糖尿病人动态血糖监测的原理和意义探析

糖尿病人血糖监测是综合治疗的重要内容和流程之一,对病情诊断分析、治疗方案确认有重要的作用.本文从糖尿病人动态监测的原理出发,探析了动态监测的重要意义.     

新生儿低血糖的风险评估及护理对策

目的 探讨新生儿发生低血糖的风险因素,以期指导护理干预.方法 118例NICU住院的新生儿出生后0h、6h、12h、24h及48h分别进行足跟微量血糖监测.结果 118例新生儿中,低血糖23例,低血糖发生率为19.5%.胎龄<37周,出生体重<2500g,剖宫产的新生儿低血糖发生的风险较大(P<0.05),而低血糖多发生于出生后0～6h.结论 加强对新生儿的血糖监测和临床护理干预,是防治新生儿低血糖症的有效措施.     

糖尿病患者心理状态与血糖水平的相关性分析及对策

目的:研究糖尿病患者心理状态与其空腹血糖的相关性,寻找心理干预辅助治疗糖尿病的方法.方法:对186例门诊病人作空腹血糖化验,抽血后采用综合性医院焦虑抑郁量表(HAD)作焦虑抑郁水平调查,统计分析二者的相关性.结果:186例糖尿病患者中抑郁及(或)焦虑症患病率39.2%,HAD分段与患者血糖呈正相关.结论:糖尿病患者存在心理健康问题,二者互为因果,因此在给予患者药物治疗的同时,要重视和加强心理护理.     

健康教育在2型糖尿病患者中的应用及效果

目的 探讨健康教育在2型糖尿病患者中的应用并评价其实施效果.方法 对本科收治的120例2型糖尿病患者采用多媒体授课、互动提问、个体指导有计划地实施糖尿病知识、技能的教育,对饮食指导、运动治疗、自我血糖监测、胰岛素的应用及并发症的防治进行教育,比较实施前后患者对糖尿病知识的了解情况、空腹血糖和餐后血糖.结果 实施健康教育提高了患者对糖尿病知识的了解,降低了空腹血糖和餐后血糖,延缓了并发症的发生(p＜0.05).结论 健康教育对2型糖尿病患者控制血糖、提高生活质量起着重要的作用.     

利用CORBA技术在线监测轧钢厂电气设备

分析了目前电气设备状态监测的问题,提出了利用CORBA技术构架多功能分布式设备在线监测与故障诊断系统的方案,实现了快速信号和慢速信号等多信号量的统一监测,并提供查询、分析和统计等功能。     

电痉挛治疗对血糖影响的临床研究

目的:了解电痉挛治疗对血糖的影响.方法:对32例电痉挛治疗的患者采用RT-200C Plus全自动生化分析仪监测治疗前及治疗后血糖并对照分析结果.结果:治疗前血糖(4.75±0.51)mmol/L,治疗后血糖(4.77±0.49)mmol/L;治疗前后血糖差异无统计学意义(P>0.05).结论:电痉挛治疗对血糖影响的差异无统计学意义.     

基于理性推理的观点演化模型

针对现实生活中个体观点形成中的理性推理过程,提出了一种基于DS(Dempster-Shafer)证据理论的观点更新规则,并在连续观点离散决策的框架下,对个体如何利用其他个体的意见和相关知识来形成自身意见的过程进行建模.实验仿真结果表明,群体中能够出现观点一致、分散等常见的舆论现象,观点演化过程中伴随着知识由确定性个体向不确定性个体的扩散,同时发现在规则网络中,意见领袖的观点的影响力在扩散过程中是逐渐减弱的,其影响范围与个体对知识不确定性的接受程度密切相关.     

工程建设远程自动化监测系统的研究

随着国家工程建设的飞速发展,相关的安全监测也日益受到重视。传统的监测耗费人力,且无法实现实时掌握基础工程建设安全状况。通过在具体基础工程中埋设相应的监测传感器,并结合数据采集模块、系统软件和远程通信技术,组成远程自动化监测系统,可以有效实现远程操控,解决实时、连续、自动监测、非接触、节省人力等问题。因此,远程自动化监测是工程建设安全监测的发展趋势。     

胰岛素对初发2型糖尿病的疗效及影响

目的:观察胰岛素对初发2型糖尿病的疗效及不良反应,以及对血糖的影响.方法:选择2008年1月至2010年1月在我院住院的T2DM患者为观察对象.120例初发2型糖尿病患者随机分为治疗组和对照组各60例,治疗3个月后,观察治疗的疗效及对血糖控制情况.结果:治疗组的疗效优于对照组,且治疗组血糖控制效果明显优于对照组,差异有统计学意义(P＜0.05).结论:胰岛素对初发2型糖尿病疗效确切,更好地降低T2DM血糖水平,值得基层医院广泛推广和应用.     

