目的:探讨强化二级预防管理对糖尿病视网膜病变患者遵医行为及预后的影响.方法:选取2019年1—12月到高明区人民医院就诊的糖尿病视网膜病变患者184例作为研究对象,按糖尿病视网膜病变分级分为强化管理组和一般管理组,每组各92例.一般管理组采用常规医院延续管理,强化管理组建立多学科协作三位一体的联动团队进行强化二级预防管理.干预随访2年后,比较两组患者的糖化血红蛋白、空腹血糖、餐后2 h血糖、生活质量、治疗及护理满意度、糖尿病相关年平均住院率、疾病相关知识掌握程度、治疗依从性、糖尿病视网膜病变分级各项指标有

目的:探讨荧光素钠眼底造影在老年糖尿病视网膜病变中的应用.方法:研究对象选择我院收治的120例2型糖尿病初诊患者,选择时间2021年1月-2021年6月,120例患者分别采用检眼镜检查以及荧光素钠眼底造影检查,分析荧光素钠眼底造影的表现特征,对比两种检查方法的差异性.结果:120例患者中70例为糖尿病视网膜病变,经过检眼镜检查50例患者为糖尿病视网膜病变,检出率为71.43％,经过荧光素钠眼底造影检查60例患者为糖尿病视网膜病变,检出率为85.71％,组间数据对比具有统计学意义(P ＜ 0.05),同时荧

目的 探讨白内障人工晶体(intraocular lens,IOL)植入术前术后前房深度(anterior chamber depth,ACD)的变化对术后屈光状态的影响,使植入的人工晶体度数准确.方法 随机选取2018年1月—2019年12月在医院常规行白内障手术并植入人工晶体患者500例,随机分为对照组和试验组;对照组用厂家提供的人工晶体常数计算白内障植入人工晶体度数,通过矫正度数预测误差再计算得出优化常数;试验组使用经过前房改变后优化的人工晶体常数并计算白内障术后矫正度数的预测误差,计算术前预测屈光值与术后实际屈光值差.分析两组患者术前术后前房的变化情况及术后屈光状态.结果 两组患者术前前房深度对比差异无统计学意义(P>0.05);但两组患者手术后前房深度明显高于术前,对比差异有统计学意义(P<0.05).试验组患者术后屈光完全矫正值为(0.93±0.21)D,对照组患者术后屈光完全矫正值为(0.83±0.19)D,对比差异有统计学意义(t=5.583,P=0.000).结论 使用通过前房深度改变得到的优化常数并计算白内障植入的人工晶体屈光度,对患者术后恢复正常视力有一定的提高.

目的 探讨4C随访管理在糖尿病视网膜病变(DR)患者中的应用效果.方法 选取2017年1月至2018年12月我院内分泌科收治的DR患者60例作为研究对象,按照随机数字法将其等分为对照组和观察组,对照组给予常规健康教育以及随访管理,观察组给予4C随访管理.比较两组患者治疗依从率、血糖达标率、生活质量及自我护理能力.结果 观察组患者依从率、血糖达标率明显高于对照组,差异具有统计学意义(P<0.05);观察组患者生活质量评分明显高于对照组,差异具有统计学意义(P<0.05);观察组患者自我护理能力评分明显高于对照组,差异具有统计学意义(P<0.05).结论 4C随访管理有利于提高DR患者依从率,促进血糖达标,对提高其生活质量具有重要意义,值得临床推广.

