糖尿病及恶性肿瘤作为慢性多发性疾病已成为影响人类健康的两大慢性杀手,严重威胁着人类的健康.文章基于"互联网+大数据"视阈下,立足于我国肿瘤合并糖尿病患者管理现状,剖析疾病管理存在的人才紧缺、服务碎片化、内容不系统全面等问题,探讨整合"互联网+大数据"资源平台,加大人才培养,加快学科之间的融合,积极建立肿瘤与糖尿病防治数据共享平台,加快大肿瘤与糖尿病的可视化研究.同时着力提高医护人员和患者信息技术素养、建立一体化信息系统和管理实施方案,探索多元化的全程一体化的慢病教育管理模式,推进肿瘤合并糖尿病的管理模式进程,引导医护人员建立良好的慢病管理素养,为肿瘤与糖尿病慢病管理的发展做贡献.

BACKGROUND:To investigate whether lower limb vascular intervention or autologous platelet-rich gel (APG) treatment would benefit diabetic lower extremity arterial disease (LEAD) patients with foot ulcers. METHODS:A total of 82 diabetic LEAD patients with foot ulcers were recruited and divided into three groups: group A (30 patients received basal treatment), group B (21 patients received basal and APG treatment), and group C (31 patients received basal and lower limb vascular intervention treatment). All patients underwent routine follow-up visits for 6 months. The baseline characteristics and parameters were examined. After treatment, changes in all parameters from baseline were recorded. The differences between groups and the relationship among each parameter were determined. RESULTS:There were no differences in the ankle brachial index (ABI) or major amputation between groups A and B (P>0.05). Compared with groups A and B, the ABI and major amputation rate of group C were improved (P<0.05). There were no significant differences in transcutaneous oxygen partial pressure (TcPO2), the heal rate or minor amputation between groups A and C (P>0.05). Compared with groups A and C, TcPO2, the heal rate and minor amputation of group B were improved (P<0.05). The logistic regression analysis indicated that major amputation was mainly associated with the ABI, and minor amputation was mainly associated with TcPO2. Lower limb vascular intervention improves the ABI and reduces major amputation, and APG improves TcPO2 and reduces minor amputation. CONCLUSIONS:In diabetic LEAD patients with foot ulcers, major amputation was mainly associated with the ABI, while minor amputation was mainly associated with TcPO2. Interventional surgery (angioplasty) mainly improves the ABI, reduces the incidence of major amputation and improves the macrovasculature, and APG mainly improves local TcPO2, reduces the incidence of minor amputation and improves the microcirculation.

目的 研究负压封闭引流联合重组人生长激素间断保留灌洗治疗糖尿病足溃疡的临床效果.方法 将2016年11月至2017年11月西南医院内分泌科收治的40例糖尿病足溃疡患者分为对照组与试验组.对照组给予负压封闭引流联合生理盐水间断保留灌洗治疗,试验组给予负压封闭引流联合重组人生长激素间断保留灌洗治疗,比较两组的创面愈合率及愈合时间.结果 治疗后第14天和第21天,试验组的创面愈合率显著高于对照组(P＜0.05);试验组的创面愈合时间显著短于对照组(P＜0.01).结论 负压封闭引流联合重组人生长激素间断保留灌洗治疗糖尿病足溃疡能明显提高创面愈合率,缩短创面愈合时间,对改善糖尿病足溃疡患者预后有重要作用.

目的 探讨马来酸曲美布汀对2型糖尿病性腹泻患者临床疗效、肠道菌群及胃肠激素水平的影响.方法 选取我院2013年10月至2018年10月收治的62例2型糖尿病性腹泻患者为研究对象,采用随机信封法分为观察组和对照组各31例,两组均给予相同的降糖基础治疗+止泻对症治疗,观察组加用马来酸曲美布汀治疗,均治疗8周后观察两组临床疗效、胃肠激素水平及肠道菌群(肠道乳酸杆菌、肠球菌、酵母菌、双歧杆菌、肠杆菌)变化情况,并记录不良反应.结果 观察组临床疗效显著优于对照组(P<0.05).治疗前,两组空腹血糖、餐后2 h血糖、糖化血红蛋白水平,肠道菌群数量比较,差异均无统计学意义(P>0.05);治疗后,两组空腹血糖、餐后2 h血糖、糖化血红蛋白较治疗前均显著的下降,乳酸杆菌、双歧杆菌较治疗前均显著的升高,肠球菌、酵母菌、肠道菌群数量较治疗前均显著下降,差异具有统计学意义(P<0.05),且观察组空腹血糖、餐后2 h血糖、糖化血红蛋白显著低于对照组,观察组乳酸杆菌、双歧杆菌均显著高于对照组,肠球菌、酵母菌、肠杆菌均显著低于对照组,差异具有统计学意义(P<0.05).观察组治疗后SS显著高于对照组,MTL、GAS显著低于对照组(P<0.05).两组不良反应比较差异无统计学意义(P>0.05).结论 马来酸曲美布汀能够提高2型糖尿病腹泻患者血糖控制效果,改善胃肠激素水平,并改善肠道菌群紊乱.

