李传平辨治糖尿病肾病经验

<正>糖尿病肾病(diabetic nephropathy,DN)是糖尿病最严重微血管病变并发症之一,也是导致终末期肾脏病的最常见的病因。根据数据统计在欧美国家,DN已成为尿毒症的首位病因,而随着我国人们生活水平的提高,DN的发病率越来越高,并且DN预后较差,常较快进展为肾功能不全。对于其治疗西医无特别有效的治疗方法,一般以对症处理为主。特别是糖尿病肾病中、晚期患者,临床上多表现为蛋白尿及水肿,     

血清胱抑素C和β2-微球蛋白联合检测对糖尿病肾病的诊断价值

糖尿病肾病（DN）是临床上最严重的糖尿病微血管并发症,其发病隐匿,病情进展缓慢,临床早期症状不明显,尿常规检查多为阴性结果,肾功能检查也未出现异常,因此容易被医生和患者所忽视。而一旦出现临床症状,即发生不可逆损害,因此对于糖尿病肾病的早期诊断和治疗对于改善患者预后具有重要作用［1］。     

“活血化瘀通络法”治疗糖尿病肾病的研究进展

糖尿病肾病（DN）是糖尿病最严重的并发症之一,也是导致终末期肾病的首要原因之一,其病理学基础是由糖尿病引起的微血管病变而导致的肾小球硬化。近年来,人们对DN的认识不断深入,中医活血化瘀通络法在DN的临床治疗中的作用越来越体现出其优越性,中医药能够明显减少尿蛋白、改善肾功能、阻止或延缓肾功能衰竭的进程,在治疗糖尿病肾病方面具有其独特的优势,现就中医药在防治DN中的研究进展概况综述如下。     

糖尿病肾病的护理体会

糖尿病肾病（DN）是糖尿病常见且难治的微血管并发症之一，也是糖尿病的主要死亡原因之一，多数研究认为30％～50％糖尿病患者会合并DN，DN已成为肾功能衰竭的主要原因之一。严格代谢控制可以防止或延缓临床DN的发生，减少蛋白质摄入量对早期肾病及肾功能不全的处理均较为有利。抗高血压治疗可延缓肾小球滤过率的下降速度。现将DN的几点护理体会报告如下。     

糖尿病肾病中医研究现状

糖尿病肾病(DN)是糖尿病(DM)常见而又严重的并发症之一。目前在美国和欧洲许多国家,DN成为引发终末期肾功能衰竭(ESRD)的首要原因,占ESRD的25%~42%;在我国,DN约占ESRD的8%左右,部分经     

三种尿酶及尿微量白蛋白测定对糖尿病肾病的早期诊断

糖尿病肾病(DN)是糖尿病的一种有害的并发症,是糖尿病患者重要死亡原因之一,因此DN的早期诊断是非常重要的。DN的早期治疗是可逆的。Ⅱ型糖尿病肾病的第一、二、三期为早期诊断,如果糖尿病(DM)患者出现了持续性蛋白尿才诊断为DN,病情已属于中晚期,为糖尿病的第四、五期,治疗难以逆转。病人往往在数年死于肾功能不全。为此我们在检测尿微量白蛋白的基础上又开展了RBP/Cr、TRF/Cr、NAG/Cr的测定。可为临床诊断糖尿病肾病提供了一个更为敏感的检测指标。使糖尿病肾     

银杏叶注射液对糖尿病肾病尿蛋白的影响

糖尿病肾病（DN）是糖尿病主要的慢性并发症之一，最后发展成慢性肾功不全，目前糖尿病肾病已成为我国引起慢性肾衰竭的第二位病因。我们自2001年1月至2005年1月用银杏叶注射液治疗糖尿病肾病68例，取得较好的疗效，现报告如下。     

中西医结合法治疗糖尿病肾病Ⅳ期38例

糖尿病肾病（DN）是糖尿病（DM）发展到一定阶段所形成的严重慢性并发症之一，南京军区总医院对642例DM患者调查显示，DN的总发生率为47．66％。据美国肾脏病资料库1996年的统计表明在终末期肾功能不全患者中，DN占首位，约为36%。随着DM发病率的逐年升高，对DN的治疗研究已是目前医学界广泛关注的重要命题之一，但时至今日尚无针对性治疗方法。     

糖尿病肾病血液透析患者的护理进展

糖尿病肾病（diabeticnephropatby,DN）又称糖尿病性肾小球硬化症,是糖尿病常见和多发的微血管最严重并发症之一,具有发病隐匿、进而肾功能不全、尿毒症进行性加重的特点。血液透析（hemodialysis,HD）是终末期糖尿病肾病患者维持生命的一种安全、可靠的肾脏代替疗法,但是存在着风险大、并发症多的问题。     

Ⅱ型糖尿病肾病30例临床分析

糖尿病肾病(DN)作为糖尿病(DM)最常见的合并症，已成为引起老年人慢性肾功能不全的一个重要因素。现就我院30例DN患者的临床资料进行分析。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。