?retinopathy

retinopathy發(fā)音

英：[ret?'n?p?θ?]　　美：[?retn'?p?θi:]

英：　　美：

retinopathy中文意思翻譯

視網(wǎng)膜病

retinopathy詞形變化

名詞復(fù)數(shù): retinopathies | 形容詞: retinopathic |

retinopathy常見例句

1 、In your lecture, you emphasize that the general changes in hypertensive retinopathy is more important than the topical or localized changes, why?───您在報(bào)告中強(qiáng)調(diào),彌漫性的高血壓視網(wǎng)膜病變比局限性改變各更有意義,為什么?

2 、PDR(proliferative diabetic retinopathy)───增殖性糖尿病視網(wǎng)膜病變

3 、Recent TCM Treatment of Central Serous Retinopathy───中心性漿液性脈絡(luò)膜視網(wǎng)膜病變的中醫(yī)治療近況

4 、Anti-angiogenesis has been one of the important strategies in treating tumor metastasis,diabetic retinopathy,rheumatic arthritis etc.───抗血管生成已經(jīng)成為**轉(zhuǎn)移、糖尿病視網(wǎng)膜病變、風(fēng)濕性關(guān)節(jié)炎等疾病的重要策略之一。

5 、Anti-angiogenesis has been one of the important strategies in treating tumor metastasis, diabetic retinopathy, rheumatic arthritis etc.───摘要抗血管生成已經(jīng)成為**轉(zhuǎn)移、糖尿病視網(wǎng)膜病變、風(fēng)濕性關(guān)節(jié)炎等疾病的重要策略之一。

6 、toxemic retinopathy of pregnancy───子癇性視網(wǎng)膜炎, 妊娠毒血癥視網(wǎng)膜病

7 、malignant hypertensive retinopathy───惡性高血壓性視網(wǎng)膜病

8 、To further inestigate, the researchers examined the association between seere hypoglycemia and smoking in 537 subjects in the Wisconsin Epidemiologic Study of Diabetic Retinopathy who took part in the last examination phase (2000 to 2001).───為了進(jìn)一步研究，研究者們檢測了從2000到2001參，與威斯康辛州糖尿病性視網(wǎng)膜病流行病學(xué)研究最后階段的537受試者嚴(yán)重低血糖和吸煙的關(guān)聯(lián)。

9 、We found that perinatal reasons, particularly retinopathy of prematurity, are increasing in every age group.───在時(shí)間軸或各年齡層間，產(chǎn)褥期因素尤其是早產(chǎn)兒視網(wǎng)膜病變都有增加的趨勢。

10 、Conclusions: There were no ophthalmologist in Matsu before our study, and it revealed the prevalence of diabetic retinopathy was relatively high among self reported diabetics.───在危險(xiǎn)因子之分析上，我們發(fā)現(xiàn)糖尿病患病期及偏遠(yuǎn)居住地（東引及莒光）和糖尿病視網(wǎng)膜病變之盛行率有明顯的相關(guān)性。

11 、proliferative retinopathy photocoagulation───增殖性視網(wǎng)膜病光凝固法

12 、Methods: We compared the degree of retinopathy with the degree of gestosis, the degree of hypertension, and the fetal death rate respectively.───方法:比較妊高征的嚴(yán)重程度與視網(wǎng)膜病變程度的關(guān)系,和高血壓與視網(wǎng)膜病變的關(guān)系,以及胎嬰死亡率與視網(wǎng)膜病變嚴(yán)重程度的關(guān)系。

13 、proliferative sickle(cell)retinopathy───增生性鐮狀(細(xì)胞性)視網(wǎng)膜病

14 、Objective To explore the influence of psychology intervention on quality of life of the patients with proliferative diabetic retinopathy (PDR) in hospital.───摘要目的探討心理干預(yù)對(duì)增殖型糖尿病性視網(wǎng)膜病變患者住院期間視功能相關(guān)生存質(zhì)量的影響。

15 、The herb has also shown promise in lessening the effects of diabetic retinopathy, a degenerative eye disease that affects people with diabetes.───山桑子對(duì)于因糖尿病而引致視覺衰退的視網(wǎng)膜病亦非常有效。

16 、Nevertheless, prolonged duration of diabetes, especially when complicated with retinopathy may contribute to sensorineural hearing impairment.───但當(dāng)其病期較長及合并有并發(fā)癥，如視網(wǎng)膜病變時(shí)，其聽力有明顯下降的趨勢。

17 、In DR group, plasma tHcy was significantly higher in proliferative diabetic retinopathy(PDR) group than that in background diabetic retinopathy(BDR) group(t=2.405,P=0.031).───在DR組 ,增殖性視網(wǎng)膜病變 (PDR)亞組總Hcy水平顯著高于背景性視網(wǎng)膜病變 (BDR)亞組 (t=2 4 0 5 ,P =0 0 31)。

18 、proliferative diabetic retinopathy───增殖型糖尿病視網(wǎng)膜病(變), 糖尿病增生性視網(wǎng)膜病

19 、Clinical observation of radiation retinopathy───放射性視網(wǎng)膜病變的臨床觀察

20 、Methods:The changes in fundus of 120 patients with PHS had been examined,the relationships of retinopathy with edema,proteinuria,Endothelin and the course of PHS patients were analyzed.───方法:對(duì)120例妊高征患者進(jìn)行眼底檢查,將眼底檢查的情況與患者的水腫、蛋白尿、血漿內(nèi)皮素和病程進(jìn)行分析。

21 、After making allowances for various stroke risk factors-- such as blood pressure, insulin treatment and cholesterol levels-- having diabetic retinopathy more than doubled the likelihood of having a stroke.───與引起中風(fēng)的各種危險(xiǎn)因素（血壓、島素治療及血脂）比，患糖尿病性視網(wǎng)膜病使中風(fēng)的可能性高出一倍多。