大型高压电机智能监测与健康管理

本文阐述通过引进振动在线信号分析,绕组局放在线监测,两种技术结合,实现高压电机机械传动部件及绕组状态监测,这些数据分析评估,实现高压电机健康管理,降低电机运维成本,避免突发事故。     

Frequency of silent ischemic heart disease in patients with diabetes mellitus

Early detection of silent ischaemia plays an important role in prevention of sudden cardiac death and acute myocardial infarction. More frequent occurrence of silent ischaemia in patients with diabetes mellitus and manifestations of ischaemic heart disease has been relayed in several studies. No studies aimed at frequency of occurrence of silent ischaemia in diabetic patients without clinical symptoms of ischaemic heart disease have been performed yet. Objectives of this study were the examination of the latter case. This study involved 67 patients with diabetes mellitus without clinical symptoms of ischaemic heart disease. The average duration time of diabetes mellitus was 11 years. The patients were divided in two groups. The first group included 26 patients with insulin dependent diabetes mellitus. The second group included 41 patients with non insulin dependent diabetes mellitus. The first control group consisted of 35 non diabetic patients with ischaemic heart disease, and the second control group consisted of 22 healthy volunteers. 24-hours ambulatory Holter monitoring and ECG exercise test were performed in all subjects. The diagnosis of silent ischaemia was established in patients with positive results of both examinations in ECG-records without any following pain. In case of only one positive results the dipyridamole stress echocardiography test with ECG was carried out to prove the diagnosis. It was proved, that silent ischaemia occurs in 19.2% of patients with insulin dependent diabetes mellitus and in 22% non insulin diabetic patients. No statistic differences between frequency of silent ischaemia occurrence in both groups were revealed. The application of 24-hours Holter monitoring combined with ECG-exercise stress test seems to be the best method in early recognition of silent ischaemia in diabetic patients.     

Costs of intensive insulin therapy in type 1 diabetes mellitus. Experiences from the DCCT study

Diabetes mellitus is one of the most common metabolic diseases in many countries of the world. Its prevalence in Germany has increased 7- to 8-fold over the past 30 years. The clinical and economical importance of diabetes is determined by the frequent occurrences of such serious complications as neuropathy, retinopathy and nephropathy. Intensive insulin therapy with regular monitoring of blood glucose (up to 4 measurements daily) and adjustment of the insulin dose accordingly may achieve virtually normal levels of blood glucose and thus decrease the risk of these complications. The present cost-effectiveness-study shows that the higher costs of invasive insulin therapy are offset by savings of 8.114 German marks per patient resulting from the reduction in morbidity and mortality. On the basis of an estimated 5% to 10% type 1 diabetes among the total diabetic population (prevalence 4.9%), potential saving of 1.62 to 3.24 billion marks are calculated for Germany.     

