目的 调查骨科围术期老年糖尿病病人血糖管理现状,研究血糖控制水平与骨科手术预后的相关性.方法 收集109例行骨科手术的老年2型糖尿病病人术前2 d至术后3 d的每天5个时点血糖水平,分析术前血糖及血糖变异水平对术后并发症的影响.结果 109例病人HbA1c中位数为7.3％,24例(22.02％)病人HbA1c>8.5％,术前所有末梢血糖中位数为9.02 mmol/L,术前末梢血糖波动系数(CV)为0.28±0.10.14例病人(12.84％)术后出现并发症,其中手术部位感染10例(9.17％).术前平均血糖>9.02 mmol/L组相较于术前平均血糖≤9.02 mmol/L组,术后并发症发生率更高(20.37％比5.45％,P<0.05),手术部位感染率显著增加(14.81％比3.64％,P<0.05).术前血糖CV>0.29组相较于血糖CV≤0.29组,围术期低血糖事件发生率显著增加(29.63％比9.09％,P<0.05).结论 合并糖尿病的老年骨科手术病人围术期血糖管理现状有待改善.加强术前血糖监测与管理,有利于降低老年糖尿病病人骨科手术并发症发生率.

目的 Meta整合透析患者照顾者的照护体验,为制定针对性照护方案和干预性措施提供参考依据.方法 计算机检索PubM ed、Web of Science、EM base、T he Cochrane Library、中国生物医学文献数据库、万方数据知识服务平台、维普资讯中文期刊服务平台、中国知网数据库关于透析患者照顾者的质性研究,检索时限从建库至2019年5月.采用NoteExpress软件筛选和分析文献、澳大利亚JBI循证卫生保健中心质性研究质量评价标准评价文献,并通过Meta整合方法对结果进行整合.结果 共纳入12篇文献,归纳为8个类别,整合成3个结果:照顾者疾病知识缺乏及渴望专业人员能够满足其不断变化的信息需求、照顾者心身负担重及渴望得到支持、照顾者能够自我调适和积极应对与患者之间的关系.结论 透析患者照顾者的照护体验较多,需要医疗卫生人员、社区、政府在关注患者和疾病的同时,也重视照护行为对透析患者照顾者的影响,并给予针对性措施,促进透析患者及其照顾者的心身健康.

目的:评价低碳水化合物早餐对新城镇居民2型糖尿病(T2DM)患者心理痛苦及饮食管理自我效能的影响.方法:选择2018年8月至2019年3月就诊于南京市某卫生院的90例新城镇居民T2DM患者,随机分为试验组与对照组两组各45例.两组患者在接受常规糖尿病相关知识教育的基础上,分别接受低碳水化合物早餐教育(试验组)和指南推荐均衡早餐教育(对照组),比较干预前后两组患者心理痛苦及饮食管理自我效能的变化.结果:试验组干预前后糖尿病痛苦量表(DDS)均分及情感、生活规律、人际关系相关痛苦均分的差值均大于对照组(P＜0.05).试验组干预前后饮食管理自我效能中务目2、3得分的差值均大于对照组(P＜0.05).除就医相关痛苦外,两组患者DDS均分及各维度得分的差值与饮食管理自我效能中条目3的差值均呈负相关(P＜0.05);DDS均分及生活规律相关痛苦得分的差值与条目2的差值呈负相关(P＜0.05).结论:低碳水化合物早餐可以显著改善新城镇居民T2DM患者的心理痛苦和饮食管理自我效能,且效果优于指南推荐均衡早餐.

