目的 對(duì)非增殖型糖尿病視網(wǎng)膜病變(nonproliferative diabetic retinopathy,NPDR)治療的臨床相關(guān)研究證據(jù)進(jìn)行評(píng)價(jià)。方法 檢索Cochrane 圖書(shū)館(2007年第3期)、PubMed(1966~2007.6)、CBM(1979~2007.6)等數(shù)據(jù)庫(kù)中與NPDR有關(guān)的臨床研究證據(jù),并對(duì)所獲證據(jù)質(zhì)量進(jìn)行評(píng)價(jià)。結(jié)果 共納入1篇系統(tǒng)評(píng)價(jià),20個(gè)隨機(jī)對(duì)照試驗(yàn)。臨床證據(jù)顯示,嚴(yán)格控制血糖和血壓是治療NPDR的基本方法,可延緩患者視網(wǎng)膜病變進(jìn)展。其它治療措施的價(jià)值尚需進(jìn)一步研究。結(jié)論 NPDR是糖尿病視網(wǎng)膜病變的早期階段,相關(guān)的系統(tǒng)評(píng)價(jià)和高質(zhì)量的隨機(jī)對(duì)照研究證實(shí)控制血糖和血壓在治療NPDR中的作用。其它治療措施的價(jià)值有待相關(guān)的系統(tǒng)評(píng)價(jià)和更多大樣本、多中心的高質(zhì)量臨床研究證實(shí)。
目的 對(duì)肝腎綜合征(hepatorenal syndrome, HRS)治療的相關(guān)臨床研究證據(jù)進(jìn)行評(píng)價(jià)。方法 運(yùn)用循證醫(yī)學(xué)的基本原理和方法系統(tǒng)檢索HRS治療的相關(guān)臨床研究證據(jù),并對(duì)證據(jù)質(zhì)量進(jìn)行評(píng)價(jià)。結(jié)果 擴(kuò)容、縮血管藥物及改善腎血流量的血管活性藥物、經(jīng)頸靜脈肝內(nèi)門(mén)體分流術(shù)、肝移植是目前臨床治療HRS的常用方法,有一定治療作用。結(jié)論 HRS是終末期肝病的常見(jiàn)并發(fā)癥,預(yù)后極差。目前對(duì)HRS治療的臨床研究大多樣本含量較低,方法學(xué)質(zhì)量不高,證據(jù)強(qiáng)度不足,有待更多大樣本、多中心的高質(zhì)量臨床試驗(yàn)。
目的 從循證醫(yī)學(xué)角度探討1 例妊娠期糖尿病患者的預(yù)后。方法 計(jì)算機(jī)檢索ACP Journal Club (1991 ~ 2006 年10 月)、Cochrane 圖書(shū)館(2006 年第4 期)、MEDLINE(1990 ~ 2006 年10 月)和中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù),查找妊娠期糖尿病預(yù)后的隊(duì)列研究、病例 - 對(duì)照研究和病例系列研究等,并對(duì)所獲證據(jù)的質(zhì)量進(jìn)行評(píng)價(jià)。結(jié)果 臨床證據(jù)表明,妊娠期糖尿病患者結(jié)束妊娠后 6 周至 28 年,2 型糖尿病的發(fā)病率為 2.6% ~ 70%,發(fā)生自發(fā)性早產(chǎn)的幾率為 6.7%,患高血壓和代謝綜合征的比例增加,有感染陰道念珠菌的危險(xiǎn)。結(jié)論 患妊娠期糖尿病的婦女較未患糖尿病的孕婦結(jié)束妊娠后糖尿病的患病率增加,自發(fā)性早產(chǎn)、高血壓、代謝綜合征及陰道感染等并發(fā)癥發(fā)病率增加。但其長(zhǎng)期終點(diǎn)事件發(fā)生率有待進(jìn)一步研究。
【摘要】 目的 應(yīng)用調(diào)查問(wèn)卷分析培訓(xùn)前后成都市社區(qū)醫(yī)生對(duì)肺炎球菌疫苗的認(rèn)識(shí),為推動(dòng)社區(qū)肺炎球菌疫苗接種奠定基礎(chǔ)?!》椒ā?duì)215名成都市社區(qū)醫(yī)生進(jìn)行肺炎球菌疾病及預(yù)防知識(shí)的培訓(xùn),并在培訓(xùn)前后行問(wèn)卷調(diào)查,回收問(wèn)卷并分析?!〗Y(jié)果 經(jīng)培訓(xùn),社區(qū)醫(yī)生提高了對(duì)肺炎球菌疾病及疫苗接種知識(shí)的掌握程度,加深了對(duì)肺炎球菌疾病及疫苗接種重要性的認(rèn)識(shí)?!