The diabetic foot ulcer (DFU) is the leading cause of the high mortality and morbidity rates of diabetes patients, and the DFU accounts for approximately 15% of all diagnosed diabetes cases in China. Traditional treatment is typically ineffective for DFUs. Here, we present a case of DFU that was successfully treated with an autologous platelet-rich gel (APG) and in vitro amplification of bone marrow mesenchymal stem cell (BMMSC) transplantation. A 54-year-old woman initially presented with a right foot diabetic ulcer at the hospital. A wound at the lateral malleolus of the right foot was observed with exudation and infection. The standard treatment included glucose reduction with insulin, blood lipid control with atorvastatin, circulation improvement with alprostadil, anti-infection treatment with sensitive antibiotics, debridement, dressing, and continuous negative pressure suction, and after the standard treatment, the APG combined with in vitro amplification of BMMSC transplantation was used to help the healing of the ulcer. All of the above interventions may have contributed to the healing of the ulcer, and an APG combined with in vitro amplification of BMMSCs may promote DFU healing. The difficulty of DFU treatment remains a challenge, particularly in diabetic patients who develop foot ulcers, due to the complexity of its multifaceted pathogenesis. This case represents an effective adjuvant treatment for such patients.

Objective:To investigate the efficacy of Trimetazidine in 156 patients with diabetic cardiomyopathy.Methods:156 patients were randomly divided into Trimetazidine treatment group (n =81) and the control group (n =75),both received conventional medical treatment.Treatment group received further Trimetazidine treatment.Blood glucose,HbA1 C,blood lipids (total cholesterol,triglycerides,LDL,HDL),E/A ratio,ECG QT dispersion,High-sensitive C-reactive protein(HsCRP)and TNF-αwere tested before and after treatment.Results:Compared with before treatment,blood glucose,total cholesterol,triglycerides,LDL,HDL were improved significantly in both group after treatment (P ＜ 0.05);in treatment group,total cholesterol,triglycerides,LDL,HDL improved much more than control group(P ＜0.05);QT dispersion decreased compared with before treatment(P ＜ 0.05),of which treatment decreased much more tan control group (P ＜ 0.05);E/A ratio improved compared with before treatment(P ＜ 0.05),of which treatment group improved much more than control group (P ＜ 0.05);HsCRP and TNF-αdecreased compared with before treatment(P ＜ 0.05),of which HsCRP and TNF-α improvement were more obvious compared with control group (P ＜ 0.05).Conclusion:Trimetazidine can assist the treatment of diabetic cardiomyopathy.

Serum cystatin C (CysC) has been identified as a possible potential biomarker in a variety of diabetic complications, including diabetic peripheral neuropathy and peripheral artery disease. We aimed to examine the association between CysC and diabetic foot ulceration (DFU) in patients with type 2 diabetes (T2D). 411 patients with T2D were enrolled in this cross-sectional study at a university hospital. Clinical manifestations and biochemical parameters were compared between DFU group and non-DFU group. The association between serum CysC and DFU was explored by binary logistic regression analysis. The cut point of CysC for DFU was also evaluated by receiver operating characteristic (ROC) curve. The prevalence of coronary artery disease, diabetic nephropathy (DN), and DFU dramatically increased with CysC (P<0.01) in CysC quartiles. Multivariate logistic regression analysis indicated that the significant risk factors for DFU were serum CysC, coronary artery disease, hypertension, insulin use, the differences between supine and sitting TcPO2, and hypertension. ROC curve analysis revealed that the cut point of CysC for DFU was 0.735 mg/L. Serum CysC levels correlated with DFU and severity of tissue loss. Our study results indicated that serum CysC was associated with a high prevalence of DFU in Chinese T2D subjects.

