2型糖尿病患者胆道术后的胰岛素强化治疗

目的：探讨胰岛素强化治疗对2型糖尿病患者胆道术后的临床疗效。方法：72例胆道术后合并2型糖尿病患者随机分为强化治疗组和对照组各36例。强化治疗组给予强化胰岛素治疗,使血糖控制在4.4～6.1mmol/L;对照组给予常规胰岛素治疗,使血糖控制在10.0～11.1mmol/L。比较两组空腹血糖（FBG）、炎性指标及预后等。结果：强化治疗组FBG、体温、WBC明显低于对照组,抗生素使用天数、院内感染发生率、重症监护天数及术后并发症明显少于对照组,但低血糖发生率显著高于对照组,差异有统计学意义（P〈0.05）。结论：糖尿病患者胆道术后强化胰岛素治疗,可降低炎性反应,并减少抗生素用量及重症监护天数,降低术后并发症,但低血糖发生率较高。     

糖尿病对胆道手术的影响及治疗对策

目的探讨糖尿病对胆道手术的影响及控制血糖的有效方法。方法通过设立严格的病例对照，比较40例糖尿病患者与非糖尿病患者、胰岛素强化治疗与非强化治疗胆道术后并发症的发生率。结果糖尿病显著增加胆道术后并发症的发生率，围手术期胰岛素强化治疗，可减少并发症的发生。结论高血糖是胆道病患者术后并发症高发生率的主要原因，严密监测血糖、尿糖，规范围手术期胰岛素强化治疗是预防术后并发症的关键。     

严格控制血糖对心脏瓣膜置换术患者近期预后的影响

目的探讨严格控制术后血糖对心瓣膜置换术患者近期预后的影响,降低术后并发症发生率。方法自2007年1月至2008年12月在武汉大学人民医院心血管外科行二尖瓣或二尖瓣+主动脉瓣双瓣膜置换术患者240例,男150例,女90例;年龄19～65岁,平均年龄53.33岁。根据胰岛素给药时间和血糖控制的程度不同,将240例患者分为两组,实验组:121例,术后给予胰岛素将血糖控制在4.4～6.1mmol/L;对照组:119例,当血糖超过11.1mmol/L时,给予胰岛素,将血糖控制在6.1～11.1mmol/L。比较两组患者术后伤口并发症、恶性心律失常情况、机械辅助通气时间、住ICU时间和中性粒细胞计数等指标的改变。结果两组患者无住院死亡。术后实验组伤口并发症发生率(3.31%vs.10.08%,χ2=4.430,P=0.035)、机械辅助通气时间(9.02±2.73hvs.10.01±3.58h,t=2.280,P=0.024)、白细胞计数下降至正常时间(11.04±3.16dvs.12.05±3.76d,t=2.168,P=0.031)、住院时间(13.49±3.81dvs.14.51±4.02d,t=2.017,P=0.045)和术后第3d中性粒细胞计数(0.82±0.04vs.0.84±0.05,t=2.644,P=0.009)较对照组均减少或缩短;而心律失常的发生率和住ICU时间与对照组比较差异无统计学意义。结论严格控制术后血糖能降低心瓣膜置换术患者伤口并发症发生率,缩短机械辅助通气时间、住院时间,减少抗生素使用,从而提高疗效、降低总体医疗费用、改善预后。     

胰岛素微泵对胃肠恶性肿瘤合并糖尿病患者术后血糖调控的疗效观察

【摘要】 目的 探讨胃肠癌合并糖尿病患者术后禁食期间使用胰岛素泵调控血糖的水平及低血糖反应发生率情况。方法 对52例胃肠癌合并糖尿病患者随机分为2组,对照组为26例,实验组为26例,分别进行胰岛素皮下注射和胰岛素经微量泵持续静脉推注两种不同途径调控血糖。结果 实验组空腹血糖为5.56±1.70 mmol/L,低血糖反应发生率发生率15.4%（5例）,对照组空腹血糖为7.17±1.98mmol/L,,低血糖反应发生率发生率34.5%（9例）,2组患者术后空腹血糖及低血糖反应发生率比较差异有统计学意义(p<0.05)。结论 胰岛素经微量泵持续静脉推注控制血糖水平稳定,胃肠癌合并糖尿病患者术后禁食期间严密监测血糖值及根据血糖值应用胰岛素经微量泵持续静脉推注调控血糖较平稳安全,减少病人局部注射次数,减轻疼痛,有利于疾病康复。     