背景 我国糖尿病患病率逐年升高,饮食管理是糖尿病治疗的基础措施.低碳水化合物饮食虽对糖尿病患者的糖脂代谢有益,但严格的碳水化合物控制与我国传统饮食文化差距较大,导致患者长期饮食依从性欠佳.目的 探讨低碳水化合物早餐治疗新城镇2型糖尿病(T2DM)患者的效果.方法 采用便利抽样法选取2018年8月—2019年3月就诊于南京市溧水区东屏镇卫生院的90例新城镇T2DM患者为研究对象,采用抛硬币法将其分为试验组和对照组,每组45例.以标准碗和基于此而制定的食物定量图谱为研究工具,为对照组进行指南推荐早餐教育,试验组进行低碳水化合物早餐教育,两组午餐、晚餐的碳水化合物摄入比例不做限定.于干预前和干预3、6个月检测两组患者空腹血糖(FPG)、早餐后2 h血糖、糖化血红蛋白(HbA1c)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、自我效能量表(SED)评分,干预2周和干预3、6个月记录饮食依从性.结果 对照组2例患者分别因脑梗死复发、嫌控制饮食麻烦退出研究,试验组3例患者分别因搬迁、外出打工、拒绝随访退出研究;失访率为5.6％.干预3个月试验组患者早餐后2 h血糖低于对照组(P<0.05).对照组患者干预3、6个月早餐后2 h血糖、HbA1c低于组内干预前(P<0.05);试验组干预3个月早餐后2 h血糖、HbA1c、HDL-C、LDL-C、TG低于组内干预前,干预6个月FPG、早餐后2 h血糖、HbA1c、HDL-C、LDL-C、TG低于组内干预前(P<0.05).干预6个月试验组患者SED评分高于对照组(P<0.05).两组患者干预3、6个月SED评分均高于组内干预前(P<0.05);试验组患者干预6个月SED评分高于组内干预3个月(P<0.05).两组患者干预3、6个月饮食依从性均高于组内干预2周(P<0.05).结论 指南推荐早餐教育和低碳水化合物早餐教育均能有效改善新城镇T2DM患者的糖脂代谢、自我效能和饮食依从性,且低碳水化合物早餐在改善糖脂代谢、自我效能方面优于指南推荐早餐教育.

餐后高血糖是指进餐后1～2 h的餐后血糖高于7.8 mmol/L,餐后高血糖是导致糖化血红蛋白升高的主要原因,且其与糖尿病慢性并发症的发生发展具有相关性,控制餐后血糖是促进糖化血红蛋白达标、防治糖尿病慢性并发症的重要措施.近年研究发现,改变进餐顺序的饮食治疗方法可以显著改善糖尿病患者的餐后血糖.本文就进餐顺序的概述、进餐顺序对糖尿病患者餐后血糖的研究现状及其可能机制做如下综述,旨在为进一步的研究提供借鉴.

背景 随着全球范围内糖尿病患病率快速升高,我国终末期糖尿病及须行血液透析患者数量日益增多,而与非糖尿病患者相比,伴有糖尿病者血液透析过程中血糖变化幅度较大且会对患者预后造成不利影响.目的分析伴有糖尿病的规律血液透析患者血液透析过程中血糖变化.方法选取2017年10月—2018年12月江苏省3家三级医院(东南大学附属中大医院、东南大学附属中大医院溧水分院、东南大学附属中大医院无锡分院)血液净化中心收治的伴有糖尿病的规律血液透析患者105例,其中3例患者血液透析过程中血糖数据缺失,最终纳入102例患者.所有患者采用无糖碳酸氢盐透析液并单纯采用胰岛素治疗,记录其透析前、透析1 h、透析2 h、透析3 h、透析结束时血糖以分析血糖变化及低血糖、高血糖发生情况.结果102例患者血液透析过程中血糖波动范围为1.6～27.8 mmol/L,平均为(8.4±3.2)mmol/L;22例(30次)出现低血糖,低血糖发生率为21.6％(22/102),其中18例(23次)为无症状性低血糖,无症状性低血糖发生率为17.6％(18/102);30例(47次)出现高血糖,高血糖发生率为29.4％(30/102),其中透析前26次.低血糖患者透析前、透析1 h、透析2 h、透析3 h血糖低于非低血糖患者(P<0.05),而低血糖与非低血糖患者透析结束时血糖比较,差异无统计学意义(P>0.05);低血糖、非低血糖患者透析前、透析1 h、透析2 h、透析3 h、透析结束时血糖比较,差异均有统计学意义(P<0.05).高血糖患者透析前、透析1 h、透析2 h、透析3 h、透析结束时血糖高于非高血糖患者(P<0.05);高血糖、非高血糖患者透析前、透析1 h、透析2 h、透析3 h、透析结束时血糖比较,差异均有统计学意义(P<0.05).低血糖患者透析日减停胰岛素、知晓低血糖定义者比例低于非低血糖患者,高血糖患者透析日减停胰岛素者比例高于非高血糖患者(P<0.05).结论伴有糖尿病的规律血液透析患者透析过程中低血糖(21.6％)、高血糖(29.4％)发生率均较高,且低血糖以无症状性低血糖多见,高血糖以透析前多见,透析日减停胰岛素、低血糖定义知晓率低是伴有糖尿病的规律血液透析患者血液透析过程中低血糖的可能相关因素,同时透析日减停胰岛素也是伴有糖尿病的规律血液透析患者血液透析过程中高血糖的可能相关因素.