〗Y(jié)論 對(duì)社區(qū)醫(yī)生進(jìn)行肺炎球菌相關(guān)知識(shí)的培訓(xùn),有利于提高社區(qū)醫(yī)生對(duì)肺炎球菌疫苗接種推薦的專(zhuān)業(yè)性和成功率。【Abstract】 Objective To know the community doctors’ understanding of pneumococcal vaccine before and after the education via questionnaire. Methods A total of 215 community doctors in Chengdu were educated in pneumococcal disease and the prevention knowledge. Questionnaire investigation was performed before and after the education and the results were analyzed. Results After the education, the acknowledgement of pneumococcal vaccination of the community doctors was improved. Conclusion The education of the knowledge of pneumococcal vaccine for the community doctors helps to improve the acknowledgement of pneumococcal vaccination.
目的 借助循證醫(yī)學(xué)的方法為初診老年2型糖尿病患者確定治療目標(biāo)及治療方案.方法 在充分評(píng)估患者情況后,提出臨床問(wèn)題,從Cochrane圖書(shū)館(2003年第3期)、Medline(PubMed網(wǎng)站1990年1月~2003年2月)、和http://sumsearch.uthsca.edu/searchform4.htm上進(jìn)行檢索.檢索主題詞為:diabetes mellitus non-insulin-dependent; self-monitor of blood glucose; micro- and macro-vascular complications;sulphonylureas; insulin; aspirin; metformin; acarbose; self-monitor of blood glucose; older patient; hypertension management; Lipid management; RCT; human; meta-analysis;systmatic review.結(jié)果 共檢索出與不同問(wèn)題相關(guān)的隨機(jī)對(duì)照試驗(yàn)112篇,系統(tǒng)評(píng)價(jià)或Meta-分析24篇.通過(guò)對(duì)檢索結(jié)果進(jìn)行分析,為患者制定了合理的治療方案.經(jīng)1年隨訪證實(shí),該方案適合患者.結(jié)論 采用循證治療的方法,為初治的老年2型糖尿病患者確定合理的治療目標(biāo)和治療方案,可有效提高治療效果.
少有文獻(xiàn)報(bào)道心臟起搏器植入術(shù)后可能發(fā)生深靜脈血栓(deep venous thrombosis, DVT),但DVT會(huì)嚴(yán)重影響病人的預(yù)后和生活質(zhì)量,并可導(dǎo)致更為致命的肺動(dòng)脈栓塞.DVT的危險(xiǎn)因素、治療策略和二級(jí)預(yù)防,各研究不盡相同.我們檢索了Cochrane Library,PubMed和Guideline網(wǎng)站上有關(guān)DVT的系統(tǒng)評(píng)價(jià)和隨機(jī)對(duì)照試驗(yàn).證據(jù)顯示,既往有DVT史、年齡>40歲和有手術(shù)史是DVT的重要危險(xiǎn)因素.肝素初始化治療和華法令在維持期的治療是必須和有效的,可改善病人的預(yù)后.對(duì)于發(fā)生過(guò)DVT的病人,在未來(lái)的高危狀態(tài)下,可用肝素和(或)口服抗凝劑進(jìn)行預(yù)防性治療.