动态血糖监测系统用于糖尿病患者血糖监测

目的 评价动态血糖监测系统监测血糖变化的精确性、可靠性及指导胰岛素治疗方案调整所起的积极作用.方法 将66例患者分为对照组(50例)与观察组(16例),两组患者均皮下注射胰岛素(4次/d)进行降糖治疗,对照组采用血糖仪监测手指血糖,观察组使用动态血糖监测系统(CGMS)监测血糖,观察两组患者血糖控制情况.结果 观察组患者血糖水平及低血糖发生率显著低于对照组(均P＜0.05).结论 CGMS对糖尿病患者的血糖控制和指导胰岛素治疗方案的调整具有积极作用.     

两种血糖控制护理对腹部手术后肠外营养患者预后的影响

目的观察两种血糖的控制护理对腹部手术后肠外营养患者预后的影响。方法选择2009年5月至2010年3月行腹部手术后应用肠外营养支持治疗1周以上的危重患者120例,随机分为胰岛素强化控制组(强化组,58例)和胰岛素常规控制组(常规组,62例)。强化组给予强化胰岛素治疗,控制血糖在4.4～6.1mmol/L;常规组在血糖10mmol/L时,启动胰岛素治疗,使血糖控制在7.8～10.0mmol/L。结果强化组低血糖发生率显著高于常规组(P0.05),而两组术后并发症(均为切口愈合不良)发生率和住院时间比较,差异无统计学意义(均P0.05)。结论腹部手术后肠外营养的患者,常规胰岛素治疗较强化胰岛素治疗能减少患者的低血糖发生率,并且不会增加术后切口愈合不良发生率。     

动态血糖监测系统用于糖尿病患者血糖监测

目的评价动态血糖监测系统监测血糖变化的精确性、可靠性及指导胰岛素治疗方案调整所起的积极作用。方法将66例患者分为对照组（50例）与观察组（16例）,两组患者均皮下注射胰岛素（4次/d）进行降糖治疗,对照组采用血糖仪监测手指血糖,观察组使用动态血糖监测系统（CGMS）监测血糖,观察两组患者血糖控制情况。结果观察组患者血糖水平及低血糖发生率显著低于对照组（均P〈0.05）。结论CGMS对糖尿病患者的血糖控制和指导胰岛素治疗方案的调整具有积极作用。     

危重患者两种血糖控制方法效果比较

目的探讨危重患者血糖控制的适宜方法 ,以提高血糖控制治疗效果、降低相关并发症。方法将126例ICU危重患者随机分为胰岛素强化治疗组(强化组)和常规治疗组(常规组)各63例,常规组将目标空腹血糖控制在11.9mmol/L以下,强化组12～24h使血糖控制在4.4～6.1mmol/L;均严格动态监测血糖变化。结果入ICU第2、3、5天强化组空腹血糖显著低于常规组(均P0.01);低血糖、病死、医院感染发生率,机械通气时间,ICU入住时间低于或短于常规组,但差异无统计学意义(均P0.05)。结论胰岛素强化治疗对危重患者有益,但较常规治疗并不能显著改善危重患者状况和预后。在护理过程中坚持严格动态观察血糖变化,避免低血糖的发生,可保证危重患者各项治疗顺利进行。     

危重患者两种血糖控制方法效果比较

目的探讨危重患者血糖控制的适宜方法,以提高血糖控制治疗效果、降低相关并发症。方法将126例ICU危重患者随机分为胰岛素强化治疗组（强化组）和常规治疗组（常规组）各63例,常规组将目标空腹血糖控制在11．9mmol／L以下,强化组12～24h使血糖控制在4．4～6．1mmol／L;均严格动态监测血糖变化。结果入ICU第2、3、5天强化组空腹血糖显著低于常规组（均P〈0．01）;低血糖、病死、医院感染发生率,机械通气时间,ICU入住时间低于或短于常规组,但差异无统计学意义（均P〉0．05）。结论胰岛素强化治疗对危重患者有益,但较常规治疗并不能显著改善危重患者状况和预后。在护理过程中坚持严格动态观察血糖变化,避免低血糖的发生,可保证危重患者各项治疗顺利进行。     

