糖尿病性黄斑水肿的诊疗思考

糖尿病性视网膜病变(diabetic retinopathy,DR)是糖尿病患者严重的眼部并发症之一,而黄斑水肿是导致糖尿病性视网膜病变患者视力下降的主要原因之一,其发病机制、诊断技术和治疗方法是一个辩证发展的过程.因此运用科学哲学方法来分析糖尿病性黄斑水肿(diabetic macular edema,DME)的诊断和治疗显得尤为重要.     

糖尿病性视网膜病变综合治疗的策略

糖尿病性视网膜病变(diabetic retinopathy,DRP)是糖尿病的常见并发症,其发病率和致盲率呈逐年上升趋势.半个多世纪以来,已经认识到DRP各种治疗手段都有一定的优势和局限性,单纯依靠一种治疗方法难以取得理想效果.因此,多种手段相结合的综合治疗措施成为糖尿病视网膜病变的一种科学合理的治疗模式.     

糖尿病性视网膜病变综合治疗的策略

糖尿病性视网膜病变（diabetic retinopathy,DRP）是糖尿病的常见并发症,其发病率和致盲率呈逐年上升趋势。半个多世纪以来,已经认识到DRP各种治疗手段都有一定的优势和局限性,单纯依靠一种治疗方法难以取得理想效果。因此,多种手段相结合的综合治疗措施成为糖尿病视网膜病变的一种科学合理的治疗模式。     

基于利益相关者视角的糖尿病视网膜监测服务探析

糖尿病性致盲已成为成年人首要致盲因素之一,通过早期糖尿病视网膜监测和系统治疗可以有效地降低糖尿病视网膜病变发生的几率,因此有效的监测手段对于科学规范管理糖尿病是十分有必要的。由于血糖的正常值和糖代谢异常的诊断切点主要依据血糖值与糖尿病视网膜病变和糖尿病发生风险的关系来确定,因此糖尿病视网膜监测可能会更加精确地监测糖尿病的变化。本文应用利益相关者分析对糖尿病视网膜监测服务开展过程中涉及的各主体利益及存在问题进行探讨,为进一步有效管理糖尿病提供相关建议。     

糖尿病性视网膜病变的个体化治疗

糖尿病性视网膜病变(DRP)是糖尿病患者致盲的一个主要原因。其发病的多样性决定了对其治疗应该个体化。就其个体化治疗的依据、方法的研究及具体的措施运用哲学原理加以综述。     

糖尿病性视网膜病变的个体化治疗

糖尿病性视网膜病变(DRP)是糖尿病患者致盲的一个主要原因.其发病的多样性决定了对其治疗应该个体化.就其个体化治疗的依据、方法的研究及具体的措施运用哲学原理加以综述.     

光学相干断层扫描观察白内障术后黄斑区病变

通过光学相干断层扫描(optical coherence tomography,OCT)技术来早期明确白内障超声乳化术后视网膜黄斑区病变。采集我院白内障超声乳化术及人工晶状体植入术后视力改善不良的老年性白内障患者,进行OCT检查,观察其图象特征。结果提示术眼黄斑区OCT图像表现为:黄斑区视网膜水肿,视网膜厚度增加;黄斑区增生膜形成,部分伴有黄斑区视网膜水肿;黄斑区神经上皮层变薄;黄斑裂孔形成;老年黄斑变性(萎缩性),表现为视网膜色素上皮层断裂、厚薄不均;部分病例视网膜色素上皮层增殖、断裂,表现为色素上皮损害。OCT由于其独特的横截面成像技术,通过精确测量视网膜厚度及观察视网膜反射性的改变,可以在白内障超声乳化术后早期发现黄斑区视网膜的病变,定量地了解病情的变化,是一种比较理想的检测手段。     

光学相干断层扫描观察白内障术后黄斑区病变

通过光学相干断层扫描(optical coherence tomography,OCT)技术来早期明确白内障超声乳化术后视网膜黄斑区病变.采集我院白内障超声乳化术及人工晶状体植入术后视力改善不良的老年性白内障患者,进行OCT检查,观察其图象特征.结果提示术眼黄斑区OCT图像表现为:黄斑区视网膜水肿,视网膜厚度增加;黄斑区增生膜形成,部分伴有黄斑区视网膜水肿;黄斑区神经上皮层变薄;黄斑裂孔形成;老年黄斑变性(萎缩性),表现为视网膜色素上皮层断裂、厚薄不均;部分病例视网膜色素上皮层增殖、断裂,表现为色素上皮损害.OCT由于其独特的横截面成像技术,通过精确测量视网膜厚度及观察视网膜反射性的改变,可以在白内障超声乳化术后早期发现黄斑区视网膜的病变,定量地了解病情的变化,是一种比较理想的检测手段.     