AIM:To observe and analyze the effect of non-mydriatic fundus photography in screening diabetic retinopathy(DR), so as to provide the basis for clinical screening.METHODS:In our hospital from December 2016 to November 2017, 120 patients(240 eyes)was diagnosed as diabetes(DM), which were treated as the subjects of observation. By the same operator with non-mydriatic fundus photography, fundus photography and 7 range fundus fluorescein angiography(FFA)after mydriasis were taken. Taking the international clinical classification of diabetic retinopathy(DR)as the standard, the above three examinations were review, grade and record by the same physician by blind method. The fundus fluorescein angiography as the gold standard, the other two results were compared to detect the sensitivity, specificity, Youden index, Kappa value of the two for DR with different grade.RESULTS: There was 70.0% eyes diagnosed as diabetic retinopathy after screened by fundus angiography, 66.7% by post-mydriatic fundus photography, 65.0% by non-mydriatic fundus photography. The grading results of diabetic retinopathy screened by different methods were basically consistent, with no significant difference(P>0.05). When screening for diabetic retinopathy of different degrees, the sensitivity and specificity of the non-mydriatic group were 92.9% and 90.3%, respectively. There was no significant difference between the results of the non-mydriatic group and the non-mydriatic group. Compared with the gold standard group(FFA), the Youden index(83.14%)was close to 1, with high reliability; Kappa=0.81, and the validation was consistent. When screening for moderately nonproliferative diabetic retinopathy, the sensitivity and specificity of non-mydriatic fundus photography were 90.6% and 95.5%; there was no significant difference between the results of non-mydriatic and the results of fundus photography after mydriasis. Compared to the gold standard group, the Youden index was 86.09%, the reliability is high, Kappa=0.86, and the test was consistency. CONCLUSION:Non-mydriatic fundus photography can be used as a simple and accurate method for screening diabetic retinopathy. It is simple and easy to carry out without risk. It is easy to train specialist technicians for multi-point operation. With the help of today's convenient network, the image is transmitted to an experienced ophthalmologist for reading and diagnosis, which is convenient and fast, so that the patient can be diagnosed and treated nearby, which has positive significance for the society.

目的 分析讨论对弱视患儿进行不同家庭干预后患儿依从性和治疗效果变化情况.方法 选取本院2013年11月～2015年11月弱视患儿96例为研究对象,根据入院先后将其均分为两组,每组48例.对照组使用常规治疗,观察组在上述治疗前提下进行家庭干预.比较两组患儿依从性和总有效率.结果 观察组依从性好率明显高于对照组(P<0.05);观察组依从性差率明显低于对照组(P<0.05).观察组和对照组总有效率分别为93.75％和79.17％,观察组总有效率明显高于对照组(P<0.05).结论 家庭干预能提高弱视患儿的依从性,并大大增加治疗效果,可在各大医院中推行此种干预方法.

目的 探讨全程护理干预在糖尿病视网膜病变患者中的应用价值.方法 选取2017年1月～2017年12月我院眼底荧光造影检查的100例糖尿病视网膜病变患者,采用随机数字表法将其分为对照组和研究组,每组50例.对照组予以常规护理,研究组予以全程护理干预.比较两组患者不良反应发生情况、症状自评量表SCL-90各维度评分、焦虑抑郁评分以及护理满意度.结果 研究组患者发热、呕吐、头晕、荨麻疹及总不良反应发生率显著低于对照组,差异有统计学意义(P＜0.05).研究组患者症状自评量表SCL-90各维度评分均显著低于对照组,差异有统计学意义(P＜0.05).两组患者干预前焦虑抑郁评分的比较,差异无统计学意义(P＞0.05).干预后,两组焦虑抑郁评分均显著降低,且研究组焦虑抑郁评分显著低于对照组,差异有统计学意义(P＜0.05).研究组患者护理满意度显著高于对照组,差异有统计学意义(P＜0.05).结论 全程护理干预在行眼底荧光造影检查的糖尿病视网膜病变患者中应用可显著降低患者不良反应发生率,改善患者不良情绪及生活质量,患者具有较高的满意度.

