Objective To investigate the significance of multidisciplinary treatment of brittle diabetes in elderly patients.Methods A total of 19 elderly patients with brittle diabetes who were admitted to our hospital from June 2014 to December 2016 received multidisciplinary diagnosis and treatment,including regular health education about diabetes by medical staffs to strengthen the self-management of diabetic patients;psychological counseling by psychotherapists to relieve mental stress;reasonable and individualized nutrition prescription developed by nutritionists;informing patients of precautions by clinical pharmacists after assessing the risk of drugs;individualized insulin and oral hypoglycemic drugs provided by clinical specialists by monitoring blood glucose level of patients.Results Before treatment,the mean fasting blood glucose (FPG) level and 2 h postprandial plasma glucose (2hPG) level were (9.34±1.7) mmol/L (2.6-17.1 mmol/L) and (15.9 ± 2.9) mmol/L,respectively.The mean glycosylated hemoglobin (HbA1c) level was (9.9±1.1)％.There were no hypoglycemic reaction and hypoglycemic coma occurring during hospitalization.The fluctuations of FPG and 2hPG were reduced significantly.The repeated examination results showed that the urine sugar were (±)-(+) and the urine ketone was negative.The mean length of hospital stay was 14.7 d.Two patients had hypoglycemic reaction during follow-up.After 12 weeks of treatment,the FPG,2hPG,and HbA1c levels were significantly lower than those on admission (t =3.57-6.52,P＜0.05).Conclusion Brittle diabetes in elderly patients can be prevented and controlled by multidisciplinary diagnosis and treatment.

随着年龄的增长,腰腿痛的发生率也逐年升高.引起腰腿痛的原因很多,其中椎间盘退行性病变是其发生的主要病因.从分子生物学角度探讨其发病机制,有望为延缓、修复、甚至扭转椎间盘退行性变提供可行的理论依据.本文对椎间盘退行性变与相关生物分子因素的研究进展进行综述,并据此展望其发展趋势.

目的 探讨80岁及以上老年人因跌倒导致的伤残及相关危险因素.方法 应用质性研究方法,对因跌倒造成伤害的28例高龄老年病人进行深度访谈,应用Claizzi分析程序进行分析.结果 因外在危险因素(家居环境、自然环境及社区环境中存在的危险因素)跌倒而造成伤害15例(54％),因内在危险因素(生理因素、病理因素、药物因素及心理因素)跌倒而造成伤害7例(25％),因多元化危险因素(内在危险因素和外在环境危险因素交互作用)跌倒而造成伤害4例(14％),因跌倒预防知识欠缺、观念淡薄跌倒而造成伤害2例(7％).造成的伤害以骨折(股骨、肱骨及骨盆等部位)为主,共11例(39％),其他依次为颅脑损伤4例(14％)、软组织严重损伤4例(14％)、关节脱位3例(11％)、膝关节半月板损伤2例(7％)、内脏损伤2例(7％)、视网膜脱落1例(4％)及鼓膜穿孔1例(4％).结论 高龄老年人跌倒致伤程度严重,跌倒的发生和致伤与多种因素有关,应采取综合性干预措施.

本研究收集心肌梗死合并糖尿病患者52例,给予螺内酯联合卡托普利治疗6个月,比较患者用药前后心室重构的逆转以及血浆内分泌激素水平和心脏功能变化.结果患者左室收缩末期内径、左心室收缩末期容积、左心室射血分数、肾素、血管紧张素Ⅱ与治疗前比较差异有显著性意义(P＜0.05).结论拮抗神经内分泌激素治疗对于心肌梗死合并糖尿病患者在逆转心室重构、改善心肌功能及降低血浆内分泌激素水平方面有肯定的临床效果.

Arnoid-Chiari I(ACM)多数伴有脊髓空洞(SM),对于两者的相互关系以及发病机制众说纷纭,手术方法及精细程度直接关系到手术后治疗效果.

患者女,38岁,地毯编制工.因进行性右侧肢体无力,活动不灵12d,伴低热,体温38℃左右,轻微头疼,无恶心、呕吐,以 "偏瘫原因待查"收入我院神经内科病房.患肺间质纤维化4年.2个月前因肺部感染当地医院给予多种抗生素治疗(具体药物、剂量不详)和连续泼尼松治疗,现口服泼尼松50mg,每日1次.

Objective:To observe the feature of ambulatory blood pressure monitoring (ABPM) in elderly patients with hypertension and effects of rehabilitation therapy. Methods: The noninvasive blood pressure recorder (product by England) was used to carry out 24h ABPM in 80 elderly patients with hypertension. Blood pressure(BP)readings were obtained automatically at 15min intervals at daytime and 30min intervals at nighttime. Thirty-eight aged patients with hypertension of mild-moderate grade accepted rehabilitation therapy. Results: 24h SBP and DBP, daytime SBP and DBP, nighttime SBP and DBP and blood pressure load in 80 elderly patients with hypertension were significantly higher than those of normal control (P0. 05). Each paramater values of rehabilitation group decreased significantly(P0. 05-P0. 01) after rehabilitation therapy of 8 weeks. Conclusion: The parameters of ABPM are of great importance in diagnosing, treating essential hypertension and evaluating the effect of rehabilitation therapy.

现对老年高血压病患者 24 h动态血压资料进行分析,旨在探讨老年高血压病动态血压监测特点及康复干预的意义 . 1 对象与方法 1.1 对象 80例老年高血压患者均是我院在 1996～ 2001年收治的病员,男 71例,女 9例,年龄 60～ 89岁,平均( 68.8± 7)岁 .病史 1～ 40年 .所有患者均符合 1993年 WHO/ISH高血压病的诊断标准 .入院后停用所有降血压药物 3 d,再进行 24 h动态血压监测 .

大量心脏康复的研究和文献针对无并发症心肌梗死(AMI)后病人,采用以运动疗法为主的综合康复干预,现已被医学界广泛接受.但针对老年心肌梗死患者出院后如何继续康复治疗,恢复并提高生活信心,改善体力和心理残疾,减轻家庭和社会负担,提高老年人生存质量等问题有待进一步探讨.本文旨在探讨老年陈旧性心肌梗死患者危险分层评估及其对于康复措施的指导意义.

目的: 探讨老年高血压患者动态血压监测特点、正常值及其预测意义.方法: 使用英国产MEDILOG ABP monitoring system无创伤性动态血压监测仪对80例老年高血压患者进行24 h*$动态血压监测, 包括采用固定日间和夜间时间段, 日间每15 min、夜间每30 min记录1次.包括24 h、日间和夜间收缩压及舒张压, 24 h、日间和夜间血压负荷值.结果: 80例患者24 h平均压及平均脉压等常用参数值明显高于正常参考值, 其中白大衣高血压占15%.结论: 动态血压监测参数值比随测血压能更准确预测心脑血管并发症状发生.单独诊断白大衣高血压与传统方式有高度一致性.