系统论方法在糖尿病性视网膜病变危险因素及治疗研究中的应用

全球糖尿病患者人数在不断的增多,大约10％的Ⅰ型糖尿病患者在10年后可出现糖尿病性视网膜病变,而大约95％的Ⅱ型糖尿病患者在20年后可出现糖尿病性视网膜病变。目前,糖尿病性视网膜病的发病机制尚不明确,影响其发生发展的因素也很复杂,因此,对糖尿病性视网膜病的发病危险因素及其诊治的研究,具有相当重要的意义。系统论,研究各种物质运动形态所共有的系统联系和关系,具有普遍的方法论意义,为现代医学的进步提供了全新的思维方式和科学方法论原则。本文试用系统论的整体性、优化原理阐述糖尿病性视网膜病变发病的危险因素与治疗进展,为对其深入研究提供方法论依据。     

系统论方法在糖尿病性视网膜病变危险因素及治疗研究中的应用

全球糖尿病患者人数在不断的增多,大约10%的Ⅰ型糖尿病患者在10年后可出现糖尿病性视网膜病变,而大约95%的Ⅱ型糖尿病患者在20年后可出现糖尿病性视网膜病变.目前,糖尿病性视网膜病的发病机制尚不明确,影响其发生发展的因素也很复杂.因此,对糖尿病性视网膜病的发病危险因素及其诊治的研究,具有相当重要的意义.系统论,研究各种物质运动形态所共有的系统联系和关系,具有普遍的方法论意义,为现代医学的进步提供了全新的思维方式和科学方法论原则.本文试用系统论的整体性、优化原理阐述糖尿病性视网膜病变发病的危险因素与治疗进展,为对其深人研究提供方法论依据.     

A new approach to identifying the effect of diabetic peripheral neuropathy on the ability to drive safely

The purpose of this study was to estimate the potential for impaired driving performance in current drivers with diabetic peripheral neuropathy compared to healthy controls. We analysed, using a driving simulator, three important aspects of driving - use of the accelerator pedal, steering wheel and eye-steering coordination - to test for any differences, and then to integrate these findings to identify a unique pattern of changes in people driving with diabetic peripheral neuropathy. Patients with diabetic peripheral neuropathy displayed differences in use of the accelerator pedal compared to healthy control drivers (p < 0.05) which could be a direct consequence of their sensorimotor impairment due to diabetic peripheral neuropathy. Drivers with DPN used the more extreme high and low positions of the pedal to a greater extent than the Control group who exhibited a more graded use of the accelerator pedal over the mid-range. Eye-steering coordination was also different in drivers with diabetic peripheral neuropathy (p < 0.05) and, as it improved during the second drive, becoming closer to healthy drivers’ values, the occasional loss of control experienced during driving reduced. These insights demonstrate that diabetic peripheral neuropathy affects multiple aspects of driving performance suggesting the need for an integrated approach to evaluate the potential for driving safely in this population.     

Consistency of adherence across regimen demands

The extent to which adherence to one demand of the diabetic treatment regimen is related to adherence to other regimen demands was explored in a sample of 227 diabetic patients. Adherence to weight control, urine/blood testing, medication taking, symptom reporting, and safety demands was assessed using a variety of methods: (a) patients' report in relation to physician's criteria, (b) patients' report in relation to their own understanding of those criteria, (c) significant others' reports, (d) nurses' ratings, and (e) physicians' ratings. Based on attribution theory, it was proposed that informed others would view patients as more consistent than patients themselves did. Separate intercorrelation matrices were created for each method. The correlations, however, were uniformly low (most rs less than .25) and mean correlations did not differ significantly between matrices. The relative independence of adherence to different demands of the diabetic regimen has important implications for the conceptualization and measurement of treatment adherence.     