22 、Methods The inquiry of quality of life and memorial university of newfoudland scale of happiness(MUNSH) were used to evaluatethe quality of life and happiness of 62 cases with diabetic retinopathy.───方法采用生活質(zhì)量調(diào)查量表和紐芬蘭紀(jì)念大學(xué)幸福度量表對(duì)62例糖尿病性視網(wǎng)膜病變患者進(jìn)行調(diào)查,并選取30例無明顯軀體疾病和眼部疾病的同齡老年人做為對(duì)照組進(jìn)行比較分析。

23 、Engorgement and torturosity of retinal vessels were also noted.These retinal vascular changes have a striking similarity to the vascular lesions of retinopathy of prematurity.───其視網(wǎng)膜血管的變化與早產(chǎn)兒視網(wǎng)膜病變的血管變化非常相似。

24 、Fifteen eyes had BSVA worse than 0.05, nine eyes had BSVA better than 0.05, the retina could not be reattached and needed to be reoperated in two cases, 1 eye developed proliferative vitreous retinopathy (PVR), two cases developed cataract.───2例（2眼）術(shù)后視網(wǎng)膜脫離未能復(fù)位需再次手術(shù)，1例（1眼）發(fā)生增生性玻璃體視網(wǎng)膜病變，2例（2眼）發(fā)生白內(nèi)障。

25 、In Europe, it is used as an anti-haemorrhagic agent in the treatment of eye diseases including diabetic retinopathy.───它已證明，以加強(qiáng)釋放胰島素的胰腺和增加胰島素受體。

26 、To investigate ultrastructural pathological change of photoreceptors in early diabetic retinopathy (DR) in rats,and to furnish the morphological evidence of visual dysfunction in DR.───探討糖尿病大鼠視網(wǎng)膜病變（diabetic retinopathy.DR.簡稱糖網(wǎng)?。?早期視細(xì)胞（視感受器）的超微結(jié)構(gòu)病變,為糖網(wǎng)病光感受器功能障礙提供形態(tài)學(xué)依據(jù)。

27 、Inconsistent findings relating to the association of SMBG with cardiac death and retinopathy may be due to confounding, incomplete coariate adjustment or chance.───SMBG與增加心源性死亡及降低視網(wǎng)膜病變的不一致，可能是由混雜因素，不完全的協(xié)調(diào)變異調(diào)整或偶然性造成的。

28 、AIDS with background retinopathy───AIDS伴背景性視網(wǎng)膜病

29 、Objective To study the effect of vitrectomy on proliferative diabetic retinopathy (PDR).───摘要目的觀察分析玻璃體切除術(shù)治療增生型糖尿病視網(wǎng)膜病變(PDR)的效果。

30 、traumatic proliferative retinopathy───外傷性增殖性視網(wǎng)膜病

31 、Background.Proliferative diabetic retinopathy (PDR) is one of the most prevalent causes of blindness in developed countries.───摘要背景：增殖性糖尿病視網(wǎng)膜病變?yōu)橐验_發(fā)國家病人視力喪失主要原因之一。

32 、proliferative vitreous retinopathy───增殖性玻璃體視網(wǎng)膜病變

33 、preproliferative diabetic retinopathy───增殖前期糖尿病性視網(wǎng)膜病變, 增殖前糖尿病性視網(wǎng)膜病

34 、TA can reduce the BRB permeability of diabetic retinopathy can be that TA increase the expression of retinal occludin.───TA降低糖尿病大鼠BRB通透性的作用可能與其增加occludin的表達(dá)有關(guān)。

35 、Purtscher's angiopathic retinopathy───[醫(yī)] 普爾夏氏[外傷]血管性視網(wǎng)膜病, 普爾夏氏病

36 、primary hypertensive retinopathy───原發(fā)性高血壓性視網(wǎng)膜病

37 、Objective: To study the syndrome and signs Character of diabetic retinopathy(DR) and its epiology and its clinic syndrome-differentiation.───摘要目的：研究糖尿病視網(wǎng)膜病變的中醫(yī)證候特點(diǎn)、主要病機(jī)。

38 、Congenital stationary night blindness (CSNB) is a group of genetically heterogeneous retinopathy with characterized clinical and visual electrophysiological abnormality.───先天性靜止性夜盲(CSNB)是一組具有不同遺傳方式的視網(wǎng)膜病變,具有特征性的臨床和視覺電生理表現(xiàn)。

39 、Diabetic Retinopathy with Cataract Treated by Krypton Yellow Laser Panretinal Photocoagulation[J].───引用該論文 馬自勤,張亞麗,郭建慧.

40 、The results of laser photocoagulation for proliferative diabetic retinopathy on 200 eyes during the past four years are presented.───摘要本篇以過去四年氬氣雷射治療200只增殖性糖尿病視網(wǎng)膜癥患眼之結(jié)果提出報(bào)告。

41 、However,the DD genotype and D allele had higher frequency in NIDDM with retinopathy than without.───DD 型與D 等位基因在DR（ ＋ ） 組出現(xiàn)頻率高，DR（ ＋ ） 組與DR（ － ） 組相比，基因型及等位基因分布差異具顯著性。

42 、Objective: To discuss the relativity on the time of therapy by using oxygen and the retinopathy of prematurity.───摘要目的：探討氧療時(shí)間與早產(chǎn)兒視網(wǎng)膜病變的相關(guān)性。

43 、The effect of nonproliferative diabetic retinopathy (NPDR) is better proliferative diabetic retinopathy (PDR).───單純型糖尿病性視網(wǎng)膜病變的療效優(yōu)于增殖型糖尿病性視網(wǎng)膜病變；

44 、Usually about 2 percent of people above 50 will have a stroke, but we found about 5 to 6 percent of people who had retinopathy had a dtroke wihin six or seven years.───年齡在50以上的人中通常約2%會(huì)發(fā)生中風(fēng)，但我們發(fā)現(xiàn)，有視網(wǎng)膜病變的人中約5至6%的人在六到七年中發(fā)生了中風(fēng)?！?/p>