目的:分析糖尿病血液透析患者糖化白蛋白值(GA)与血透过程中平均血糖水平的相关性,探讨GA是否可用于评估糖尿病血液透析患者透析过程中平均血糖水平.方法:选取江苏省两家医院血液透析中心进行维持性血液透析的糖尿病患者,监测患者GA、糖化血红蛋白(HbA1c)以及3次血液透析过程中各时间点血糖水平,取3次透析5个时间点血糖水平平均值,分析GA和HbA1c值与平均血糖水平的相关性.结果:GA和HbA1c值与平均血糖水平均呈正相关,但HbA1c与平均血糖水平之间的相关性弱且明显低于GA值与平均血糖水平的相关性(r=0.318,P=0.019;r=0.679,P=0.000).结论:糖尿病血液透析患者糖化白蛋白值与透析过程中平均血糖水平具有良好的相关性,可以用于糖尿病血液透析患者透析过程中平均血糖水平的评估.

目的 研究多维度健康教育对糖尿病高危足患者自护行为的影响.方法 纳入我院选取2019年11月～2020年04月的高危糖尿病足患者共120人,按照时间分组法分为实验组与对照组各60例.对照组实施常规健康教育方案,实验组应用多维度健康教育方案.对比两组患者自我护理能力、足部皮肤损伤发生率、糖化血红蛋白、踝肱指数、Wagner分级评估差异.结果 ①两组入院时自我护理能力与糖化血红蛋白无明显差异,差异无统计学意义(P＞0.05),干预3月后实验组的自我护理能力得分,糖化血红蛋白水平优于对照组,足部皮肤损伤率低于对照组,差异有统计学意义(P＜0.05);②两组干预前踝肱指数无明显差异,差异无统计学意义(P＞0.05),干预12月后实验组踝肱指数高于对照组,Wagner分级优于对照组,差异有统计学意义(P＜0.05).结论 多维度健康教育能够改善糖尿病患者糖尿病足认知度并降低其血糖水平,提升其自我管理能力.

糖尿病肾病(DKD)是糖尿病最主要微血管并发症之一,近年来随着糖尿病患病率的上升,其患病人数也呈上升趋势.预计到2030年,全球DKD患者将超过1亿,情况不容乐观[1].据文献报道,糖尿病和肾功能损伤均是认知障碍的相关危险因素,且两者交互作用会进一步加重认知障碍[2-3].

目的 调查糖尿病维持性血液透析(diabetes-maintenance hemodialysis,D-MHD)患者认知功能状况及其影响因素.方法 便利抽样法选取江苏省 2所二级医院血液净化中心行血液透析治疗的患者为研究对象,采用倾向性评分匹配法调整混杂因素,将D-MHD患者设为观察组,非D-MHD患者设为对照组.采用蒙特利尔认知评估量表评估两组患者的认知功能.结果 观察组命名、语言维度及整体发生认知障碍比例较对照组高,观察组患者的整体认知和视空间/执行功能、命名、语言维度的评分均较对照组低,差异均有统计学意义(均P＜0.05).不同年龄、性别、文化程度、糖尿病病程、糖化白蛋白和透析前血糖水平的D-MHD患者认知功能总分及某些维度认知评分比较,差异均有统计学意义(均P＜0.05).相关分析显示,认知功能总分或各维度认知水平与年龄、糖尿病病程、糖化白蛋白水平、透析前血糖水平呈负相关,与文化程度呈正相关.结论D-MHD患者认知水平整体偏低,影响因素较多.应将D-MHD患者血糖水平控制在正常范围内,重视低龄、糖尿病初期、女性患者,并基于文化程度的不同开展个性化健康教育.

综述了进餐顺序对糖尿病病人的糖代谢、胰岛素分泌、饮食行为、肥胖指标和安全性的影响,以及进餐顺序在国内外糖尿病病人饮食治疗中的应用现状,以期为进一步的研究提供依据.

阐述评估糖尿病肾病血液透析病人血糖控制的意义,综述糖尿病肾病维持性血液透析病人血糖控制指标的研究进展,比较糖化血红蛋白、糖化白蛋白、校正后糖化白蛋白、持续血糖监测系统在血液透析过程中的应用.

