠营养管放置的方法成功率均高,不良反应小,操作简单安全.     

经皮内镜下胃和空肠造口术在临床中的应用

目的: 探讨经皮内镜下胃和空肠造口术的方法. 方法: 114例病人胃造口术(PEG)采用Pull法,26例空肠造口术(PEJ),在PEG基础上用异物钳钳夹胃腔内空肠造口管,推送胃镜将其送至Treitz韧带以下. 结果: PEG成功率为100%,通过改良胃镜下直接置管方法,26例PEJ全部一次放置成功.15例局部有活动性出血, 8例局部有分泌物和红肿,经相应处理后缓解.21例引起呼吸道感染,用抗生素治愈,1例胃黏膜下出血,形成血肿, 1例在第8天发现胃造口内固定片嵌顿,未出现严重并发症. 结论: PEG简单、安全、可行;PEJ方法可一次使造口管到达空肠,有临床应用价值.     

硬膜外麻醉用于分娩镇痛的临床分析

目的：观察低浓度罗哌卡因配伍芬太尼硬膜外麻醉用于分娩镇痛的效果。方法：研究组采用低浓度罗哌卡因配伍芬太尼硬膜外麻醉用于分娩镇痛的产妇120例,同期未采用分娩镇痛的产妇110例为对照组,观察镇痛效果,比较两组的产程时间、分娩方式、新生儿Apgar评分及产后出血量。结果：研究组镇痛效果好,与对照组比较活跃期明显缩短（P〈0．05）,两组第二产程、第三产程时间、新生儿评分、产后出血无显著差异性。结论：硬膜外麻醉用于无痛分娩镇痛安全有效,对新生儿的Apgar评分无影响。     

纯化水、注射用水和灭菌注射用水的质量分析及比较

不含任何附加剂供药用的水,在《中国药典》中收载的有3种：纯化水（Purified water）、注射用水（Water for Injection）和灭菌注射用水（Sterile water for Injection）。纯化水为蒸馏法、离子交换法、反渗法或其他适宜的方法制得供药用的,不含任何附加剂的水;注射用水为纯化水经蒸馏所得的水;灭菌注射用水为注射用水照注射剂生产工艺制备所得的水。这3种水的质量直接关系到病人的身体健康和生命安全,因此,其质量必须符合《中国药典》现行版的规定,才能供药用。