45 、There was a linear positive correlation between TCSS grading of neuropathy and the grading of diabetic nephropathy and diabetic retinopathy(P───TCSS神經(jīng)病變分級(jí)與糖尿病腎病、糖尿病視網(wǎng)膜病變的分期呈線性正相關(guān)（P

46 、Objective To investigate the therapeutic effect of viteoretinal surgery for proliferative diabetic retinopathy (PDR).───摘要目的探討玻璃體視網(wǎng)膜手術(shù)對(duì)增生性糖尿病視網(wǎng)膜病變的治療效果。

47 、Hammes PH,Ali SS.Aminoguanidine does not inhibit the initial phase of diabetic retinopathy in rats[J].───張細(xì)之,王燕,余楊桂.實(shí)驗(yàn)性糖尿病視網(wǎng)膜病變動(dòng)物模型研究近況[J].中國實(shí)用眼科雜志,1999;

48 、Objective o determine the effect of lens status upon the anatomic and visual results in primary vitrectomy of proliferative diabetic retinopathy.───摘要目的探討不同晶狀體狀態(tài)對(duì)增殖性糖尿病視網(wǎng)膜病變手術(shù)療效的影響。

49 、The overall prevalence of diabetic retinopathy was 41.1%.───整體的盛行率是41.1%。

50 、And we see that a lot in cases of central serous retinopathy.─── 在中心性漿液性脈絡(luò)膜視網(wǎng)膜病變中 經(jīng)常會(huì)看到這種癥狀

51 、In its earliest stages, retinopathy often has no oert symptoms but can progress oer time to a phase in which the blood essels of the eye leak and rupture easily, eentually causing blindness.───在疾病早期，視網(wǎng)膜病沒有明顯的癥狀，但是隨著時(shí)間的推移能進(jìn)展到一個(gè)階段：眼血管滲漏斷裂，甚至致盲。

52 、The diabetic retinopathy is retinal change that develops secondary to hypoxic retinal environment.It may be helpful to supply oxygen to improve the hypoxic condition.───摘要糖尿病視網(wǎng)膜病變是因視網(wǎng)膜缺氧而產(chǎn)生的變化，如果供給充分的氧氣，可能對(duì)缺氧狀況能有所改善。

53 、Near the end of last year, I was diagnosed with severe, proliferative diabetic retinopathy.───在去年年底，由于糖尿病我被診斷出患有嚴(yán)重的長期視網(wǎng)膜炎癥；

54 、Ophthalmology referrals were offered to 6.2% of patients.The photographs classified all patients with macular edema detected by biomicroscopy as having vision-threatening retinopathy.───對(duì)6.2%的患者進(jìn)行眼科治療，視網(wǎng)膜成像將所有活體顯微鏡檢查，顯示黃斑水腫的患者，都判定為有視力損害的視網(wǎng)膜病變。

55 、Pregnancy was found to be among the major risk factors for the worsening of retinopathy.───妊娠被認(rèn)為是糖尿病性視網(wǎng)膜病變惡化的一個(gè)主要危險(xiǎn)因素。

56 、This is concentrated in the study of diabetic retinopathy in stem cell therapy targets a specific application of biotechnology examples.───情況就是這樣，為生物技術(shù)集中于特定目標(biāo)的應(yīng)用干細(xì)胞研究中，用于治療糖尿病性視網(wǎng)膜病變。

57 、Objective To observe the characteristics of fundus images and fluorescin angiography (FFA) in diabetic retinopathy (DR) combined with retinal vein occlusion (RVO).───摘要目的分析糖尿病視網(wǎng)膜病變(DR)合并視網(wǎng)膜靜脈阻塞(RVO)的眼底特征和熒光素眼底血管造影(FFA)的圖像特征。

58 、proliferating diabetic retinopathy───增殖性糖尿病性視網(wǎng)膜病

59 、Keywords Kerman capsule;Diabetic retinopathy;───可明膠囊;糖尿病性視網(wǎng)膜病變;

60 、Patz A. Macular edema an over looked complication of diabetic retinopathy[J].Trans Am Acad Ophthalmol Otolaryngo 1973;77:34.───吳京,劉業(yè)滋,付瑞.早期糖尿病患者糖尿病視網(wǎng)膜病變發(fā)病率調(diào)查分析[J].中國實(shí)用眼科雜志1999;17(2):96-97.

61 、It plays an important role in diabetic retinopathy,age-related macular degeneration,the CNV,neovascular eye diseases caused by ischemia and hypoxia.───在糖尿病視網(wǎng)膜病變、老年性黃斑變性、CNV、缺血缺氧引起的眼部新生血管疾病中扮演著重要的角色。

62 、There is a series of remodeling of retinal neuronal and glial cells in the process of retinopathy.───在視網(wǎng)膜病變過程中會(huì)出現(xiàn)一系列神經(jīng)元和神經(jīng)膠質(zhì)細(xì)胞的重塑改變。

63 、As a non-invasive method for measurement of retinal blood flow, HRF has important value in revealing the mechanism and degree of pathological changes and choice of treatment for diabetic retinopathy.───HRF作為非侵入性的血流測量技術(shù)，對(duì)于揭示病變的機(jī)制、病變的程度及治療的選擇具有重要的價(jià)值。

64 、Objective To observe the effect of posterior vitrectomy combined with phacoemulsification and IOL implantation for proliferative diabetic retinopathy.───摘要目的觀察后部玻璃體切除聯(lián)合超聲乳化及人工晶狀體植入術(shù)（簡稱“后三聯(lián)手術(shù)”）治療糖尿病性視網(wǎng)膜病變的療效。