【摘要】 目的 老年綜合評(píng)估法篩查75歲以上2型糖尿?。╰ype 2 diabetes mellitus,T2DM)合并老年綜合征的情況,并觀察以甘精胰島素為基礎(chǔ)的治療方法對(duì)老年綜合征、血糖、低血糖事件、治療滿意度等的影響。 方法 應(yīng)用老年綜合評(píng)估中的日常生活能力、工具性日程生活能力、簡(jiǎn)易智能量表、老年抑郁量表、微型營(yíng)養(yǎng)評(píng)定法,分別評(píng)估2005年12月—2009年12月老年門(mén)診及病房住院的日常生活能力、認(rèn)知功能狀態(tài)、情緒障礙和營(yíng)養(yǎng)狀態(tài),對(duì)其合并功能障礙、癡呆、抑郁、營(yíng)養(yǎng)障礙、傷害性跌倒等老年綜合征的患病情況進(jìn)行橫斷面調(diào)查;篩選至少合并一種老年綜合征和一個(gè)其他合并疾病,血糖控制差、預(yù)期壽命有限的患者進(jìn)行以甘精胰島素為基礎(chǔ)的降糖治療,采用自身前后對(duì)照的方法了解對(duì)糖化血紅蛋白(hemoglobin A1c, HbA1c)、低血糖事件、治療滿意度的影響,并觀察甘精胰島素治療方案對(duì)上述老年綜合征的影響?!〗Y(jié)果 132例老年門(mén)診及病房住院的75歲以上T2DM患者功能障礙者高達(dá)50.0%(66例),罹患包括輕度認(rèn)知功能障礙在內(nèi)的癡呆比例為39.4%(52例);合并抑郁癥28.0%(37例);營(yíng)養(yǎng)失衡30.0%(39例)。33例患者符合甘精胰島素治療納入標(biāo)準(zhǔn),經(jīng)過(guò)2年的隨訪發(fā)現(xiàn),以甘精胰島素為基礎(chǔ)的治療方案在適當(dāng)降低HbA1c水平時(shí),不增加老年綜合征的患病率,但可以減少胰島素多次皮下注射的次數(shù),降低低血糖事件發(fā)生次數(shù)(由1.58次/例降為0.81次/例),提高患者治療滿意度?!〗Y(jié)論 75歲以上T2DM患者合并老年綜合征的比例高,老年綜合評(píng)估能及時(shí)發(fā)現(xiàn)老年綜合征;以甘精胰島素為基礎(chǔ)的治療方案不增加老年綜合征的發(fā)生,并能顯著降低低血糖事件數(shù)、改善營(yíng)養(yǎng)狀態(tài)、提高患者對(duì)治療的滿意度。【Abstract】 Objective To screen geriatric syndrome in patients older than 75 years with type 2 diabetes mellitus (T2DM) by the method of comprehensive geriatric assessment, and observe the impact of glargin-based therapy on geriatric syndrome, blood glucose level, the event of hypoglycemia and treatment satisfaction degree in patients older than 75 years with T2DM who suffered at least one kind of Geriatric syndromes. Methods From December 2005 to December 2009, activity of daily living (ADL), instrument activity of daily living (IADL), mini-mental state examination, geriatric depression scale and mini-nutritional assessment in comprehensive geriatric assessment were used to assess daily living ability, cognitive function status, emotional disorder and nutritional status of out/in-patients older than 75 years with T2DM in the Department of Geriatrics. Cross-sectional study was carried out to investigate geriatric syndromes such as combined functional disorder, dementia, depression, nutritional disorder and impairment falls in those patients, and patients with T2DM combined with at least one kind of geriatric syndrome and another kind of combined disease were screened out. A glargin-based anti-hyperglycemic therapy was carried out for those patients with poor blood glucose control limited remaining life time. The effects of this therapy on hemoglobin A1c (HbA1c), the event of hypoglycemia and treatment satisfaction degree of the patients were studied through a self-comparison method. Then, its effect on the above-mentioned geriatric syndromes was observed. Results Among all the 132 out/in patients older than 75 years with T2DM, the prevalence rates of functional disorder (including ADL and IADL), dementia including mild cognitive disorder, depression, and malnutrition were respectively 50.0% (66), 39.4% (52), 28.0% (37), and 30.0% (39). Only 33 patients met the criteria of glargin-based treatment. After 2 years of follow-up, we found that the glargin-based treatment could properly decrease the level of HbA1c without increasing the prevalence rate of geriatric syndrome. Moreover, it could reduce the frequency of insulin injection and the events of hypoglycemia, and treatment satisfaction degree was also significantly improved. Conclusions Geriatric syndrome has a relatively high prevalence rate in patients older than 75 years with T2DM. Comprehensive geriatric assessment is beneficial in finding out the geriatric syndrome, and glargin-based hypoglycemic therapy can significantly reduce the events of hypoglycemia, improve nutritional status, and increase treatment satisfaction degree without increasing the rate of geriatric syndrome .
