综述了运动疗法在糖尿病患者中的应用现状.具体内容包括糖尿病患者与医护人员对运动疗法的态度、糖尿病运动疗法的类型疗效、运动疗法对糖尿病患者的安全性.认为如何充分发挥患者的主观能动性帮助其坚持运动治疗、保证糖尿病患者自我管理质量仍是今后的研究方向.

目的 观察目视管理理论的图示法在老年患者留取24 h尿标本中的应用效果.方法 按实施图示法健康宣教前后进行分组,2017年7月期间(实施口头宣教)收治患者52例为对照组,2017年9月期间(实施图示法宣教)收治患者52例为观察组.对照组用口头讲解辅以文字提示牌进行留取24 h尿标本的宣教;观察组采用基于目视管理理论的图示法健康宣教,即制作图示指导册进行留取24 h尿标本宣教.统计患者留取24h尿标本的正确率和宣教的时间.结果 观察组患者留取24h尿标本的正确率高于对照组,留取尿标本宣教时间短于对照组,经比较,差异有统计学意义(P＜0.01).结论 基于目视管理理论的图示法有利于提高老年患者留取24 h尿标本的正确率,节约宣教的时间.

目的 探讨强化干预策略对降低糖尿病患者低血糖发生率的应用效果.方法 采用方便取样法,抽取符合纳排标准,将我科201 7年5月收治的79例糖尿病住院患者设为对照组,2017年6月收治的71例糖尿病住院患者为观察组,对照组采用常规护理模式,观察组在常规护理基础上采用强化干预策略.将两组患者住院期间及出院后1个月低血糖发生率及发生原因进行比较;将比较两组糖尿病患者自我管理行为.结果 对照组患者住院期间低血糖发生率为59.49％,出院1个月低血糖发生率为50.63％;观察组糖尿病患者低血糖发生率32.39％,出院1个月低血糖发生率为11.27％,观察组明显低于对照组,差异有统计学意义(P＜0.05);两组患者低血糖原因比较差异有统计学意义(P＜0.05);两组患者糖尿病自我管理行为差异无统计学意义.结论 强化干预策略可降低糖尿病患者低血糖的发生率.

目的 观察合并轻度认知功能损害的糖尿病患者在首次接受胰岛素注射教育时存在的困难环节,为临床上进行有效的糖尿病胰岛素笔注射教育提供理论依据.方法 选择在本院住院的合并轻度认知功能损害的糖尿病患者和无合并轻度认知功能损害的糖尿病患者各35例,按胰岛素笔注射教育内容及评价表对患者进行教育和教育效果评估.统计患者掌握胰岛素注射健康教育内容所需时间和次数,评价患者在首次教育后胰岛素笔注射操作各步骤的掌握情况.结果 合并轻度认知功能损害的糖尿病患者掌握胰岛素笔注射技术的学习时间和次数都多于无合并轻度认知功能损害的糖尿病患者;胰岛素笔注射技术的"装笔芯""摇匀""判断剩余胰岛素是否够用"等项内容合并轻度认知功能损害的糖尿病患者更不易掌握.结论 合并轻度认知功能损害的糖尿病患者掌握胰岛素笔注射技术明显困难于非合并轻度认知功能损害的患者,对合并轻度认知功能损害的糖尿病患者要采取针对性健康教育方案来提高教育效果.

自身免疫性低血糖是由于血中非外源性胰岛素诱导产生高浓度免疫活性胰岛素和高效价胰岛素自身抗体,从而引起的严重的自发性低血糖症,又名 Hirata病. 该病较为罕见,国内1985年首次报道,截至2011年11月累计报道81例[1]. 其临床特点是自发性低血糖表现,常易与其他原因引起的低血糖症混淆,易造成临床上误诊和漏诊. 本科于2016年4月收治1例自身免疫性低血糖患者,应用糖皮质激素治疗后效果显著,跟踪随访患者1年半. 现将护理体会报道如下.

Objective: Sites for subcutaneous insulin injections include the upper arms, abdomen, buttocks and outer sides of the thigh. No similar study has explored the feasibility of using the inner side of the thigh for insulin injection, since the 4mm pen needles were introduced for clinical use. This study aimed to determine whether the inner side of the thigh is suitable for insulin injection.Research design and methods: Seventy-five patients with diabetes under insulin therapy from the Inpatient Department of Endocrinology were recruited for this non-blinded, non-randomized observational study. Subcutaneous adipose layer thicknesses of the upper, middle and lower area of the inner and outer thighs of 35 patients were measured by ultrasound, distance from the skin surface to the femoral deep vessels in 20 patients was measured, and insulin was injected at the upper inner and outer sides of the thigh in 20 patients. Pain perception, bleeding or bruising, leakage at the injection sites, blood glucose changes after insulin injection, and preferred ratings of the patients were measured.Clinical trial registration: ClinicalTrials.gov NCT02307968.Results: Subcutaneous adipose layer thicknesses at both the upper inner and outer thighs were more than 4mm and the minimum distance was 10 mm. Among the 100 injections at the upper inner thigh, only three incidents of perceived pain occurred. No bleeding or bruising and leakage were observed from the inner or outer sides. Furthermore, the difference in blood glucose control between insulin injections at the inner side and outer sides was not statistically significant. Patient ratings for injections at the inner side were similar to injections at the outer side. The key limitation of this study was the small sample size of adult patients as well as the non-randomized controlled design of this study.Conclusion: The upper inner thigh might be a new option for insulin injection rotation.

