目的 了解住院糖尿病患者的抑郁狀態，采取有效的心理干預措施提高其治療依從性。 方法 對2010年6月－2011年5月收治的450例住院糖尿病患者接受心理護理前后的抑郁自評量表（SDS）評分進行對比，并進行統計學分析。 結果 65.3%的住院糖尿病患者存在抑郁狀態，導致患者產生抑郁狀態的原因多樣。 結論 糖尿病患者易并發抑郁狀態，健康教育能減輕患者的抑郁狀態。
【摘要】 目的 老年綜合評估法篩查75歲以上2型糖尿病（type 2 diabetes mellitus，T2DM）合并老年綜合征的情況，并觀察以甘精胰島素為基礎的治療方法對老年綜合征、血糖、低血糖事件、治療滿意度等的影響。 方法 應用老年綜合評估中的日常生活能力、工具性日程生活能力、簡易智能量表、老年抑郁量表、微型營養評定法，分別評估2005年12月—2009年12月老年門診及病房住院的日常生活能力、認知功能狀態、情緒障礙和營養狀態，對其合并功能障礙、癡呆、抑郁、營養障礙、傷害性跌倒等老年綜合征的患病情況進行橫斷面調查；篩選至少合并一種老年綜合征和一個其他合并疾病，血糖控制差、預期壽命有限的患者進行以甘精胰島素為基礎的降糖治療，采用自身前后對照的方法了解對糖化血紅蛋白（hemoglobin A1c， HbA1c）、低血糖事件、治療滿意度的影響，并觀察甘精胰島素治療方案對上述老年綜合征的影響。 結果 132例老年門診及病房住院的75歲以上T2DM患者功能障礙者高達50.0%（66例），罹患包括輕度認知功能障礙在內的癡呆比例為39.4%（52例）；合并抑郁癥28.0%（37例）；營養失衡30.0%（39例）。33例患者符合甘精胰島素治療納入標準，經過2年的隨訪發現，以甘精胰島素為基礎的治療方案在適當降低HbA1c水平時，不增加老年綜合征的患病率，但可以減少胰島素多次皮下注射的次數，降低低血糖事件發生次數（由1.58次/例降為0.81次/例），提高患者治療滿意度。 結論 75歲以上T2DM患者合并老年綜合征的比例高，老年綜合評估能及時發現老年綜合征；以甘精胰島素為基礎的治療方案不增加老年綜合征的發生，并能顯著降低低血糖事件數、改善營養狀態、提高患者對治療的滿意度。【Abstract】 Objective To screen geriatric syndrome in patients older than 75 years with type 2 diabetes mellitus (T2DM) by the method of comprehensive geriatric assessment, and observe the impact of glargin-based therapy on geriatric syndrome, blood glucose level, the event of hypoglycemia and treatment satisfaction degree in patients older than 75 years with T2DM who suffered at least one kind of Geriatric syndromes. Methods From December 2005 to December 2009, activity of daily living (ADL), instrument activity of daily living (IADL), mini-mental state examination, geriatric depression scale and mini-nutritional assessment in comprehensive geriatric assessment were used to assess daily living ability, cognitive function status, emotional disorder and nutritional status of out/in-patients older than 75 years with T2DM in the Department of Geriatrics. Cross-sectional study was carried out to investigate geriatric syndromes such as combined functional disorder, dementia, depression, nutritional disorder and impairment falls in those patients, and patients with T2DM combined with at least one kind of geriatric syndrome and another kind of combined disease were screened out. A glargin-based anti-hyperglycemic therapy was carried out for those patients with poor blood glucose control limited remaining life time. The effects of this therapy on hemoglobin A1c (HbA1c), the event of hypoglycemia and treatment satisfaction degree of the patients were studied through a self-comparison method. Then, its effect on the above-mentioned geriatric syndromes was observed. Results Among all the 132 out/in patients older than 75 years with T2DM, the prevalence rates of functional disorder (including ADL and IADL), dementia including mild cognitive disorder, depression, and malnutrition were respectively 50.0% (66), 39.4% (52), 28.0% (37), and 30.0% (39). Only 33 patients met the criteria of glargin-based treatment. After 2 years of follow-up, we found that the glargin-based treatment could properly decrease the level of HbA1c without increasing the prevalence rate of geriatric syndrome. Moreover, it could reduce the frequency of insulin injection and the events of hypoglycemia, and treatment satisfaction degree was also significantly improved. Conclusions Geriatric syndrome has a relatively high prevalence rate in patients older than 75 years with T2DM. Comprehensive geriatric assessment is beneficial in finding out the geriatric syndrome, and glargin-based hypoglycemic therapy can significantly reduce the events of hypoglycemia, improve nutritional status, and increase treatment satisfaction degree without increasing the rate of geriatric syndrome .
目的探究非糖尿病患者入院時糖化血紅蛋白（HbA1c）水平與冠狀動脈旁路移植術（CABG）后血糖波動及不良事件的相關性，從而為擬行 CABG 手術的患者強化術前血糖管理提供理論支持。方法本研究連續性納入 2013 年 10 月至 2017 年 12 月于北京朝陽醫院心臟外科接受 CABG 的患者共 304 例，根據入院時 HbA1c 平均濃度高低分為高水平組和低水平組兩組，其中低水平組 139 例，男 102 例、女 37 例，年齡 36～85（61.5±9.5）歲；高水平組 165 例，男 118 例、女 47 例，年齡 34～85（63.1±9.4）歲。患者術后持續檢測 5 次，將術后 5 次血糖標準差定義為血糖波動性。其次定義術后主要不良事件包括：院內死亡、心肌梗死、胸骨切口感染、新發腦卒中、新發腎功能衰竭、新發心房顫動以及多系統衰竭。結果本研究結果提示，相對于入院前低水平組，高水平組患者術后血糖波動較為明顯［0.8（0.6，1.2）mmol/L vs. 1.0（0.8, 1.8）mmol/L，P<0.01］。本研究亦提示相對于高水平組，低水平組患者術后主要不良事件發生率明顯偏低（P=0.001）。進一步通過回歸分析矯正其他混雜因素影響，HbA1c（OR=2.773，P=0.002）及術后血糖波動（OR=3.091，P<0.001）仍可預測術后不良事件的發生。結論本研究初步提示入院 HbA1c 可有效預測 CABG 患者術后 24 h 血糖波動，其次入院 HbA1c 及術后血糖波動可進一步預測術后不良事件的發生。這提示我們將患者術前 HbA1c 控制在較低水平，有利于控制術后血糖波動及術后不良事件的發生。