目的:探討老老年患者頸動脈中層厚度(IMT)及其相關危險因素的關系,為老老年患者心腦血管疾病的預防及治療提供臨床參考。方法:根據年齡將139例老老年患者納入分析,有血糖、血壓、血脂代謝紊亂的123例作為觀察組,無血糖、血壓、血脂代謝紊亂的16例作為對照組,分別進行頸動脈超聲檢查、動態血壓監測、糖化血紅蛋白及血脂等生化指標檢查,并結合臨床資料進行分析。結果: 老老年患者均無一例外地存在著IMT增厚,在相同的年齡情況下,吸煙史、血脂紊亂、糖調節異常、血管炎癥反應與IMT的增厚呈正相關,各組未顯示出統計學差異,IMT的發生發展與年齡、性別、吸煙史、血糖、血壓控制水平及血脂紊亂等因素在兩組對照中均未顯示出統計學差異,多因素Logistic回歸分析,顯示年齡、吸煙史及病程為危險因素(OR為0500～1196)。結論:老老年患者均不同程度地存在著IMT增厚,其中增齡是其最主要的危險因素,但是對合并有血糖、血壓、血脂代謝紊亂的老老年患者也應該積極重視對各種危險因素的篩選和干預,特別在疾病發生發展的早期可能對延緩病變的進展和減少心腦血管事件有一定意義,可是其用藥的安全性在該類患者就顯得尤為重要。
By reviewing the current status of chronic pain and combining with the new definition of pain revised by the International Association for the Study of Pain in 2020, firstly a prevention-based approach, self-management of pain, and multidisciplinary collaboration based on the integration of bio-psycho-social-environmental factors is proposed. The medical mode will greatly improve the treatment effect of chronic pain and the quality of life of patients. Secondly, the importance of strengthening humanistic care and paying attention to health education, as well as improving medical staff’s awareness of chronic pain and the level of diagnosis and treatment are pointed out. Finally, it is clarified that innovative non-drug treatments and the establishment of digital pain management platforms are the future of chronic pain.
【摘要】 目的 探討2型糖尿病（T2DM）胰島素抵抗導致糖尿病性心功能不全的臨床表現特點及相關激素的改變。 方法 2008年1-4月對T2DM患者35例（胰島素抵抗指數HOMA-IRlt;2.69者19例為A1組，HOMA-IR≥2.69者16例為A2組）及健康體檢者20人B組測體重指數（BMI）、空腹血糖（FPG）、胰島素、心鈉素（ANP）、腦鈉素（BNP）水平；心臟彩色多普勒超聲分別測E/A、e/a、S/D、LVEF、DT期。 結果 A2組BMI較A1、B組均明顯增加（Plt;0.05），A1、B組間差異無統計學意義（Pgt;0.05）。ANP、BNP及DT值在A1、A2組均較B組增高（Plt;0.05），BNP在A2組高于A1組（Plt;0.05），ANP、DT值在A1、A2組間差異均無統計學意義（Pgt;0.05）。E/A、e/a和S/D在A1、A2組均較B組降低（Plt;0.05），A1、A2組間差異均無統計學意義（Pgt;0.05）。A2組患者LVEF較A1、B組均明顯降低（Plt;0.05），A1、B組間差異無統計學意義（Pgt;0.05）。 結論 隨著胰島素抵抗加重，心肌舒張順應性較差和收縮力下降，伴隨相關激素（心臟利鈉肽）分泌增加，最終產生心功能不全的臨床表現、體征及多普勒超聲心動圖表現。【Abstract】 Objective To investigate the clinical features and related hormone changes of diabetic cardiac insufficiency leaded by insulin resistance in type 2 diabetes mellitus (T2DM). Methods From January to April 2008, 35 patients with T2DM (group A1: HOMA-IRlt;2.69, n=19; group A2: HOMA-IR≥ 2.69, n=16) and 20 subjects without T2DM (group B) were enrolled. The body mass index (BMI), fasting plasma glucose (FPG), insulin (FINS), atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and E/A, e/a, S/D, LVEF and DT stage of all subjects were detected. Results The BMI in group A2 was higher than those in group A1 and group B (Plt;0.05), while the difference between the later two groups was not statistically significant (Pgt;0.05). The ANP, BNP and DT stage were all higher than those in group B (Plt;0.05), the BNP was higher in group A2 than in group A1 (Plt;0.05), while the difference of neither ANP nor DT stage between the later two groups was statistically significant (Pgt;0.05). The values of E/A, e/a and S/D in group A1 and A2 were all lower than those in group B (Plt;0.05), while there were no statistically significant diferences between group A1 and A2 (Pgt;0.05). The values of LVEF of group A1 and A2 were both significantly reduced than that in group B (Plt;0.05), and the values in group A2 were the lowest (Plt;0.05). Conclusion With the aggravating of insulin resistance, myocardial contractility and diastolic function will decline, meanwhile the ANP and BNP secretion will increase, and then the clinical and echocardiographic manifestation will appear.