Objective To investigate the effect of standardized eating plan based on blood glucose on blood glucose level during dialysis.Methods A total of 30 diabetic nephropathy patients who underwent maintenance hemo-dialysis in the outpatient department of hemodialysis center of the hospital from October 2017 to December 2017 were se-lected. 30 patients received two kinds of intervention before and after, namely the intervention of routine nursing meas-ures and the intervention of standardized eating plan based on blood glucose value, and blood glucose data during the two interventions were collected. Results The incidence of hypoglycemia before intervention (6.67% ) was lower than after intervention ( 1.33% ), and the difference was statistically significant ( P<0.05 ) . Before intervention, the blood glucose level of patients showed a progressive decline with the progress of dialysis. There was no statistically sig-nificant difference in blood glucose levels between patients before and after intervention during dialysis ( P>0.05 ) . Conclusions Standardized feeding scheme based on blood glucose values can significantly reduce the incidence of hy-poglycemia during dialysis and stabilize blood glucose levels at various time points during dialysis.

Purpose: Patients undergoing maintenance hemodialysis (MHD) have a higher prevalence of cognitive impairment and inferior cognitive performance than the general population, and those with cognitive impairment are at higher risk of death than those without cognitive impairment. Having diabetes has been associated with an increased risk of cognitive decline in end-stage kidney disease patients treated with peritoneal dialysis or kidney transplant. However, these findings may not extend to the hemodialysis population. Thus, we aim to investigate the relationship between having diabetes and cognitive function in MHD patients. Methods: This was a cross-sectional study. A total of 203 patients treated with MHD from two blood purification centers were enrolled as subjects. The Chinese version of the Montreal Cognitive Assessment (MoCA) was utilized to assess cognitive function. Results: MHD patients with diabetes had a significantly higher prevalence of global cognitive impairment and inferior performance in global cognition, visuospatial/executive function, naming, language, abstraction and orientation tasks compared with those without diabetes. According to the multiple linear analyses, having diabetes was significantly associated with lower global cognitive function, naming, and language scores, with d coefficients and 95% CIs of -1.30 [-2.59, -0.01], -0.25 [-0.47, -0.02], and -0.32 [-0.58, -0.07], respectively (all P < 0.05). Having diabetes could not independently predict an increased risk of global cognitive impairment. Conclusions: In MHD patients, having diabetes is significantly associated with lower cognitive function scores. Medical staff should evaluate early and focus on the decline of cognitive function in MHD patients with diabetes, in order to achieve early diagnosis and early intervention. (C) 2020 Chinese Nursing Association. Production and hosting by Elsevier B.V.

目的 基于微信为核心家属参与下的同伴支持教育对儿童青少年Ⅰ型糖尿病的效果.方法 选择我院接受诊疗的60例Ⅰ型糖尿病患儿进行分组对比研究.采用随机数字法将所有患儿分为实验组与常规组.常规组由专科护士提供健康教育,实验组采取基于微信为核心家属参与下的同伴支持教育.总结并对比两组患儿的血糖控制状况以及生活质量、自我护理行为情况.结果 实验组患儿的各项血糖指标均明显优于常规组,组间数据差异明显,对比结果有统计学意义(P<0.05).结论 基于微信为核心家属参与下的同伴支持教育对儿童青少年Ⅰ型糖尿病的效果显著,能够有效提高患儿血糖控制效果,降低风险事件的发生,值得在临床中推广.

目的 探讨计步器干预对住院2型糖尿病患者运动量及久坐时间的影响.方法 连续入选2015年7月—2016年1月东南大学附属中大医院内分泌科住院的2型糖尿病患者,采用随机数字表法将患者分为试验组和对照组.对照组仅接受常规治疗、护理.试验组在接受常规治疗、护理的基础上给予计步器干预,干预时长为7 d;利用加速度器监测运动量(运动步数)、久坐时间及热卡消耗情况.结果 本研究最终共纳入47例2型糖尿病患者(试验组24例,对照组23例).两组年龄、性别、身高、收缩压(SBP)、舒张压(DBP)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、餐后2 h C肽/空腹C肽、峰值耗氧量比较,差异无统计学意义(P>0.05);对照组体质量、体质指数(BMI)高于试验组(P<0.05).两组干预前、干预后的运动步数、久坐时间及热卡消耗组间比较,差异均无统计学意义(P>0.05);组内比较:试验组干预前后运动步数比较,差异无统计学意义(P=0.23);对照组干预后运动步数少于干预前(P=0.02).相关性分析显示干预前运动步数与干预前久坐时间呈负相关、与干预前热卡消耗呈正相关(r=-0.42,P<0.05;r=0.56,P<0.05),校正年龄、BMI后,仅干预前运动步数与干预前热卡消耗呈正相关(r'=0.47,P<0.05).结论 计步器干预有助于维持住院2型糖尿病患者运动量,但不能明显减少久坐时间及增加热卡消耗.