Objective To investigate the serum homocysteine (HCY), high sensitive C reactive protein (hs-CRP) and N terminal pro brain natriuretic peptide (NT-proBNP) levels in patients with chronic heart failure (CHF). Methods Seventy elderly patients with CHF were enrolled in this study from July 2015 to November 2016 in Gaoming District People's Hospital of Foshan City, Guangdong Province. Seventy cases of healthy elderly people were selected as the control group. Two groups of subjects were tested and compared the levels of HCY, hs-CRP and NT-proBNP in patients with different NYHA grades. The correlation between HCY, hs-CRP, NT-proBNP and NYHA classification were analyzed. The t test was used between the two groups, multiple groups were analyzed by ANOVA, and multiple comparisons were performed using the SNK-q test, the correlation was analyzed by bivariate Pearson linear correlation. Results The average levels of HCY, hs-CRP and NT-proBNP in the observation group was significantly higher than that in the control group, the difference was statistically significant (t=13.490, 12.428, 31.235; P < 0.05). There were significant differences in the levels of HCY, hs-CRP and NT-proBNP among patients with different grades of NYHA (F=1.245, 1.367, 26.524; P < 0.05). Further analysis shows that the NYHA grade III and IV patients’ HCY, hs-CRP and NT-proBNP were significantly higher than the average water level II patients. The differences were statistically significant (q=4.211, 4.194, 15.626, 10.401, 9.334, 37.832; P < 0.05). NYHA grade IV patients’ HCY, hs-CRP and NT-proBNP were significantly higher than the NYHA grade III patients. The differences were statistically significant (q=5.542, 5.764, 18.380; P < 0.05). Bivariate Pearson linear correlation analysis showed that the HCY, hs-CRP and NT-proBNP in the observation group were positively related to the cardiac function and NYHA classification (r=0.142, 0.643, 0.274; P < 0.05 or 0.01). Conclusion HCY, hs-CRP and NT-proBNP can be used as an important reference for clinical diagnosis and disease evaluation of elderly patients with CHF. Key words: Chronic heart failure; Diagnostic techniques and procedures; Hypersensitivity C reactive protein; N terminal pro brain natriuretic peptide; Homocysteine

目的 对比免散瞳眼底照相与散瞳后7方位眼底照相两种筛查方法 在糖尿病视网膜病变(DR)诊断中的应用价值.方法 选取120例(240眼)糖尿病并到眼科进行DR筛查的患者作为研究对象,均行免散瞳眼底照相、散瞳后7方位眼底照相及眼底荧光血管造影检查,以眼底荧光血管造影检查作为"金标准",对比两种筛查方法 诊断DR的敏感性、特异性及准确度.结果 免散瞳眼底照相诊断DR患者109眼,诊断符合率为96.25%(231/240),散瞳后7方位眼底照相诊断DR患者110眼,诊断符合率为98.33%(236/240),两种筛查方法 比较差异无统计学意义(χ2=1.977,P=0.130>0.05).免散瞳眼底照相对DR的诊断敏感性、特异性分别为94.64%(106/112)、97.66%(125/128);散瞳后7方位眼底照相的诊断敏感性、特异性分别为97.32%(109/112)、99.22%(127/128).两种筛查方法 诊断敏感性、特异性比较差异无统计学意义(χ2=1.042、1.016,P=0.249、0.311>0.05).结论 免散瞳眼底照相操作简便、诊断效能较高,是最佳的筛查DR的方法 .

目的 探究免散瞳眼底照相筛查不同分期糖尿病视网膜病变的临床意义.方法 150例(300只眼)2型糖尿病患者进行临床探究,对患者行免散瞳彩色数码眼底照相技术筛查,根据患者的不同糖尿病视网膜病变情况进行分期,按照病程情况分类统计患者的发病率;对于糖尿病视网膜病达到Ⅲ期及以上的患者行荧光素眼底血管造影术(FFA)检查,比较分析2种不同检查方式的有效情况.结果 150例(300只眼)2型糖尿病患者进行免散瞳眼底检查,检查结果显示患有不同程度视网膜病变的占31.67%(95/300).病程<1、1~、5~、10~、>20年糖尿病视网膜病变检出率分别为14.58%、17.31%、25.00%、42.16%、48.00%.免散瞳眼底照相检查和FFA检查的诊断一致性较高(P<0.05).结论 本次研究证明在进行糖尿病视网膜病变诊断筛查过程中,可以使用免散瞳眼底照相进行筛查,检测效果与FFA效果一致性较高,且操作简便,进一步为糖尿病视网膜病变的诊断与治疗提供了评价标准.