65 、Positive rate of rose Bengal staining the positive rate in proliferating diabetic retinopathy group was higher significantly than non-proliferating diabetic retinopathy group and the control ?48% vs 24% and 14%? P < 0.05? P < 0.01?.───孟加拉玫瑰紅染色**率:增殖性糖尿病視網(wǎng)膜病變組**率顯著高于非增殖性糖尿病視網(wǎng)膜病變組和對(duì)照組(48%比24%和14%,P

66 、Central serous angiospastic retinopathy───中心性漿液性脈絡(luò)膜視網(wǎng)膜病變

67 、Method NO content in blood of the patients with diabetics(NDR) and diabetic retinopathy(DR) were detected while normal people served as control group.───方法檢測糖尿病無視網(wǎng)膜病人（NDR）、糖尿病視網(wǎng)膜變病人（DR）及正常人血中NO的含量,進(jìn)行對(duì)比分析。

68 、Abstract : bjective To observe the therapeutic effect of laser photocoagulation on diabetic retinopathy (DR)at different stages.───摘要 ： 目的 觀察視網(wǎng)膜激光光凝治療不同分期糖尿病視網(wǎng)膜病變（DR）患者的療效。

69 、Daily urinary albumin excretion, the presence of retinopathy, and intima-media thickness (IMT) of the carotid artery were also evaluated.───另外，還檢測了他們每天的尿白蛋白量、是否患視網(wǎng)膜病，以及頸動(dòng)脈內(nèi)膜-中層厚度（IMT）。

70 、With color Doppler flow imaging(CDFI), blood flow parameters of central retinal artery (CRA)and central retinal vein (CRV) were assessed for 105 normal persons and 42 diabetic retinopathy patients (DRP).───利用彩色多普勒測定105例正常人與42例糖尿病性視網(wǎng)膜病變（DRP）視網(wǎng)膜中央動(dòng)、靜脈（CRA、CRV）血流參數(shù)，計(jì)算其比值來研究CRA，CRV血流動(dòng)力學(xué)相互關(guān)系。

71 、To analyze the risk factors of no light perception (NLP) after vitreoretinal surgery for proliferative diabetic retinopathy (PDR).───分析增生型糖尿病視網(wǎng)膜病變(PDR)患者玻璃體視網(wǎng)膜手術(shù)后無光感的危險(xiǎn)因素。

72 、The authors reviewed the application of Fundus fluorescein angiography to the diagnosis,stage,evaluation of progress and treatment effect in diabetic retinopathy.───作者綜述了熒光素眼底血管造影在糖尿病視網(wǎng)膜病變診斷、分期、病情及療效判定中的應(yīng)用。

73 、Flesh Electroretinogram of Proliferative Diabetic Retinopathy after Panretinal Photocoagulation[J].───引用該論文 鐘凌,李樺,陳平,劉徽南.

74 、But the dia betic retinopathy screening is far from adequate. The importance of diabetic ret inopathy screening is not addressed.───但是目前在中國對(duì)糖尿病視網(wǎng)膜病變的篩選還遠(yuǎn)遠(yuǎn)不夠。

75 、Previous studies have shown that effective treatments for diabetic retinopathy can reduce severe vision loss by up to 94 percent.───以前的研究指出糖網(wǎng)早期治療可以降低超過94%的嚴(yán)重視力損害。

76 、Objective Compare islet membrane dissection technology and common procedure of peeling the proliferative memebrane in vitrectomy for proliferative diabetic retinopathy (PDR).───摘要目的研究增生性糖尿病視網(wǎng)膜病變(PDR)有嚴(yán)重纖維血管膜者進(jìn)行島狀除膜及傳統(tǒng)撕膜兩種手術(shù)的臨床效果。

77 、In corresponding studies of candesartan therapy in subjects with both type 1 and type 2 diabetes who had retinopathy at baseline, the drug failed to mitigate retinopathy progression.───在相應(yīng)的1型和2型糖尿病視網(wǎng)膜病變坎地沙坦治療研究中，該藥物卻不能減輕視網(wǎng)膜病變的進(jìn)展。

78 、Proliferative diabetic retinopathy(PDR)───增殖性視網(wǎng)膜病變

79 、Objective: To investigate the expression of CD105 in oxygen-induced retinopathy (OIR) in C57BL/6J mice.───摘要目的：通過高氧誘導(dǎo)C57BL/6J小鼠視網(wǎng)膜新生血管動(dòng)物模型，觀察CD105在視網(wǎng)膜新生血管中的表達(dá)。

80 、The nonproliferative diabetic retinopathy (NPDR) effective treatment,is the key of prevention proliferative diabetic retinopathy(PDR), regarding reduces blinding rate especially is important.───單純型DR的有效治療，是預(yù)防增殖型DR的關(guān)鍵，對(duì)于降低致盲率尤為重要。

81 、In a separate study, researchers identified a predictie relationship between small pupil size in adolescents with type 1 diabetes and the presence of microalbuminuria and retinopathy 12 years later.───另一項(xiàng)研究中，研究人員鑒定1型糖尿病青少年小瞳孔大小同12年后微白蛋白尿及視網(wǎng)膜病之間的關(guān)系。

糖尿病護(hù)理論文寫作3篇

老年糖尿病患者的自我管理能力研究進(jìn)展

摘要:糖尿病隨著近年來生活水平的不斷提高，糖尿病的患者幾乎成為了中國患者的主流。而糖尿病的危害也在日趨嚴(yán)重，它可能會(huì)導(dǎo)致以酮癥酸中毒為代表的急性并發(fā)癥和慢性并發(fā)癥，包括整個(gè)視網(wǎng)膜的病變和神經(jīng)病變，有血管病變引起的下肢截癱等嚴(yán)重后遺癥。本文從糖尿病的病因切入，了解糖尿病的爆發(fā)原因以及臨床癥狀，社會(huì)發(fā)展糖尿病的分類的具體化，不同類型的不同表現(xiàn)與原因。普及糖尿病臨床的治療方法與注意事項(xiàng)，更是強(qiáng)調(diào)糖尿病患者自我護(hù)理的重要性，對(duì)此，我們對(duì)于糖尿病未來的預(yù)防和治療，要更加的努力鉆研。