Objective To observe and analyze standardized hospital diabetic foot the safety of the dressing room of the hos-pital infection management, to establish prevention and control measures. Methods Through targeted monitoring method for diabetic foot treatment room in our hospital infection management and monitoring and evaluation on the prevention and control measures. Results The diabetic foot in our dressing room staff on diabetic foot related knowledge at a rate of 71.88%, hand hygiene measures are enforced is 78.13%, disinfection isolation measures percent of pass is 75.0%, aseptic operation percent of pass is 71.88%. After the implementation of strict safety management measures, all qualified rate in-creased by 93.75%, 96.88%, 96.88% and 96.88% in turn. Conclusion Diabetic foot dressing room hospital infection pre-vention and control measures is the main link staff hand hygiene, disinfection and aseptic operation must implement in place.

Insulin resistance (IR) correlates closely with cardiovascular disease. C1q/TNF-related protein-3 (CTRP3) is a novel adipokine that modulates insulin activity in various diseases. This study investigated the relationship between CTRP3 and IR as well as systemic inflammation in newly diagnosed obese and hypertensive patients (NCT02226471).

Objective To evaluate the treatment effect of negative pressure wound therapy ( NPWT) followed by ultrasonic debridement surgical system ( UDSS) in patients with diabetic foot. Methods Forty-seven diabetic foot ulcer patients( WagnerⅡ~Ⅲ) were divided into two groups,of which 26 patients treated with UDSS combined NPWT,and 21 patients treated with traditional surgical debridement combined NPWT were control group. Cure rate, markedly effective rate and adverse reaction and complication were compared between two groups. Results Compared with control group,the experiment group had higher markedly effective rate in the first week(P<0. 05),and healing rates were higher in the 2th,4th,6th,12th weeks (P<0. 05). There were no differences in the adverse reactions and complications between the two groups. Conclusion UDSS combined with NPWT can accelerate wound cure,may play an important role for the treatment of diabetic foot ulcer.

目的护理门诊对糖尿病患者进行针对性的宣教通过院外遵医行为达到有效控制血糖的目的。方法分析患者院外未遵医行为的原因，通过评估针对性的进行个体化教育并为其设计合理的管理方案。结果护理门诊对院外持续的遵医行为起到关键作用，可有效的控制血糖。结论糖尿病由于其治疗过程漫长，大多时间需自我管理，护理门诊可帮助其良好的遵医行为，达到真正的行为改变从而有效的控制血糖。

Insulin resistance (IR) is closely correlated with cardiovascular disease (CVD). Retinol-binding protein 4 (RBP4) is a novel adipokine that modulates the action of insulin in various diseases. This study addressed the relationship between RBP4 and IR in newly diagnosed essential hypertension.

目的：探讨护患角色情景模拟法在临床护理教学中的应用效果。方法选取在我科的临床实习生112名，在临床带教中采用情景模拟教学法，模拟活动结束后发放调查表，进行分析总结及师生意见反馈。结果运用护患情景模拟教学法能增强护生的学习兴趣、实践能力、思维能力等。结论护患角色情景模拟教学法在护生临床实习带教中的应用可有效的提高临床护理教学质量。

Objective To observe the effect of ultrasonic water-jet debridement system and conventional gauze on diabetic foot ulcer treament.Metheds 62 cases of diabetic foot ulcer patients were randomly divided into two groups,the conventional treatment group and the ultrasonic scalpel treatment group.And the healing rate,the average healing time and transcutaneous oxygen pressure were observed.ResultsCompared with the conventional treatment group,the healing rate and transcutaneous oxygen pressure of ultrasonic scalpel treatment group increased significantly(P0.05),at the same time the average healing time of ultrasonic scalpel treatment group decreased significantly(P0.05).Conclusion Ultrasonic water-jet debridement system can not only improve the healing rate of diabetic foot skin ulcer but also shorten the average healing time,which may related to the improvement of transcutaneous oxygen pressure.

