预混胰岛素方案和三加一联合强化治疗2型糖尿病的疗效探究

目的:分析预混胰岛素方案和三加一联合强化降糖方案治疗2型糖尿病对血糖波动水平及血糖达标时间的影响。方法:选取我院收治的2型糖尿病患者120例,随机分为观察组和对照组各60例。对照组给予早、晚餐前皮下注射门冬胰岛素50治疗,观察组给予三餐前皮下注射赖脯胰岛素联合睡前皮下注射甘精胰岛素治疗。比较两组胰岛素用量、血糖达标时间、低血糖发生率以及血糖达标两天后血糖水平标准差(SDBG)、变异系数(CV)、四分位血糖波动范围(IQR)、餐后血糖波动幅度(PPGE)等血糖波动指标。结果:治疗后观察组胰岛素用量、血糖达标时间明显低于对照组(P<0.05),两组低血糖发生率比较无明显差异(P>0.05);与治疗前相比两组血糖达标2d后的SDBG、IQR、PPGE明显降低(P<0.05),CV明显升高(P<0.05);血糖达标2d后,观察组血清SDBG、CV、IQR及PPGE水平明显低于对照组(P<0.05)。结论:与预混胰岛素方案相比,三加一联合强化降糖方案对2型糖尿病患者血糖波动的控制效果更好,且血糖达标时间相对较短,低血糖发生率相对较低,值得在临床上推广。

2型糖尿病血糖波动水平与脂蛋白a和血尿酸的关系

目的:研究2型糖尿病患者血糖波动水平与脂蛋白a和血尿酸水平的关系。方法:以50例2型糖尿病伴蛋白尿患者作为观察组,50例2型糖尿病尿微量蛋白阴性患者作为对照组。测定并记录患者一般临床资料、血液生化指标;评估患者血糖浓度波动。分析血糖波动与脂蛋白a和血尿酸水平的关系。结果:两组平均病程、餐后2小时血糖(2hPG)、三酰甘油、总胆固醇、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血尿酸、脂蛋白a和尿微量白蛋白(U-mALB)水平差异均有统计学意义(均P <0. 01);观察组平均血糖波动幅度(MAGE)、最大血糖波动幅度(LAGE)、血糖水平标准差(SDBG)、平均餐后血糖波动幅度(MPPGE)均显著高于对照组(P <0. 01); U-mALB与脂蛋白α和血尿酸呈显著正相关(r分别为0. 886,0. 943,均P <0. 05),总胆固醇、MAGE与脂蛋白a呈独立正相关(r分别为0. 560,0. 965,均P <0. 05),SDBG和MAGE与血尿酸呈独立正相关(r分别为0. 641,0. 495,均P <0. 05)。结论:2型糖尿病血糖波动水平可影响脂蛋白a的表达和血尿酸的水平。

Therapeutic effect of premixed insulin regimen and triple plus one combined therapy on type 2 diabetes

Objective:To analyze the level of blood glucose fluctuation and the time of blood glucose reaching the standard in the treatment of type 2 diabetes mellitus with premixed insulin regimen and three plus one intensive hypoglycemic regimen.Methods:A total of 120 patients with type 2 diabetes who were admitted to our hospital from April 2017 to April 2018 were divided into observation group and control group according to random number method,with 60 cases in each group.Patients in the control group were given insulin asparagus injection before breakfast and dinner,while patients in the observation group were given insulin Laipu injection before three meals combined with insulin glargine injection before bedtime.The insulin dosage,blood glucose compliance time,SDBG,CV,and quartile blood glucose fluctuation range were compared between the two groups.IQR,PPGE and other indicators of blood glucose fluctuations.Results:After treatment,the insulin dosage and blood glucose compliance time of the observation group were significantly lower than those of the control group(P<0.05).There was no significant difference in the incidence of hypoglycemia between the two groups(P>0.05).The SDBG,IQR,and PPGE of the day were significantly lower(P<0.05),and the CV was significantly higher(P<0.05).After two days of blood glucose compliance,the serum levels of SDBG,CV,IQR,and PPGE were significantly lower in the observation group than those in the control group(P<0.05).Conclusions:Compared with the premixed insulin regimen,the three plus one intensive hypoglycemic regimen has a better effect on controlling blood sugar fluctuation in type 2 diabetes mellitus,and the time for blood sugar to reach the standard is relatively short,and also the incidence of hypoglycemia is relatively low.Hence,it is worth popularizing in clinical practice.

互动式头针疗法对偏瘫肩痛的影响

目的:观察互动式头针对偏瘫肩痛的治疗效果。方法:选取我院康复科2014年12月~2015年12月诊治的脑卒中后偏瘫肩痛患者60例,随机分为观察组和对照组各30例。观察组采用互动式头针(头针与作业疗法互动),对照组采用传统头针结合作业疗法,1个月为1个疗程,共观察3个疗程。选用简明Mc Gill疼痛问卷(short-form of MPQ,SF-MPQ)评定患者肩部疼痛程度;采用改良Bathel指数(modified Bathel index,MBI)进行日常生活活动能力评定;采用运动功能测试量表(Wolf motor function test,WMFT)评定上肢运动功能改善情况。结果:两组SF-MPQ评分均明显低于治疗前(P<0.05),且观察组SF-MPQ评分明显低于对照组(P<0.05);治疗后1个月、2个月、3个月,两组WMFT评分明显高于治疗前(P<0.05);观察组治疗后3个月评分明显高于对照组(P<0.05);两组MBI指数评分均明显高于治疗前(P<0.05),且观察组MBI指数评分明显高于对照组(P<0.05)。结论:互动式头针疗法可以显著改善偏瘫肩痛患者的疼痛,且能显著提高患者的上肢运动功能,值得在临床上进一步研究及推广使用。