關(guān)鍵詞:糖尿病自我管理、糖尿病分類、防治方式、未來展望

Abstract: With the continuous improvement of living standards in recent years, diabetes patients have almost become the mainstream of Chinese patients. The harm of diabetes is becoming more and more serious. It may lead to acute complications and chronic complications such as ketoacidosis, including retinopathy and neuropathy, paraplegia caused by vascular diseases and other serious sequelae. This article starts from the etiology of diabetes, to understand the causes of the outbreak of diabetes and clinical symptoms, the classification of social development diabetes, different types of different manifestations and causes. To popularize the clinical treatment methods and precautions of diabetes, we should emphasize the importance of self-care of diabetes patients. For this, we should make more efforts to study the prevention and treatment of diabetes in the future.

Key words: diabetes self-management; diabetes classification; prevention and treatment; future prospect

目錄

1糖尿病病因以及患病比率.....................3

2.11型糖尿病....................................4

2.22型糖尿病...................................5

2.2.1遺傳易感性....................................5

2.2.2胰島素抵抗（IR)和B細(xì)胞的功能缺陷.............5

2.2.3糖耐量降低(TGP)和空腹血糖.....................5

2.2.4臨床糖尿病....................................6

2.3妊娠糖尿病等等...............................6

3非科學(xué)性糖尿病自我管理的列舉和糾正..........7

3.1認(rèn)識(shí)錯(cuò)誤.....................................7

3.2飲食問題.....................................7

3.3 運(yùn)動(dòng)問題.....................................8

3.4 心理健康.....................................8

4糖尿病自我管理的重要性和展望.................9

5糖尿病自我管理不當(dāng)對(duì)老年人的生活響..........10

老年人是指步入65歲之后的群體，不同于青壯年時(shí)期的身姿矯健，老年人在身體的各個(gè)部分都出現(xiàn)了難以逆轉(zhuǎn)的損傷，生理機(jī)能逐漸退化，列如消化系統(tǒng)和代謝功能的衰退。由于老年人身體素質(zhì)的羸弱，增大了老年人患病的幾率，尤其是在老年人群體中高發(fā)病率的糖尿病患病率首當(dāng)其沖，每年患糖尿病的老人人數(shù)占老年人總?cè)丝跀?shù)量的26%，且這個(gè)數(shù)據(jù)近幾年不斷上漲，更加醒目的數(shù)據(jù)是每年大約有近130萬老年人由于糖尿病去世。

隨著老年人生活質(zhì)量的提高和運(yùn)動(dòng)量的減弱，糖尿病的患病率[1]不可小覷，況且糖尿病對(duì)不少的老人造成了極大的身心痛苦，也對(duì)這些家庭有著不小的經(jīng)濟(jì)負(fù)擔(dān)。然而糖尿病此類慢**，一蹴而就的治療方式并不存在，它更大程度上要求老年人的自律和自我健康管控，需要長此以往的進(jìn)行與糖尿病的斗爭。

一、糖尿病病因以及患病比率

糖尿病是一種以高血糖為主要特征的代謝性疾病群，由于胰島素的分泌絕對(duì)不足或者相對(duì)不足，引起的機(jī)體血糖升高的一系列代謝性疾病?；加刑悄虿≈缶哂幸恍┑湫吞卣?多尿、多飲、多食與體重減輕之類，這些方法是判斷老年人是否患糖尿病的一個(gè)參考方法。準(zhǔn)確的檢驗(yàn)和判斷老年人是否換糖尿病的方法有三種，第一種是連續(xù)檢測兩次老年人空腹靜脈血糖，觀察是否大于等于7.0mmol,第二種是觀察老年人餐后血糖大于等于11.1mmol / l ,最后一種是老年人血糖不論任何時(shí)候都大于等于11.1mmol / l 。老年人一旦出現(xiàn)以上三種檢測結(jié)果，應(yīng)立即就醫(yī)，謹(jǐn)遵醫(yī)囑，做到及早發(fā)現(xiàn)及早治療。同時(shí)，胰島素是從胰島素原分解的，每當(dāng)一個(gè)胰島素分子產(chǎn)出，同時(shí)一分子的C-肽也應(yīng)運(yùn)而生。C-肽能夠檢測自身胰島素分泌的情況，對(duì)鑒別不同類型的糖尿病有極大的幫助。

根據(jù)世界衛(wèi)生組織的相關(guān)報(bào)告，2019年全世界約有3.82億人口患有糖尿病，其中中國糖尿病患者的人數(shù)就有1.144億，位居世界糖尿病患者人數(shù)之最。2008年我國的成人中糖尿病患者占據(jù)了9.7%，2010年上升至11.6%，多么觸目驚心的證據(jù)，而且糖尿病患者的人數(shù)仍然日趨增長，基于此數(shù)據(jù)，有眾多學(xué)者預(yù)測2030年，全球糖尿病患者將高達(dá)5.784億，2045年繼續(xù)上漲，最有可能達(dá)到7.002億,這是一個(gè)怎樣的概念呢？就2019年的數(shù)據(jù)計(jì)算大約11人中有1 人為糖尿病患者，而就2030年數(shù)據(jù)計(jì)算大概每9 人中將有1名患有糖尿病。2045年呢？長此以往糖尿病的可怕性不言而喻。而我們更應(yīng)該清楚的知道糖尿病作為一種慢性疾病，治療的難纏的會(huì)對(duì)患者家庭造成多大的經(jīng)濟(jì)困擾，會(huì)有越來越多的人和家庭由于糖尿病這個(gè)惡魔漸入困頓，甚至于分崩離析。糖尿病除去其自身病因的侵?jǐn)_，不可忽略的是它多樣的并發(fā)癥，涉及之廣小到糖尿病神經(jīng)病變，大到心血管疾病等等，無法徹底根治。據(jù)現(xiàn)有資料分析、可得出結(jié)論，糖尿病患者中最終會(huì)由于各種原因，約15%的糖尿病患者將患發(fā)糖尿病足病，在這其中約80%的糖尿病足病患者可能由于此病導(dǎo)致截肢，而且糖尿病患者下肢截肢的危險(xiǎn)性是非糖尿病患者的15倍以上[2]杜絕此類病情的主要方法就是本遍論文的研究重點(diǎn)和意義即糖尿病的全面認(rèn)識(shí)和自我管理方式方法。

