围手术期血糖控制

糖尿病患者围手术期血糖控制是临床糖尿病处理的一大难题,围手术期血糖控制状况对术后病死率及感染等并发症有重要影响.良好的血糖控制可以改善患者预后,但严格控制血糖也会增加低血糖和多项不良事件发生的风险.目前时围手术期血糖控制的目标尚无统一标准,缺乏充分的前瞻性对比研究和循证证据.本文作者对近几年关于围手术期血糖控制相关文献综合整理,结合相关临床经验,就围手术期血糖控制进行探讨.     

外科手术患者的血糖管理

随着糖尿病患患者数的迅速增加,需要接受外科手术治疗的糖尿病患者也越来越多。糖尿病患者的血糖控制与外科手术相互影响,一方面,手术应激可进一步加重糖尿病患者的糖代谢紊乱;另一方面,合并糖尿病使患者发生围手术期并发症甚至死亡的风险大大增加。因此,对糖尿病患者进行完整的术前评估,良好的术前、术中、术后血糖管理是糖尿病患者手术顺利进行、平稳渡过围手术期、改善预后的重要保证。     

老年糖尿病患者人工髋关节置换术的围手术期处理体会

探讨老年糖尿病患者人工髋关节置换术围手术期的治疗方法。对2000年1月~2006年3月54例糖尿病患者行人工髋关节置换术进行术后随访,利用临床关节功能及放射学检查进行分析。54例手术患者血糖控制满意且顺利度过围手术期。按Harris评分标准,术后髋关节功能优良率分别为人工股骨头置换组74%(14/19),人工全髋关节置换组91%(32/35)。未发现感染及假体松动现象等并发症。老年糖尿病患者如果有髋关节置换手术指征,没有严重的并发疾病,在重视围手术期处理的情况下,可以行人工髋关节置换术,且疗效肯定。     

围手术期应激性高血糖管理

由于手术应激原影响,外科大手术围术期发生应激性高血糖屡见不鲜。围手术期血糖监测与控制对临床治疗意义重大。本文概括了围手术期应激性高血糖的发病机制、主要危害,从辩证思维的角度,归纳出灵活掌握控制标准,注意“度”的原则、整体性原则及动态性原则,从而有效控制围手术期发生的应激性高血糖。     

靶控输注舒芬太尼复合丙泊酚在老年直肠癌根治术合并2型糖尿病患者围术期指标的影响

探究靶控输注(TCI)舒芬太尼复合丙泊酚在老年直肠癌根治术合并2型糖尿病患者围术期指标的影响。选取自2015年9月～2016年9月间我院收治的老年直肠癌根治术且合并2型糖尿病患者78例,采用随机数字表法将研究对象分为A组(TCI舒芬太尼复合丙泊酚注射)和B组(多次舒芬太尼复合丙泊酚注射)。观察两组患者围手术期血气指标、血糖指标、麻醉效果和不良反应。TCI舒芬太尼复合丙泊酚对行直肠癌根治术的老年直肠癌合并2型糖尿病患者的麻醉效果较佳,能够稳定血流动力学和血糖指标,减少围手术期不良反应的发生,值得推广应用。     

围手术期应激性高血糖管理

由于手术应激原影响,外科大手术围术期发生应激性高血糖屡见不鲜.围手术期血糖监测与控制对临床治疗意义重大.本文概括了围手术期应激性高血糖的发病机制、主要危害,从辩证思维的角度,归纳出灵活掌握控制标准,注意"度"的原则、整体性原则及动态性原则,从而有效控制围手术期发生的应激性高血糖.     

糖尿病血糖控制的理性思考

糖尿病是严重威胁人类健康的疾病之一,其发病率逐年增加。血糖控制是糖尿病治疗的基石。糖尿病的血糖控制要根据不同患者的具体情况,选择适宜的药物和治疗方案,平稳适度的控制血糖,以达到最有利于患者的治疗效果。用认识论和联系的观点对糖尿病血糖控制的依据、措施和目的进行综合分析。     

糖尿病患者白内障手术围手术期风险评估

白内障超声乳化手术的日趋成熟和完善为广大糖尿病患者带来了福音,但作为一个特殊高危群体,手术风险不容忽视。结合以往临床经验,就糖尿病患者白内障手术围手术期风险评估的重要性和必要性作一阐述。以期警示临床严格把握手术适应证,认真作好术前风险评估,实事求是,因人而宜,针对每一位患者的自身条件作出最优化临床决策。     

青壮年肝癌患者围手术期心理特征与人文关怀

青壮年患者因其在家庭、社会生活中的重要角色,其在治疗阶段情绪波动较大,而围手术期患者紧张、悲观、焦虑和恐惧等心理反应会对其生理功能产生巨大的不良影响,限制了对患者诊疗过程中配合,尤其是对围手术期影响明显。为了降低围手术期患者心理应激产生的不良影响,同时适应生理一心理一社会医学模式的转变,管床医生在围手术期必须对手术患者...     