Aims: The primary objective was to evaluate the impact of the smart phone-based diabetes management application, Welltang, on glycated hemoglobin (HbA1c). The second objective was to measure whether Welltang improves blood glucose, low-density lipoprotein cholesterol, weight, blood pressure, hypoglycemic events, satisfaction of patients to use Welltang, diabetes knowledge of patients, and self-care behaviors.Methods: One hundred evenly randomized subjects with diabetes, aged 18-74 years, were recruited from the outpatient Department of Endocrinology for a 3-month study. The Welltang intervention group received training for the use of Welltang, while the control group received their usual standard of care. HbA1c, blood glucose, low-density lipoprotein cholesterol, weight, blood pressure, hypoglycemic events, satisfaction of patients to useWelltang, diabetes knowledge of patients, and self-care behaviors were measured. Patient data were analyzed using independent t test and paired sample test using SPSS version 12.Results: The average decrease in HbA1c was 1.95% (21 mmol/mol) in the intervention group and 0.79% (8 mmol/mol) in the control group (P < 0.001). Measures of self-monitored blood glucose, diabetes knowledge, and self-care behaviors improved in patients in the intervention group. Eighty four percent of patients in the intervention group were satisfied with the use of Welltang. Differences in hypoglycemic events, low-density lipoprotein cholesterol, weight, and blood pressure were not statistically significant.Conclusion: Diabetes patients using the Welltang application achieved statistically significant improvements in HbA1c, blood glucose, satisfaction of patients to use of Welltang, diabetes knowledge, and self-care behaviors. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

[目的]应用持续质量改进的方法,规范护理实习生胰岛素笔的使用。[方法]对2012年6月—2013年4月内分泌病房实习的50名护理实习生进行胰岛素笔使用的调查分析,针对影响因素,2013年5月成立科室持续质量改进护理小组,通过 PDCA 循环,对实施持续质量改进后的实习生进行管理效果评估。[结果]实施持续质量改进后,评估50名实习生的胰岛素笔使用情况,规范率达92.4%；实习生对科室总体评价均为满意。[结论]持续质量改进的方法可以提高实习生胰岛素笔注射操作的规范性。

抽血检验是临床诊断的重要依据之一[1].随着医学科学技术的发展,临床新开展的特殊试验特殊抽血越来越多,对抽血时间、注意事项等要求也越来越严格.由于人体的激素分泌具有脉冲性及昼夜节律变化等特点,许多内分泌功能试验需要短时间内多次采血,采血的时间性强.当各种“温馨提示牌”应用于临床以便提醒病人时,却仍有漏抽血、不按时抽血的情况发生[2,3].本院内分泌科因病人人数多、特殊抽血多,且抽血时间不同,临床护士在实际操作中容易延误病人的采血时间,影响化验结果.因此,为了方便护士操作,按时给病人采血,保证试验结果的准确性,制作了特殊试验抽血提示单并应用于临床工作中,效果满意.现介绍如下.

甲状旁腺功能亢进症是一组由于甲状旁腺分泌过多甲状旁腺激素(PTH)而导致骨质吸收及高钙血症引起的具有特殊症状和体征的临床综合征[1]。成人血清钙的正常值为2.25 mmol/L~2.74 mmol/L,当血清钙>2.75 mmol/L 为高钙血症,>3.5mmol/L为高钙危象。高钙危象是临床少见且严重的急症之一,病情凶险,病死率高达60%[2]。2012年11月我院内分泌科收治1例甲状旁腺功能亢进致高钙危象病人,由于顽固性高钙,病人入院后又合并消化道溃疡,病情复杂凶险,经手术治疗并配合精心护理,成功挽救病人生命。现将护理总结如下。

目的探讨心理护理对2型糖尿病合并阻塞性睡眠呼吸暂停综合征(OSAHS)患者焦虑、抑郁等负性情绪的影响。方法选择2型糖尿病合并OSAHS患者68例,随机分成干预组和对照组,每组各34例,对照组进行常规护理,干预组在常规护理的基础上实施认知干预、心理支持、家庭支持、放松训练等心理干预措施。2组均采用汉密尔顿焦虑量表(HAMA)和抑郁量表(HAMD)分别在入院初和出院时进行评分,然后比较2组干预前后的分值。结果与对照组相比,干预组出院时HAMA、HAMD评定总分均显著低于入院时,比较差异有统计学意义(P<0.01)。结论 2型糖尿病合并OSAHS患者通过全面有效的心理护理,可减少患者焦虑、抑郁等负性情绪的产生,从而降低心理因素带来的不良影响。

糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)和高渗性非酮症糖尿病昏迷(byperosmolar nonketotic diabetic coma,HNDC)均为糖尿病严重的急性并发症,死亡率与年龄有关.DKA死亡率一般为2%～10%,＞65岁的老年患者超过20%,HNDC死亡率高于DKA,达10%左右,＞85岁为35%,且死亡率随渗透压增高而逐渐增高[1],二者合并出现在临床上亟少见.本病起病隐匿,常见诱因有感染、各种应激(如手术、外伤、脑血管意外等)、进食过多含糖饮料及输注高渗葡萄糖溶液、使用利尿剂等.本院内分泌科收治1例因大量输注葡萄糖后诱发DKA合并HNDC的患者,经积极治疗护理后好转出院,现将护理体会报告如下.

我院在糖尿病健康教育临床护理带教中引入循证护理的原则和方法,帮助护生掌握自我更新知识和技能的方法与技巧,提高了护生学习积极性和主动性,现报告如下.