The aim of the study was to analyse the influence of prevention measures on pressure injuries for high-risk patients and to establish the most appropriate methods of implementation. Nurses assessed patients using a checklist and factors influencing the prevention of a pressure injury determined by brain storming. A specific series of measures was drawn up and an estimate of risk of pressure injury determined using the Braden Scale, analysis of nursing documents, implementation of prevention measures for pressure sores and awareness of the system both before and after carrying out a quality control circle (QCC) process. The overall scores of implementation of prevention measures ranged from 74.86 14.24 to 87.06 +/- 17.04, a result that was statistically significant (P 0.0025). The Braden Scale scores ranged from 8.53 +/- 3.21 to 13.48 +/- 3.57. The nursing document scores ranged from 7.67 +/- 3.98 to 10.12 +/- 1.63; prevention measure scores ranged from 11.48 +/- 4.18 to 13.96 +/- 3.92. Differences in all of the above results are statistically significant (P 0.05). p id="iwj12764-para-0004 Implementation of a QCC can standardise and improve the prevention measures for patients who are vulnerable to pressure sores and is of practical importance to their prevention and control.

Objective To analyze the quality of life (QoL) of residents with normal blood glucose, pre-diabetes mellitus (PDM), newly detected type 2 diabetes mellitus(T2DM) or diagnosed T2DM. Methods Patients with T2DM or PDM in an epidemiologic survey in Jiangsu Province as well as patients with T2DM in the Basic Public Health Services were included and all received questionnaire. The quality of life scale Euro Qol five-dimensional (EQ-5D)&World Health Organization Well-Being Index (WHO-5) were applied to evaluate the quality of life. Single and multiple statistical methods were used to compare differences between groups. Results The score of EQ-5D visual analog scale (VAS) and Well-Being Index of the T2DM were lower than those in residents with normal glucose (75±17 vs 84±17 and 77±22 vs 79±23,χ2=55.643, 660.489, all P<0.05). There was no difference between PDM and residents with normal glucose in Well-Being Index (80±23 vs 79±23), and there were also no statistical difference between PDM and newly detected T2DM in both the EQ-5D VAS and WHO-5 index (82±16 vs 81±16, 81±22 vs 80±23, all P>0.05). Further analysis showed that the risk factors of high EQ-5D VAS in T2DM were male, low age, high education, and non-farmer occupations (z=3.36, χ2=31.199, 82.821, 62.708, all P<0.05), while WHO-5 index was influenced by the education, occupation and marital status (χ2=32.964, 66.883 and 9.527, all P<0.05). Multiple factors analysis showed that EQ-5D VAS was influenced by basic diseases, low family income, positive family history, senior and education (B=-5.033-1.409,t=-13.244-10.059,all P<0.05), and WHO-5 Well-Being Index was affected by age, the level of blood glucose, basic diseases and marital status (B=-3.986-1.842, t=-8.288-22.055, all P<0.05). Conclusion The overall quality of life in T2DM is lower than the general population and is affected by many factors. More attention should be paid to the Qol of T2DM and improve their psychological adjusting ability.

Purpose: The aim of this study was to investigate the possible therapeutic effect of cognitive training on the cognitive function of patients with vascular cognitive impairment with no dementia (VCIND). Design: A randomized controlled trial. Method: Seventy-three cases of VCIND patients were used as subjects, of which 36 patients were subjected to routine care with systemic cognitive training and classified as the intervention group, whereas the other 37 patients were subjected to a routine care only and classified as the control group. Multidimensional neuropsychological assessments were performed 3 months before and after the intervention. Findings: The patients’ performance on functional tests was significantly improved after intervention (p < .05) except from Stroop Color-Word Test (p ≥ .05). Conclusions: After systemic cognitive training, VCIND patients showed a significant improvement in visuospatial function, memory function, language function, and attention function, whereas their execution function was partially improved. Clinical Relevance: Despite the promising results, there is still a need to improve the support for patients affected by VCIND requiring rehabilitation.

在我国护理硕士专业学位研究生培养方案的指导下,结合本校院系一体化管理的优势,制订培养护理专门人才的培养目标,围绕培养目标设置课程和临床实践方案;建立团队制导师和基于临床能力的考评方法;构建了具有专科特色的护理硕士专业学位培养模式,并顺利完成在校护理专业硕士研究生的阶段培养.该培养模式符合我国护理专科化的发展需求及护理学和专业学位的特点.