二、糖尿病的分類

糖尿病是腎上腺素分泌不足的一類統(tǒng)稱。實(shí)際上糖尿病的分類可以大概分為三類。

(一)1型糖尿病

該類型的病因是由于胰島B 細(xì)胞的破壞或者功能不完善造成的胰島素分泌不足，從而產(chǎn)生的糖尿病酮癥酸中毒。1型糖尿病是由于機(jī)體胰島素分泌的絕對(duì)不足，所以治療1型胰島素口服藥物完全無效，只能通過終生注射胰島素來對(duì)人體進(jìn)行胰島素的補(bǔ)充。對(duì)1型胰島素二次分類存在自身免疫性與特發(fā)性，而自身免疫性糖尿病又因?yàn)榘l(fā)病時(shí)間的遲早分為急發(fā)性和緩發(fā)型。急發(fā)性糖尿病通常在青少年期就已見端倪，易發(fā)生糖尿病酮癥酸中毒。緩發(fā)型又稱成人晚發(fā)型自身免疫性糖尿病，通常在20-48歲之間發(fā)病。

(二)2型糖尿病

2型糖尿病是糖尿病分類中發(fā)病率最高的糖尿病類型，高達(dá)95%的發(fā)病率。其發(fā)病基礎(chǔ)具有明顯遺傳基礎(chǔ)、胰島素抵抗和B 細(xì)胞分泌異常。但究其病因主要可以從遺傳、飲食不當(dāng)造成的身體負(fù)荷加重、運(yùn)動(dòng)量過少、生活壓力過大，過量飲酒分析，該類型糖尿病發(fā)病階段分為四個(gè)階段[3]：

①遺傳易感性:在遺傳特性的基礎(chǔ)下，它更多的發(fā)病誘因是環(huán)境因素?？梢詮娜丝诶淆g化，人體肥胖癥、運(yùn)動(dòng)量減少、壓力驟增等等因素入手，迫使糖尿病的遺傳基因進(jìn)行激活。

②胰島素抵抗( IR ) 和B 細(xì)胞的功能缺陷

胰島素抵抗和胰島素分泌不足是一個(gè)長此以往的誘因，作為2型糖尿病病發(fā)的兩個(gè)主要因素，它們在糖尿病病發(fā)之前已經(jīng)潛伏多年，尋找機(jī)會(huì)伺機(jī)而動(dòng)。

③糖耐量降低( TGP )和空腹血糖調(diào)解受損( IFG )

一般 TGP 更多的是糖尿病前期的表現(xiàn)，具體為葡萄糖不受耐的類型之一；IFG 是一類非糖尿病性空腹高血糖，通過其血糖濃度高于正常值，但低于糖尿病的判斷值。這兩者均代表了正常葡萄糖穩(wěn)態(tài)和糖尿病的高血糖之間的代謝狀態(tài)，表明其調(diào)解受損。

④臨床糖尿病

在該階段糖尿病對(duì)機(jī)體的侵蝕速度加快，但由于各自機(jī)體情況不同，有的機(jī)體無明顯的癥狀，有的或伴隨出現(xiàn)代謝紊亂癥侯群，還有甚著出現(xiàn)糖尿病的并發(fā)癥。此期，胰島分泌功能漸漸敗下陣來，分泌功能降低，胰島素抵抗能力加強(qiáng)，外周組織器官列如脂肪組織、肌肉組織對(duì)胰島素的敏感性有著明顯的降低，葡萄糖攝入利用量不足，胰島素對(duì)肝臟葡萄糖輸出抑制減弱，葡萄糖外輸情況嚴(yán)重，從而引起餐后血糖升高，及空腹、餐后持續(xù)高血糖。嚴(yán)重時(shí)或出現(xiàn)胰島B細(xì)胞功能衰竭，基礎(chǔ)胰島素分泌不足患酮癥[4]。

（三）、妊娠糖尿病等等

此類糖尿病的發(fā)病期集中在妊娠期，孕期控制飲食、適當(dāng)運(yùn)動(dòng)即可避免[5]，即使此類糖尿病在分娩期之后就會(huì)恢復(fù)，但存在22%-50%的孕婦會(huì)發(fā)展成2型糖尿病，且當(dāng)孕婦再次妊娠時(shí)有50%的可能性復(fù)發(fā)[5]。妊娠糖尿病的另一方面不得不強(qiáng)調(diào)說明，孕婦在孕期如若血糖控制不良，極有可能使得孩子患有糖尿病、肥胖癥等代謝綜合征[6]。

三、非科學(xué)性糖尿病自我管理的列舉和糾正

糖尿病的自我管理必須依從于一個(gè)科學(xué)合理的防治計(jì)劃，合理的計(jì)劃將在糖尿病的防治行動(dòng)中事半功倍，但一個(gè)不合理的自我管理必將使患者墜入深淵，加重病情，導(dǎo)致糖尿病的并發(fā)癥發(fā)生[7]。因此，對(duì)糖尿病自我管理的誤區(qū)進(jìn)行整理，并加以指導(dǎo)和糾正，能大大避免非科學(xué)性糖尿病自我管理，對(duì)患者以及家屬將起到極大的幫助[7]。