麻醉医生与围手术期患者的人文关怀

围手术期患者紧张、忧郁、焦虑和恐惧等心理反应会对其生理功能产生巨大的不良影响,这对于麻醉和手术极为不利。为了降低围手术期患者心理应激产生的不良影响,同时适应生理-心理-社会医学模式的转变,麻醉医生在围手术期必须对手术患者实施有效的人文关怀。麻醉医生可以在三个阶段对患者实施相应的人文关怀。     

Stereotypes and prejudice in the blood: Sucrose drinks reduce prejudice and stereotyping

Prejudice and stereotyping cause social problems and intergroup tension. The current work examined whether bolstering self-control by giving participants glucose would reduce stereotype use for an impression formation task. Previous work has demonstrated that self-control depends on biologically expensive brain processes that consume energy derived from glucose in the bloodstream. In the current study, glucose was manipulated via lemonade sweetened with either sugar or Splenda. Compared to the control group, the participants in the glucose condition used fewer stereotypes when writing an essay about a day in the life of a gay man. In addition, high-prejudice participants in the glucose condition used fewer derogatory statements in their essays than high-prejudice participants in the control condition. The findings are discussed in terms of the importance of self-control resources in the effective regulation of prejudice and stereotyping.     

Privacy and the new technology

Technology has been charged with destroying personal privacy. Some look to technology itself for solutions and countermeasures to the threat; others seek to control the threat by laws. But protection by control of human incentives holds most promise. Schools, for example, suffer from datamania, which might be alleviated by proper control of incentives. This article suggests several steps we can take to avoid any individual gain from acquiring information about others.     

Does the brain consume additional glucose during self-control tasks?

A currently popular model of self-control posits that the exertion of self-control relies on a resource, which is expended by acts of self-control, resulting in less of this resource being available for subsequent acts of self-control. Recently, glucose has been proposed as the resource in question. For this model to be correct, it must be the case that A) performing a self-control task reduces glucose levels relative to a control task and B) performing a self-control task reduces glucose relative to pre-task levels. Evidence from neurophysiology suggests that (A) is unlikely to be true, and the evidence surrounding (B) is mixed, and is unlikely to be true for subjects who have not recently fasted. From the standpoint of evolved function, glucose might better be thought of as an input to decision making systems rather than as a constraint on performance.     

Type A Behavior and Diabetic Control: Implications of Psychological Reactance for Health Outcomes1

According to laboratory research, Type A coronary-prone individuals are sensitive to threats to their personal control and react to such threats with active and often stressful coping responses. The present investigation tested the prediction that these features of Type A behavior would interfere with blood glucose regulation in insulin-dependent diabetes mellitus patients. Two independent hypotheses were investigated. Because elevated sympathetic arousal, a concomitant of stressful coping, is associated with elevated glucose levels, it was predicted that Type A diabetics experiencing high levels of life stress would display poorest blood glucose control (indexed by Hemoglobin A₁c). The second hypothesis was derived from the observation that Type As are more likely than Type Bs to respond to control threats with reactance in order to restore the perception of control. Given that illness or treatment can reduce personal control, it was predicted that Type A diabetics would be most reactant and, thus, most medically noncompliant. To test these hypotheses, 37 Type 1 diabetics were assessed for Type A behavior, life change, attributional style, desire for control (both within treatment and in general), and specific perceptions of and actions to their diabetes. Type As were more likely than Type Bs to show poor blood glucose control. However, for patients in general, and Type As in particular, blood glucose regulation was not related to life stress. Rather, those Type As who displayed poor glucose control made more extreme self-attributions about the cause of their diabetes, were angrier about it, and felt they should fight it. The implications of these findings for a reactance-Type A model of medical compliance are discussed.     