糖尿病酮症酸中毒急救措施

辩证思维是最重要的科学思维方法,是指导临床工作的重要科学方法。糖尿病酮症酸中毒（DKA）为糖尿病的急性并发症,是导致糖尿病死亡的主要原因之一。在临床诊治过程中,应科学合理运用辩证思维方法,对DKA快速正确地诊断,积极及时地救治,从而降低糖尿病的病死率,提高患者的生存质量。     

糖尿病自我管理的面面观

糖尿病是慢性终身性疾病。糖尿病患者的自我管理处于中等或偏低的水平,导致患者出现各种急慢性并发症,严重影响了患者的生活质量。患者的自我效能影响患者的自我管理行为。因此,有必要介绍糖尿病自我管理理论及研究现状,为提高糖尿病患者的自我管理水平提供参考资料。     

Blood glucose monitoring by diabetic adolescents: compliance and metabolic control

Self-monitoring of blood glucose (SMBG) is used in the management of diabetes to guide insulin and diet adjustments. However, SMBG has not achieved its potential impact on diabetic control, perhaps due to poor compliance. Research on SMBG compliance interventions has been hampered by a lack of reliable and practical methods of behavioral assessment. The appearance of reflectance meters with memory permits precise, yet efficient, measurement of SMBG behaviors, allowing more effective interventions. This study evaluated a behavioral contract for SMBG compliance among diabetic adolescents, using reflectance meters with memory to assess the target behavior. Thirty patients were randomized to either meter-alone or meter-plus-contract conditions; an additional 12 patients served in a conventional-therapy control group. Compliance for the meter-alone group declined sharply during the 16-week intervention, whereas it remained at or above baseline levels for the meter-plus-contract group. Despite the large between-groups differences in SMBG frequency, both groups showed equal, moderate improvement in measures of diabetic control, suggesting that SMBG frequency had little impact on health status in this sample. There were no intervention-specific effects on overall diabetes compliance or patient or parent adjustment to diabetes. Few of the measured patient characteristics were significant predictors of treatment response. Further research into maximizing the therapeutic impact of SMBG is needed.     

Mathematical analysis of energy regulatory pattens of normal and diabetic rats.

Analysis of feeding patterns indicated that diabetic (alloxan) hyperphagia is characterized by doubling of meal sizes with no change in feeding frequency. Correlation of meal sizes and intermeal intervals did not provide any systematic relationships for either normal or diabetic rats. When equations of the general form Y = A + Bcos (X) were fit to successive satiety ratios (postmeal interval/meal size), the diabetic rats showed significantly lower A coefficients, reflecting a lower average level of satiety, as well as significantly lower B coefficients, reflecting less systematic variability in the satiating value of food around the average level. It is concluded that the major regulatory deficit in diabetic animals is a chronic reduction in the long-term signal of body nutrient repletion.     

肺减容术复苏的启示

慢性阻塞性肺气肿是老年病中最常见也是威胁极大的一种疾病，目前常规的疗法疗效不佳，本文阐述了肺减容术治疗慢阻肺这一方法的提出和发展的曲折道路，指出：其复苏是建立在理论研究进步和实践积累上的重新认识，对肺减容术的提出沉降，复苏，飞跃的过程这一典型个案进行了哲学分析。     

健康教育及分层管理在糖尿病足病防治中的作用——3年随访观察

为探讨早期糖尿病足病健康教育及分层管理措施对糖尿病患者足病的防治作用,对初诊糖尿病患者进行了足部风险评估,分为正常、低危、中危、高危不同程度糖尿病足病风险人群,然后对不同风险人群组实施系统性、长期性兼个体化的糖尿病足病防治健康教育和分层管理3年.研究发现,糖尿病足病发生发展状况明显改善,与糖尿病足病相关的溃疡复发率相对风险降低52.30％,再住院率相对风险降低43.28％,溃疡发生率降低61.99％.因此,早期糖尿病足病健康教育和分层管理的防治策略可提高患者对足部的自我管理和护理能力,对糖尿病足病的发生发展起到了有效的防治作用.