（一）認(rèn)識(shí)錯(cuò)誤

據(jù)2017公布的一組數(shù)據(jù)而言，在中國平均每30秒就會(huì)有一個(gè)人罹患癌癥，平均每30秒就有一個(gè)人患糖尿病，平均每30秒，至少有一個(gè)人由于心腦血管疾病死亡，所以這也造成了另一個(gè)局面，一部分患者和患者家屬介懷，對(duì)糖尿病存在認(rèn)知誤差 ，認(rèn)為一旦患有糖尿病就是被判了死刑，從而放棄治療，導(dǎo)致糖尿病得不到有效抑制，錯(cuò)過治療的黃金時(shí)段[8]。另一部分患者由于自身糖尿病無明顯癥狀，覺得“沒關(guān)系”，“我沒病，吃嘛嘛香”因此在糖尿病初期不甚在意，延誤治療。更有患者在使用過藥物后，糖尿病在短期內(nèi)得以控制，就放棄繼續(xù)治療，認(rèn)為自己已經(jīng)痊愈，殊不知這樣做將面臨更嚴(yán)重的后果[9]。

（二）飲食問題

糖尿病患者在日常飲食中一定要注意均衡飲食，搭配合理，患者每天攝入的熱卡主要由碳水化合物、蛋白質(zhì)、脂肪這三大供能物質(zhì)提供[10]，除此之外，人體內(nèi)另一部分物質(zhì)：水、微量元素、維生素、礦鹽等作為輔助物質(zhì)用以均衡機(jī)體營養(yǎng)。但部分悲觀患者認(rèn)為余下的時(shí)光所剩無幾，從而大吃特吃，認(rèn)為不應(yīng)該“虧待”自己；也有患者采用饑餓式療法，造成營養(yǎng)缺失，其實(shí)以上兩種心理認(rèn)識(shí)都是不全面、不正確的，糖尿病患者是需要控制攝入量但并不意味著糖尿病患者要背負(fù)節(jié)食的枷鎖[11]。

由于糖尿病患者每天攝入的熱卡要基本維持不變，部分患者為了不出錯(cuò)的或許會(huì)選擇一成不變的飲食物質(zhì)，忽略飲食的多元性[12]，一味的盯住一樣，造成患者的厭煩情緒，在糖尿病的飲食管理中在保障攝入熱卡不變的條件下，可以對(duì)患者飲食進(jìn)行變動(dòng)[13]。同時(shí)不應(yīng)該對(duì)飲食時(shí)間沒有規(guī)劃，進(jìn)食時(shí)間和進(jìn)食量不規(guī)律對(duì)糖尿病患者的自我管理極大不利。糖尿病患者要捉到少食多餐，餐餐定時(shí)定量，戒煙戒酒[14]。

運(yùn)動(dòng)問題

由于老年人的身體難以經(jīng)受高強(qiáng)度的運(yùn)動(dòng)量，所有越來越多的老年人選擇了居家休息，但科學(xué)調(diào)差顯示適當(dāng)?shù)倪\(yùn)動(dòng)將有助于老年人的身體健康，對(duì)于糖尿病人呢？2018年5月9日昆明新華社報(bào)道：中科院科學(xué)家通過四年時(shí)間進(jìn)行了獼猴實(shí)驗(yàn)，此實(shí)驗(yàn)最終數(shù)據(jù)結(jié)果揭示了肥胖是導(dǎo)致糖尿病的罪魁禍?zhǔn)?，印證了糖尿病發(fā)病的獨(dú)立且危險(xiǎn)要素是糖尿病。該成果已在國際期刊《美國生理學(xué)-內(nèi)分泌及代謝》上發(fā)表。中國科學(xué)院昆明動(dòng)物研究所研究員梁斌如是說道，肥胖與糖尿病的關(guān)聯(lián)簡而言之就是由肥胖轉(zhuǎn)為糖尿病過程中，人體肝臟能量代謝出現(xiàn)了轉(zhuǎn)變，脂肪積累到支鏈氨基酸降解”。由此建議糖尿病患者運(yùn)動(dòng)要進(jìn)行運(yùn)動(dòng)，比如一些強(qiáng)度小的有氧運(yùn)動(dòng)，散步、太極、空竹、廣場舞等運(yùn)動(dòng)，相比較蝸居在家，外出運(yùn)動(dòng)對(duì)糖尿病患者的身心健康都有著極大的幫助[15]。但一部分患者對(duì)自己的身心素質(zhì)有著很大的自信，可能會(huì)選擇引體向上、俯臥撐等一類力量性運(yùn)動(dòng)，但這是非常不理性的。據(jù)醫(yī)學(xué)數(shù)據(jù)分析，力量性運(yùn)動(dòng)通常會(huì)對(duì)患者的心臟負(fù)荷在短時(shí)間內(nèi)會(huì)有明顯的加強(qiáng)，極有可能引發(fā)心臟病[16]。

心理健康

據(jù)科學(xué)分析部分糖尿病患者由于患有糖尿病之后，心理上產(chǎn)生抑郁傾向，且精神病患者患抑郁癥的幾率遠(yuǎn)大于普通人，這一點(diǎn)在老年糖尿病患者中尤為明顯。特別是由于病情出現(xiàn)反反復(fù)復(fù)，患者可能出現(xiàn)疲于人際交往，疲勞嗜睡，食欲不振甚至于破罐子破摔的心理，但更多的由于我們不能與患者感同身受，所有我們很難理解糖尿病患者的心理變化，繼而忽略?；颊咭坏┏霈F(xiàn)不遵醫(yī)囑、抵觸治療的傾向，其家人往往難以理解，造成患者與家人的矛盾，使患者的情緒雪上加霜[17]。