疾病对社会经济发展的影响

历史上大规模暴发的传染病对社会经济的发展有着非常深刻的影响,它直接打击了社会经济发展的核心与所有生产力要素中最根本的——人类本身;但是,在整个社会经济的发展过程中,公共卫生与医疗保健的作用一直未引起人们的关注,随着人类文明的不断进步,对疾病的控制已经成为世界各国的中心任务,卫生保健服务直接增进了人类健康,促进社会经济健康与持续地发展。     

Glucose consumption decreases impulsive aggression in response to provocation in aggressive individuals

Impaired executive control is implicated in aggression. Research suggests that the acute administration of glucose can improve executive control. In two experiments undergraduates completed a measure of trait aggression and consumed a glucose or placebo beverage before being given the chance to administer a blast of white noise to a fictitious participant. In Experiment 1, all participants were provoked and mentally depleted or not. Glucose was most effective in reducing aggression for those high in trait aggression even when depleted. In Experiment 2, participants were provoked or not. When provoked, glucose reduced aggression among those high in trait aggression. However, when not provoked, glucose increased aggression among those high in trait aggression. These data suggest that the acute administration of glucose can be beneficial in reducing aggression in response to provocation among those high in trait aggression.     

Post-training glucose administration attenuates forgetting of passive-avoidance conditioning in 18-day-old rats.

The study of memory modulation in infant rats has typically focused on reminder/retrieval treatments involving reexposure to components of the internal or external training context. Rarely have studies employed pharmacological treatments to investigate the neurochemical substrates of memory storage in preweanling rats. The present study investigated the effect of 100 mg/kg of glucose, a common memory modulator in adult mammals, on memory for passive-avoidance conditioning in 18-day-old Sprague-Dawley rats. Subjects that were administered an immediate post-training injection of glucose performed significantly better, on a retention test 24 h following training, than those animals that received saline. The glucose group also performed comparably to a control group that was tested 10 min following training. These results are consistent with those of the memory modulation literature in adults and suggest that the rapid rate of forgetting in immature organisms may be the result of a deficiency in a general memory modulatory system.     

Conditioning as sensitization

The concept of sensitization has a long history in psychology, and on both empirical and logical grounds it has been argued that sensitization and conditioning denote different neurophysiological processes. Investigators have devised elaborate control procedures that purport to differentiate sensitized and conditioned responses. But, mainly on logical grounds, it is argued that there is no valid basis for considering sensitization and conditioning as separate processes. A theory of learning is proposed in which sensitization is the basic construct.     

Acetylcholine esterase activity and behavioral response in hypoxia induced neonatal rats: effect of glucose, oxygen and epinephrine supplementation

Brain damage due to an episode of hypoxia remains a major problem in infants causing deficit in motor and sensory function. Hypoxia leads to neuronal functional failure, cerebral palsy and neuro-developmental delay with characteristic biochemical and molecular alterations resulting in permanent or transitory neurological sequelae or even death. During neonatal hypoxia, traditional resuscitation practices include the routine administration of 100% oxygen, epinephrine and glucose. In the present study, we assessed the changes in the cholinergic system by measuring the acetylcholinesterase (AChE) activity and the behavioral responses shown by hypoxia induced neonatal rats and hypoxic rats supplemented with glucose, oxygen and epinephrine using elevated plus-maze and open-field test. The acetylcholine esterase enzyme activity showed a significant decrease in cerebral cortex, whereas it increased significantly in the muscle of experimental rats when compared to control. Hypoxic rats supplemented with glucose, glucose and oxygen showed a reversal to the control status. Behavioral studies were carried out in experimental rats with elevated plus-maze test and open-field test. Hypolocomotion and anxiogenic behavioral responses were observed in all experimental rats when compared to control, hypoxic rats supplemented with glucose, glucose and oxygen. Thus, our results suggest that brain damage due to hypoxia, oxygen and epinephrine supplementation in the neonatal rats cause acetylcholine-neuromuscular-defect leading to hypolocomotion and anxiogenic behavioral response. Glucose and glucose with oxygen supplementation to hypoxic neonates protect the brain damage for a better functional status in the later life.     

心脑血管疾病患者高血糖的管理

糖尿病是心脑血管疾病的主要危险因素,血糖控制不佳会加重此类患者的病情,影响其预后,因此,急慢性心脑血管疾病患者的高血糖要积极处理。在血糖控制过程中,要综合考虑患者的病情,选择安全、有效的降糖方案,避免低血糖和药物的副作用。本文就心脑血管疾病患者高血糖的管理进行了总结。