目的觀察羅格列酮對(duì)老年糖尿病大鼠認(rèn)知功能、血清高敏C-反應(yīng)蛋白(hs-CRP)水平及海馬組織核轉(zhuǎn)錄因子-κB(NF-κB)、白細(xì)胞介素-6(IL-6)、腫瘤壞死因子-α(TNF-α)表達(dá)的作用。 方法將30只20~22月齡老年Wistar大鼠隨機(jī)分為3組:對(duì)照組(n=6)予生理鹽水腹腔注射;糖尿病組(n=12)和羅格列酮組鏈脲佐菌素55 mg/kg腹腔注射;造模后羅格列酮組以羅格列酮4 mg/(kg·d)+無(wú)菌水混懸液灌胃,糖尿病組和對(duì)照組以等量無(wú)菌水灌胃,共8周。8周后應(yīng)用Morris水迷宮實(shí)驗(yàn)評(píng)價(jià)各組大鼠的認(rèn)知功能。檢測(cè)各組大鼠血清hs-CRP水平、海馬區(qū)域NF-κB、IL-6、TNF-α的表達(dá)。 結(jié)果羅格列酮組、糖尿病組Morris水迷宮測(cè)試中逃避潛伏期分別較正常對(duì)照組延長(zhǎng)(P<0.05);與糖尿病組相比較,羅格列酮組Morris水迷宮測(cè)試中潛伏期縮短(P<0.05),中心區(qū)停留時(shí)間百分比和通過(guò)原平臺(tái)位置次數(shù)增加(P<0.05)。與對(duì)照組相比,羅格列酮組和糖尿病組血清hs-CRP水平,NF-κB、IL-6、TNF-α表達(dá)升高(P<0.01);羅格列酮組血清hs-CRP水平、NF-κB、IL-6、TNF-α表達(dá)較糖尿病組相比降低(P<0.05)。 結(jié)論糖尿病大鼠認(rèn)知功能受損與血清CRP水平相關(guān)。羅格列酮對(duì)糖尿病大鼠的認(rèn)知功能減退有改善作用,其機(jī)制可能與降低血清CRP水平,抑制海馬組織NF-κB信號(hào),降低IL-6、TNF-α的表達(dá)有關(guān)。
目的 調(diào)查分析醫(yī)學(xué)生與老年患者交流/溝通的現(xiàn)狀,以提高醫(yī)學(xué)生的醫(yī)患溝通技能。 方法 對(duì)90名醫(yī)學(xué)實(shí)習(xí)生進(jìn)行問(wèn)卷調(diào)查,數(shù)據(jù)錄入和分析采用SPSS 13.0軟件。 結(jié)果 醫(yī)學(xué)生對(duì)醫(yī)患交流/溝通的重要性有一定認(rèn)識(shí),但在溝通的主動(dòng)性上不夠充分;對(duì)于醫(yī)患溝通內(nèi)容和背景知識(shí)的準(zhǔn)備還遠(yuǎn)遠(yuǎn)不夠。 結(jié)論 應(yīng)加強(qiáng)對(duì)醫(yī)學(xué)生交流/溝通技能的培養(yǎng),培養(yǎng)適合現(xiàn)代醫(yī)學(xué)模式的高級(jí)醫(yī)學(xué)人才。