胰岛素强化治疗对胃癌手术患者临床结局的影响

目的 研究胰岛素强化治疗对胃癌手术患者临床结局的影响.方法 46例胃癌手术患者随机分为术后胰岛素强化治疗组(n=23,血糖控制在4.4～6.1 mmool/L)和常规治疗组(n=23,血糖控制在10.0～11.1 mmol/L).动态监测比较两组围手术期空腹血糖(FBG)、空腹胰岛素定量(FINS)、白细胞介素-6(IL-6)、肿瘤坏死因子-α[(TNF-α)及C-反应蛋白(CRP)水平,并根据稳态模式评估法(HOMA)计算胰岛素抵抗指数(HOMA-IR);记录两组患者术后并发症发生情况.结果 两组患者均无低血糖发生,胰岛素强化治疗组术后发热天数、抗生素使用天数、住院天数及并发症发生率均明显低于常规治疗组(P＜0.05);强化治疗组术后1 d、3 d血清InHOMA-IR、IL-6、TNF-α及术后1、3、7 d的CRP均明显低于常规治疗组(P＜0.05).结论 胰岛素强化治疗可拮抗术后机体的高炎状态,抗炎效应可能是胰岛素强化治疗又一改善手术创伤患者预后的重要机制.     

Study examining attitudes of staff, patients and relatives to witnessed resuscitation in adult intensive care units

Background. Witnessed resuscitation is widely accepted in paediatricpractice and is becoming more common in adult emergency departments,but information on this topic is sparse. Methods. We gave a questionnaire to 50 intensive care medicaland nursing staff and 55 patients and next of kin before electivepostoperative admission to the intensive care unit to examinestaff opinion about witnessed resuscitation, patient and relatives’demand for witnessed resuscitation, and their perception ofthe benefits. Results. We found that 56% of doctors and 66% of nurses favouredgiving relatives the option to stay. If relatives requestedto be present, 70% of doctors and 82% of nurses would allowthis if the relatives were escorted. The role of the escortwas felt to explain, prevent interference, and to provide emotionalsupport. We found that 29% of patients and 47% of relativeswanted to be together during resuscitation, the commonest reasonsbeing to provide support and to see that everything was done.We found that 95% of patients and 91% of relatives felt theirviews should be formally sought before ICU admission. Conclusions. Intensive care staff support witnessed resuscitation.Many intensive care personnel have experienced witnessed resuscitationand the majority felt that relatives gained benefit. Almostall agree that the views of both patient and relatives shouldbe sought formally before admission to intensive care. Br J Anaesth 2003; 91: 820–4     

Stress in UK intensive care unit doctors

Background. Doctors have long been considered at risk of occupationalstress. Methods. A postal survey of all members of the Intensive CareSociety using validated instruments. Results. Eight-five per cent of members returned questionnairesand 70% were eligible for the study. Twenty-nine per cent weresuffering General Health Questionnaire-12 (GHQ-12) identifieddistress and 12% Symptom Checklist-Depression (SCL-D) defineddepression. There were no significant age or sex differencesbetween staff suffering distress or depression and those whodid not. Dissatisfaction with career correlated highly withboth distress and depression (P<0.01). Twenty doctors (3%)were bothered by suicidal thoughts. The most stressful aspectsof work were bed allocation, being over-stretched, effect ofhours of work and stress on personal/family life, and compromisingstandards when resources are short. Logistic regression revealedmental health problems were predicted by five stressors: ‘lackof recognition of one’s own contribution by others’;‘too much responsibility at times’; ‘effectof stress on personal/family life’; ‘keeping upto date with knowledge’; and ‘making the right decisionalone’. Conclusions. Nearly one in three ICU doctors appeared distressed(GHQ), and one in 10 depressed (SCL-D); this is no greater thanthat reported in other specialities. Perceived stressors revealsome key areas of concern for the employer and the specialty. Br J Anaesth 2002; 89: 873–81     