非心脏手术患者合并各类房室传导阻滞以及窦房结功能低下等心脏疾患实施外科手术的时候，经常由于手术过程中牵拉、麻醉以及手术创伤等引起心律失常，严重影响到患者的心输出量，严重者会出现心跳骤痛，威胁到患者的生命安全，特别是一些高龄患者在围手术期发生缓慢型心律失常需要给予高度重视[1]。有相关文献报道称，非心脏手术患者实施临时心脏起搏，能够显著减少手术过程中出现缓慢心律失常的概率，降低患者在围手术期发生心血管并发症的概率，增强患者对于手术和麻醉的耐受性[2]。本研究选取围手术期实施临时心脏起搏患者资料88例进行回顾性分析，患者手术之前全部存在不同程度的窦房结功能障碍或是传导异常，88例患者中≥70岁组患者40例，＜70岁组患者48例，所有患者全部通过穿刺股静脉或是锁骨下静脉途径，通过VVI方式进行起搏，比较2组患者的临床特点，现报告如下。

目的 比较小切口非超声与超声乳化白内障摘除术治疗白内障的临床疗效.方法 根据患者入院时间的顺序将符合纳入标准的80例白内障患者分为两组,每组40例,超声组采取超声乳化白内障摘除术,小切口组则行小切口非超声乳化白内障摘除术,比较两组手术前后散光度、角膜中央厚度变化、术后视力恢复及并发症发生情况.结果 术后1d两组患者散光度、角膜中央厚度较术前均明显上升,差异有统计学意义(P＜0.05).两组间手术前后不同时间点散光度、角膜中央厚度比较差异均无统计学意义(P＞0.05).小切口组术后1周、术后1个月视力＞0.05比率分别为85.0％、90.0％,较超声组的87.5％、92.5％差异无统计学意义(P＞0.05).两组角膜水肿、前房虹膜反应发生率比较差异无统计学意义(P＞0.05).结论 小切口非超声与超声乳化白内障摘除术均具有并发症少、术后视力恢复快特点.

目的:探究丹参酮ⅡA磺酸钠对慢性心力衰竭患者冠状动脉血流动力学的影响.方法:选取70例在我院治疗的慢性心力衰竭患者作为研究对象,随机分为观察组和对照组,每组35例.其中对照组给予常规药物治疗,观察组联合丹参酮ⅡA磺酸钠治疗,比较两组患者冠状动脉供血情况、心功能和临床疗效.结果:观察组冠状动脉供血情况优于对照组,两组差异明显,P<0.05;观察组的心功能明显优于对照组,且P<0.05;观察组的临床总有效率为94.3%,对照组的总有效率为77.1%,两组差异明显,P<0.05.结论:在慢性心力衰竭患者的治疗中利用丹参酮ⅡA磺酸钠能够改善患者的冠状动脉供血和心功能,提高临床治疗效果.

目的:研究丹参酮ⅡA磺酸钠对急性心肌梗死患者再灌注治疗后对心功能的影响.方法:88例急性心肌梗死患者,随机分为研究组和对照组,各44例.在对两组患者实施再灌注治疗后,给予对照组常规药物,研究组在此基础上给予丹参酮ⅡA磺酸钠,观察并比较两组患者的心功能改善情况.结果:经过治疗后,研究组患者在治疗后2d与2周的心功能的收缩和舒张改善情况均优于对照组,差异有统计学意义(P＜0.05).结论:将丹参酮ⅡA磺酸钠注射液应用于急性心肌梗死患者再灌注治疗后,可以对其心室的收缩及舒张功能起到良好的改善作用,有效地促进心肌功能的恢复,值得在临床上应用.

目的：探讨显微镜下行下泪小管断裂吻合术的方法要点及效果。方法观察28例下泪小管断裂行吻合手术患者,使用硬膜外腰麻管做泪道支撑物,术后随访3~6个月。结果全部28例患者均吻合成功,术后出现并发症5例,经处理后泪道通畅；术后3个月拔管,1例出现泪小点轻度损伤,但泪道冲洗通畅,总有效率为96.4%。结论腰麻管植入术治疗泪小管断裂以其价格便宜,容易获得,手术操作相对简单,而值得年轻医生学习掌握。