目的观察盐酸度洛西汀与加巴喷丁治疗糖尿病周围神经痛的疗效。方法将2010年1月至2012年4月在我院内分泌科收治住院的糖尿病周围神经痛患者100例,其中男性53例,女性47例,年龄(64.3±8.7)岁,简单随机分2组:①盐酸度洛西汀组(n=53),②加巴喷丁组(n=47),两组共治疗8周,分别于治疗前,治疗后1周、8周采用视觉模拟评分方法(visual analogue scale,VAS)及健康调查简易量表(medical outcomes study,SF-36)进行疼痛评分并记录不良反应。结果 VAS评分:度洛西汀组从治疗前的(70.3±7.8)降低至治疗后1周的(41.4±5.6)和治疗后8周的(23.5±3.2),加巴喷丁组从治疗前的(72.4±7.5)降低至治疗后1周的(45.3±6.5)和治疗后8周的(26.7±3.4);SF-36:度洛西汀组从治疗前的(74±6)降低至治疗后1周的(44±4)和治疗后8周的(27±3),加巴喷丁组从治疗前的(73±7)降低至治疗后1周的(47±5)和治疗后8周的(23±5)。经秩和检验或χ2检验,差异没有统计学意义(P>0.05)。度洛西汀组不良反应明显低于加巴喷丁组,差异有统计学意义(P<0.01)。结论度洛西汀治疗糖尿病周围神经痛疗效与加巴喷丁相当,但不良反应少。

<正>继心脑血管疾病、恶性肿瘤之后,糖尿病(diabetes mellitus,DM)已经成为第三位严重危害人民健康的慢性非传染性疾病。据调查,我国成人糖尿病患病率高达9.7%[1]。尽管世界各国高度重视糖尿病的防治工作,但即使是已经使用胰岛素的患者,血糖达标率也只有37%[2],其重要原因之一就是患者对于胰岛

<正>注射用头孢吡肟通过抑制细菌细胞壁的生物合成而达到杀菌作用,临床上常用于细菌引起的中重度感染。随着临床的广泛应用,其不良反应也日益凸显出来,主要包括神经系统不良反应、变态反应、血液系统不良反应、消化系统不良反应以及药物热[1]。我科出现1例神经系统不良反应,现将其护理体会报告如下。

<正>糖尿病是危害人们身体健康的常见疾病。患者在积极配合治疗控制血糖的同时却往往会忽略了低血糖的问题。一般情况下,当低血糖发生时,患者通常伴有心慌、冷汗、发抖、饥饿感等低血糖症状,以提醒患者自行进食含糖食物,及时进行早期处置则预后良好[1]。然而有些患者屡发低血糖后,则可表现为无先兆症状的低血糖昏迷[2]。若昏倒在公路上、楼梯口,或正在驾驶车辆、正在进行高空作业,后果更是不堪设想。为了方便患者,我科设计了糖尿病患者急救卡,现将应用体会报告如下。

目的:探讨2型糖尿病患者行胃转流术围手术期的护理方法。方法:对5例2型糖尿病行胃转流术患者,进行术前准备,做好心理护理;术后注意观察病情、血糖监测和控制、饮食护理、自理能力训练,并注重出院指导及随访。结果:本组5例术后随访提示糖尿病病情有明显好转,血糖恢复正常4例,另1例在随访中。结论:2型糖尿病行胃转流术患者围手术期护理质量的好坏直接影响到手术效果。

Objective:To explore the application of continuous blood glucose monitoring system(CGMS) to the initially diagnosed patients with type 2 diabetes mellitus and nursing points.Methods:65 patients who were admitted to hospital from January 2006 ~ December 2009 and initially diagnosed of type 2 diabetes mellitus were randomly divided into routine nursing care group(n=34) and CGMS group(n=31).The conventional blood glucose monitoring was used in the routine nursing care group and CGMS was applied in the CGMS group.The time of blood glucose reached the standard,the rate of reaching the standard,insulin dose,frequency of hypoglycemia and blood glucose value in the different period of treatment were analyzed in the two groups.Results:The time of blood glucose reached the standard was shorter,the rate of reaching the standard was higher and frequency of hypoglycemia was less in the CGMS group(P<0.05) and there was no difference in the insulin dose between the two groups.The FBG and PBG were up to the standard in 2 hours after treatment and PBG was controlled better within 2 hours in the CGMS group(P<0.05).Conclusion:The application of CGMS is conducive to the control of blood glucose of initially diagnosed patients with type 2 diabetes mellitus and it is safer.