Effect of octreotide pretreatment on surgical outcome in acromegaly

Pretreatment with octreotide (OCT) in acromegaly has been reported to improve surgical outcome. The objective of this study was to analyze retrospectively the effects of a 3- to 6-month presurgical treatment with OCT in acromegalics focusing on electrocardiographic (ECG) records, blood pressure levels, glucose and lipid profile, tumor size and consistency, easy tumor removal at surgery, and morphological findings at pathology. Fifty-nine patients with acromegaly who were undergoing surgical treatment were studied randomly before surgery; 37 patients were untreated, and 22 were treated with OCT at doses ranging 150-600 micrograms/day for 3-6 months. At study entry, untreated and OCT-treated patients had similar circulating GH and insulin-like growth factor I (IGF-I), glucose, and cholesterol levels as well as prevalence of overt diabetes mellitus, hypertension, and ECG abnormalities. In untreated and OCT-treated patients, respectively, radiological imaging documented microadenoma in 0 and 1, intrasellar macroadenoma in 10 and 6, intra- and suprasellar macroadenoma in 18 and 11, invasive macroadenoma in 9 and 4 patients. Before surgery, serum GH and IGF-I levels significantly decreased in the 22 OCT-treated acromegalics, and in 5 of them, a significant shrinkage was documented. ECG abnormalities disappeared in 7 of 11 (63.6%) OCT-treated patients. In 3 of the 7 patients with diabetes mellitus, treatment with OCT together with low carbohydrate intake normalized blood glucose levels, whereas in 2 patients, insulin could be replaced by oral antidiabetics, and in 2 patients, the insulin dose was reduced. Presurgical blood glucose, total cholesterol and triglyceride levels, as well as systolic (145.2 +/- 3.4 vs. 132.9 +/- 2.5 mm Hg; P < 0.01) and diastolic (94.3 +/- 1.7 vs. 84.3 +/- 1.6 mm Hg; P < 0.001) blood pressure levels were significantly higher in untreated than in OCT-treated patients. Two weeks after surgery, circulating GH and IGF-I levels were normalized in 11 untreated (29.7%) and 12 OCT-treated (54.5%) patients (P < 0.005, by chi 2 test). Macroscopically, no difference was found between untreated and OCT-treated adenomas, whereas at pathology, a significant increases in cellular atypia (31.6% vs. 19.2%; P < 0.05) was found in OCT-treated adenomas. One patients in the untreated group died from cardiorespiratory arrest during the early postoperative period. Finally, the average duration of hospitalization after operation was longer in untreated than in OCT-treated patients (8.6 +/- 0.7 vs. 5.6 +/- 0.5 days). We conclude that a 3- to 6-month treatment with OCT before surgery for GH-secreting adenoma improved clinical conditions and surgical outcome and reduced the duration of hospitalization after operation.     

Assessing hypertension management: the role of 24-hour blood pressure monitoring

BACKGROUND: The first fully automatic portable invasive blood pressure recorder was developed 30 years ago. Today, portable noninvasive ambulatory blood pressure devices are capable of measuring blood pressure intermittently for periods of 24 to 48 hours. OBJECTIVE: To discuss the utility of automatic ambulatory blood pressure recording in assessing antihypertensive therapy. SUMMARY: Ambulatory blood pressure monitoring is helpful in assessing the pharmacodynamics and the clinical efficacy of antihypertensive drugs. It is superior to office blood pressure measurement in predicting hypertensive end-organ disease. In clinical trials, ambulatory blood pressure monitoring permits a more varied population to enter a study, the number of subjects required is often reduced, and a placebo control group may be unnecessary. CONCLUSIONS: The various methods of analyzing ambulatory blood pressure data should be used in a complementary fashion to evaluate antihypertensive drug therapy. We believe that this technique will soon become much more commonly used for hypertension management.     

Current zinc intake and risk of diabetes and coronary artery disease and factors associated with insulin resistance in rural and urban populations of North India

OBJECTIVE: To determine the association between current zinc intake and prevalence of coronary artery disease (CAD) and diabetes as well as factors associated with insulin resistance. DESIGN, SUBJECTS AND METHODS: In this cross sectional survey, 3575 subjects, aged 25 to 64 years, including 1769 rural (894 men. 875 women) and 1806 urban (904 men, 902 women) subjects were studied. The survey methods included questionnaires for 7-day food intake record, physical examination, and electrocardiography using World Health Organization criteria. RESULTS: The prevalence of CAD, diabetes and glucose intolerance was significantly higher among subjects consuming lower intakes of dietary zinc. There was a higher prevalence of hypertension, hypertriglyceridemia and low high-density lipoprotein cholesterol levels which showed significant upward trend with lower zinc intakes. Serum lipoprotein (a) and 2-hour plasma insulin levels also were associated with low zinc intake. Multivariate logistic regression analysis after adjustment for age showed that zinc intake and CAD were inversely associated. Serum zinc (odds ratio:men 0.77, women 0.57), serum triglycerides (men 0.86, women 0.81), blood pressure (0.83 men, women 0.76), diabetes mellitus (men 0.90, women 0.85), central obesity (men 0.88, women 0.87), glucose intolerance (men 0.66, women 0.57) and low high-density lipoprotein cholesterol (men 0.72, women 0.70) were significant risk factors for CAD (explained by tertiles of zinc status) in urban subjects. These associations were not observed in rural subjects. CONCLUSION: Lower consumption of dietary zinc and low serum zinc levels were associated with an increased prevalence of CAD and diabetes and several of their associated risk factors including hypertension, hypertriglyceridemia and other factors suggestive of mild insulin resistance in urban subjects.     