ICU护理工作量测量量表信效度检测

目的检测ICU护理工作量测量量表（ICNSS）的信度和效度，使其适合ICU护理工作量测量。方法严格遵循英文量表翻译原则翻译ICNSS，依据原评分原则并结合国情列出ICNSS评分细则，依据专家对ICNSS内容效度评定结果对评分细则进行修订，并应用修订后的中文版ICNSS量表在ICU收集护理工作量，测量观察者间信度、量表内在一致性和区分效度。结果修订后的ICNSS量表各项目和评分细则内容效度指数均达到0，80以上；观察者间信度为95．45％；量表总的内在一致性为0．83，各子项目内在一致性为0．62～0.76；在不同患者群体间显示护理工作量具有显著性差异（P〈0．01）。结论修订后ICNSS量表适用于ICU护理工作量的评估。     

ICU护理工作量测量量表信效度检测

目的 检测ICU护理工作量测量量表(ICNSS)的信度和效度,使其适合ICU护理工作量测量.方法 严格遵循英文量表翻译原则翻译ICNSS,依据原评分原则并结合国情列出ICNSS评分细则,依据专家对ICNSS内容效度评定结果对评分细则进行修订,并应用修订后的中文版ICNSS量表在ICU收集护理工作量,测量观察者间信度、量表内在一致性和区分效度.结果 修订后的ICNSS量表各项目和评分细则内容效度指数均达到0.80以上;观察者间信度为95.45%;量表总的内在一致性为0.83,各子项目内在一致性为0.62～0.76;在不同患者群体间显示护理工作量具有显著性差异(P＜0.01).结论 修订后ICNSS量表适用于ICU护理工作量的评估.     

Intensive care of the elderly - a retrospective study

Access to intensive care is to a large extent a prerequisite of the treatment of increasingly old patients for more and more complicated diseases. The ultimate outcome of such treatment is little known, however. In this study we have followed up 143 patients (91 males and 52 females), aged 70 years or more, who were treated in the intensive care unit (ICU) of Danderyd Hospital for 48 h or more during the years 1979-1982. As a comparison, another group of 143 patients in all age groups treated in the ICU for 48 h or more were studied during 1 year (1980). The main diagnostic groups were infectious diseases, trauma, acute abdominal diseases, malignancy, cardiovascular diseases, and other diseases. The mean mortality within 12 months at age 70 years and above was 52%, highest for cardiovascular diseases (73%) and malignant diseases (60%). Within this age group, the main part of the occupancy in our ICU was held by patients who died within 18 months (58%). The results show that the ICU-cost per patient per year saved was not much higher for patients in diagnostic groups with higher mortality or longer duration of stay in the ICU than in other groups. Calculations of ICU-cost seem to be a relevant parameter for the evaluation of the results of ICU care. Fifty per cent of all patients were able to return home some time after intensive care. The humanitarian end result is thus encouraging, but better criteria for selection of patients are needed.     

Repeated deep accidental hypothermia

Deep accidental hypothermia after self-poisoning with drugs occurred twice in the same patient within 25 days. Initial rectal temperatures were 22.0 degrees C and 23.3 degrees C, respectively; the clinical conditions were otherwise identical. In the first instance, active rewarming by means of peritoneal irrigation was performed, while spontaneous rewarming was allowed on the second occasion. Normothermia was attained within 24 hours in both cases, and the patient was discharged in her habitual state of well-being. The course of these nearly identical cases illustrates the possibility of a passive treatment for deep hypothermia.     

Glycemic control: how tight in the intensive care unit?

Determining the optimal level of glycemic control in critical illness has proven difficult since the original Leuven study conclusions were published in 2001. Conflicting evidence, scientific methodologies, hospital cultures, and a-priori biases have challenged many clinical practice patterns. Specifically, the prioritization of patient safety has resulted in many practitioners changing from a glycemic control target of 80-110 mg/dL to a more liberal target of 140-180 mg/dL. However, a detailed examination of the evidence can provide a more population-specific glycemic control strategy. This position paper presents an approach for cardiac surgery patients in the intensive care unit (ICU) consistent with extant evidence and real-life variables. We argue that in the cardiac surgery ICU, glycemic targets may be as low as 80-110 mg/dL when formal intensive insulin therapy and nutrition support protocols are used with low rates of hypoglycemia, patient safety mechanisms, properly trained staff, and a supportive hospital administration all in force. Cardiac surgery ICUs that already follow this model may continue with 80-110 mg/dL blood glucose targets, whereas others may advance their blood glucose targets in a stepwise fashion: from 140 to 180 mg/dL to 110-140 mg/dL to 80-110 mg/dL, on the basis of their performance.