Heart rate variability as an assessment of acute rejection after heart transplantation

BACKGROUND: Orthotopic heart transplantation is currently a widely accepted treatment for end-stage heart disease. Early detection and adequate therapy of acute rejection increases the survival rate. Currently, the most reliable technique for the detection of acute cardiac rejection (ACR) is endomyocardial biopsy (EMB), which is an invasive procedure with some intrinsic problems. The purpose of this study was to assess heart rate variability (HRV) as a noninvasive procedure for frequent monitoring of ACR. METHODS: Six consecutive orthotopic cardiac transplant recipients were prospectively recruited into this study. The follow-up periods ranged from seven to 359 days (median; 146 days). A precordial electrocardiograph (ECG) of 288 seconds was recorded at 5:00 PM before the patient underwent EMB. The results from the frequency domain analysis of the ECG signals were evaluated to correlate with the findings from EMB. RESULTS: Of 48 EMBs, 42 (87.5%) showed no evidence of rejection, four showed mild focal ACR (EMB grade 1A), one mild diffuse ACR (1B) and one moderate plurifocal ACR (3A). There was no moderate focal ACR (2), severe diffuse ACR (3B) or severe ACR (4). Correlation between ACR (3A) and a significant increase in HRV with a corresponding 'broad-band' or bell-shaped pattern on the power spectrum was noted. CONCLUSIONS: Our study in consecutive cardiac transplant recipients indicates that the changes in HRV provide clinicians with a new concept for heart transplant monitoring. Further study is needed to verify clinical utility.     

New approaches to resolving diagnostic problems in patients with angina pectoris

Several new noninvasive techniques are now available to evaluate the patient with chest pain to determine if myocardial ischemia is present. Continuous ambulatory ECG monitoring can detect myocardial ischemia in some patients who have normal ECG responses to graded exercise tests. Defects in myocardial perfusion can be visualized by radionuclide imaging at rest and after exercise. Also, abnormal left ventricular wall motion due to myocardial ischemia can be detected by gated blood pool scanning at the same time. Other techniques can olso be valuable in evaluating wall motion. Standard M-mode echocardiography can detect anteroseptal and posteroinferior wall motion abnormalities with remarkable anatomic detail, and newer echo techniques are promising for delineating the motion of other parts of the left ventricle. Finally, abnormal contractile areas can be assessed by videotracking the fluoroscopic cardiac silhouette and by a new noninvasive technique, the displacement cardiograph, which does not involve radiation exposure. Although none of these tests are both highly sensitive and highly specific for myocardial ischemia, their combined application in a symptomatic patient may provide considerable useful information which will help to determine who should be subjected to the risk and expense of coronary arteriography.     

QT dispersion may be a useful adjunct for detection of myocardial infarction in the chest pain center

BACKGROUND: QT dispersion has been proposed as a noninvasive measurement of the degree of inhomogeneity in myocardial repolarization. Increased QT dispersion has been reported after myocardial infarction. We hypothesized that increased QT dispersion may be a useful adjunct for risk stratification in patients being evaluated in a chest pain center. METHODS AND RESULTS: Patients were admitted to the chest pain center for evaluation of chest pain. Exclusion criteria included (1) systolic blood pressure <90 mm Hg, (2) ischemia or infarction on the initial electrocardiograph (ECG), (3) elevated creatine kinase or MB fraction, and (4) chest pain associated with cocaine use. Serial creatine kinase and MB levels and ECGs were obtained at 0, 6, and 9 hours. Patients were monitored for (1) creatine kinase and MB rise, (2) ECG changes for infarction, (3) ST-segment changes, and (4) rest angina. A negative evaluation at the chest pain center led to an exercise stress test. Patients with a positive exercise stress test were admitted for further evaluation and patients with a negative exercise stress test result were discharged home. Patients were divided into 3 groups. Group 1 consisted of patients who were found to have an acute myocardial infarction (AMI), group 2 consisted of patients with prior history of coronary artery disease but no evidence of AMI, and group 3 consisted of patients without prior coronary artery disease or AMI. QT dispersion was measured on the initial ECG in all patients. A total of 586 patients were evaluated. Group 1 consisted of 13 patients with mean QT dispersion of 44.6+/-18.5 ms, group 2 consisted of 267 patients with a mean QT dispersion of 10.0+/-13.8 ms, and group 3 consisted of 303 patients with a mean QT dispersion of 10.5+/-10.0 ms. Analysis of variance showed a significantly higher QT dispersion in patients who had AMI compared with other patients with chest pain (P< .001). CONCLUSIONS: QT dispersion can be a useful diagnostic adjunct for detection of AMI in patients with chest pain with a normal ECG and normal cardiac enzymes.     

Glucose measurement in patients with diabetes mellitus with dermal interstitial fluid

Although measurement of capillary blood glucose remains the standard method of self-monitoring for persons with diabetes mellitus, a less-invasive method of monitoring would be desirable. Measurement of dermal interstitial fluid glucose might meet this need. To test this possibility, plasma glucose, capillary blood glucose (current standard), and dermal interstitial fluid glucose were measured in 17 subjects with type I diabetes during a 5-hour pre- and postprandial period when plasma glucose was changing rapidly. The objective was to assess the ability of dermal interstitial fluid glucose to accurately predict plasma glucose over a wide range of potential glucose concentrations. Dermal interstitial fluid glucose was highly correlated with plasma glucose (r = 0.95, p < 0.0001). The mean absolute and percent differences between dermal interstitial fluid glucose and plasma glucose were 1.2 mmol/L (21 mg/dl) and 10.6%, respectively. The kinetics of dermal interstitial fluid glucose and plasma glucose were similar. There was no significant difference between dermal interstitial fluid glucose and plasma glucose in mean glucose excursion, peak glucose concentration, or time to peak glucose concentration. The correlation between dermal interstitial fluid glucose and plasma glucose was as strong as the correlation between capillary blood glucose and plasma glucose. In conclusion, dermal interstitial fluid glucose can be used to estimate plasma glucose, and has the potential to be used for monitoring patients with diabetes mellitus.     

T wave alternans as a predictor of recurrent ventricular tachyarrhythmias in ICD recipients: prospective comparison with conventional risk markers

INTRODUCTION: The current standard for arrhythmic risk stratification is electrophysiologic (EP) testing, which, due to its invasive nature, is limited to patients already known to be at high risk. A number of noninvasive tests, such as determination of left ventricular ejection fraction (LVEF) or heart rate variability, have been evaluated as additional risk stratifiers. Microvolt T wave alternans (TWA) is a promising new risk marker. Prospective evaluation of noninvasive risk markers in low- or moderate-risk populations requires studies involving very large numbers of patients, and in such studies, documentation of the occurrence of ventricular tachyarrhythmias is difficult. In the present study, we identified a high-risk population, recipients of an implantable cardioverter defibrillator (ICD), and prospectively compared microvolt TWA with invasive EP testing and other risk markers with respect to their ability to predict recurrence of ventricular tachyarrhythmias as documented by ICD electrograms. METHODS AND RESULTS: Ninety-five patients with a history of ventricular tachyarrhythmias undergoing implantation of an ICD underwent EP testing, assessment of TWA, as well as determination of LVEF, baroreflex sensitivity, signal-averaged ECG, analysis of 24-hour Holter monitoring, and QT dispersion from the 12-lead surface ECG. The endpoint of the study was first appropriate ICD therapy for electrogram-documented ventricular fibrillation or tachycardia during follow-up. Kaplan-Meier survival analysis revealed that TWA (P < 0.006) and LVEF (P < 0.04) were the only significant univariate risk stratifiers. EP testing was not statistically significant (P < 0.2). Multivariate Cox regression analysis revealed that TWA was the only statistically significant independent risk factor. CONCLUSIONS: Measurement of microvolt TWA compared favorably with both invasive EP testing and other currently used noninvasive risk assessment methods in predicting recurrence of ventricular tachyarrhythmias in ICD recipients. This study suggests that TWA might also be a powerful tool for risk stratification in low- or moderate-risk patients, and needs to be prospectively evaluated in such populations.