在糖尿病患者的日常治療中，可以適當(dāng)加入心理治療，減輕糖尿病患者的心理負(fù)擔(dān)。在日常生活中患者與家人的交流也必不可少，這兩者齊頭并進(jìn)能很大程度上對(duì)患者的內(nèi)心世界了深入的了解，繼而解決患者的心理問題[18]。

糖尿病自我管理的重要性和展望

迄今為止糖尿病的發(fā)病率和傷殘率仍舊只高不低，難以根治，但一個(gè)合理、可行性高的糖尿病自我管理體系將有效的抑制糖尿病的發(fā)病率，糖尿病患者自我管理是一套基于患者層面的社會(huì)生態(tài)模式，其目的在于控制糖尿病畫著的血糖，以達(dá)到穩(wěn)定病情的目的，防治糖尿病并發(fā)癥。通過糖尿病的自我管理方式可以改善患者的健康狀況，提高患者的幸福指數(shù)[19]。

目前的糖尿病自我管理主要分為四類，飲食管控、運(yùn)動(dòng)管控、心理檢查和藥物管理?；谒幬锕芾?，即謹(jǐn)遵醫(yī)囑的條件下，對(duì)患者展開自我管理。經(jīng)由科學(xué)研究證明自我管理系統(tǒng)的完善與否直接于患者生命時(shí)長掛鉤。因此對(duì)于糖尿病的治療更多取決于生活中的自我管理[20]。

糖尿病的治療過程我們一定要積極動(dòng)員身邊的一切社會(huì)資源，為糖尿病患者營造一個(gè)高效便利的方式，使患者有足夠的空間與醫(yī)療水平去完善自我管理[21]。在醫(yī)療層面上，應(yīng)當(dāng)分配更多的資源給予糖尿病患者，加強(qiáng)治療糖尿病新藥的研究和臨床試驗(yàn)，將中草藥、西藥混合研究，探索道路，也要考慮到人工智能，或許它也能幫助我們攻克糖尿病，避免未來糖尿病成為困擾中國社會(huì)的疑難雜癥；在社會(huì)層面上，給予糖尿病患者更多的幫助，對(duì)糖尿病患者的家庭經(jīng)濟(jì)負(fù)擔(dān)進(jìn)行幫扶、對(duì)患者進(jìn)行心理治療；同時(shí)，加大對(duì)糖尿病的宣傳，讓普通民眾對(duì)糖尿病的有一定程度的了解，做到及早發(fā)現(xiàn)、及早防治[22]。而且為一些有患者的家庭提供了一些自我管理參考，避免由于知識(shí)盲區(qū)對(duì)患者的管理出現(xiàn)偏差。隨著全球乃至我國的醫(yī)療水平發(fā)展日趨上升，對(duì)糖尿病的治愈方式也會(huì)有很大的提升，通過患者家庭的積極監(jiān)督和患者的自我管理，社會(huì)各界的共同努力，為糖尿病患者創(chuàng)造良好的醫(yī)療條件，在我國的糖尿病患者治療水平和自我管理水平的共同提升下，相信糖尿病患者的福音未來可期[23]。

五糖尿病的自我管理不當(dāng)對(duì)老年人的生活影響

對(duì)于長期患糖尿病的患者來說，自我管理的水平?jīng)Q定著生活質(zhì)量的高低。在糖尿病易患高發(fā)群體[24]中老年人是占據(jù)主要地位的，所以說老年人對(duì)于糖尿病的自我管理和護(hù)理是起著關(guān)鍵作用的。從社會(huì)層面上來說，這項(xiàng)任務(wù)并不簡單。因?yàn)楝F(xiàn)在的社會(huì)基本是空巢老人比較多，兒女都外出務(wù)工，自我管理的完善性并不能得到完全的保證。[25]①老人對(duì)于糖尿病的認(rèn)識(shí)有所欠缺，以至于很多的自我管理的要點(diǎn)不能完全掌握，對(duì)自己身體的健康程度不能完整正確的評(píng)價(jià)。包括家里人對(duì)于糖尿病知識(shí)[26]的混淆，可能會(huì)導(dǎo)致老年人生活的舒適度下降，出行一時(shí)受到限制，盲目的進(jìn)行治療可能會(huì)導(dǎo)致進(jìn)一步的糖尿病惡化。②在基本知識(shí)了解的基礎(chǔ)上，自我管理開始對(duì)飲食和運(yùn)動(dòng)量進(jìn)行控制，老人的身體本來代謝下降，運(yùn)動(dòng)耐力差，在自我管理不當(dāng)?shù)那闆r下，可能會(huì)引發(fā)更加嚴(yán)重的并發(fā)癥如酮癥酸中毒[27]，糖尿病性腎衰竭以及血管病變引起的呼吸衰竭或下肢截癱，加劇了老年生活的悲劇。面對(duì)糖尿病的自我管理不當(dāng)所帶來的深遠(yuǎn)影響，更是在老年人所剩無幾的短暫時(shí)光里雪山加霜，所以老年人在做好自我管理[28]的同時(shí)，享受美滿的晚年。

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[7]趙麗華，張宇，王詠梅，王麗華。 一日多餐飲食對(duì)妊娠期糖尿病患者血糖的影響[J]. 中華護(hù)理教育，2017,（01）：65-68.

[8]袁曉丹，姚平，劉超，樓青青。 個(gè)體化行為干預(yù)對(duì)2型糖尿病患者1年效果評(píng)價(jià)[J]. 護(hù)理與康復(fù)，2017,（03）：212-216+220.

[9]馮小芬，韋玉和，邵雪景，趙志勇，印永，羅春媛。 微信群管理糖尿病患者的短期觀察[J]. 中國糖尿病雜志，2017,（02）：149-153.

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[11]鄧開琴，何仕蓉，彭露瑤，陳青青，王璉，胡慧。 同伴支持在糖尿病患者健康教育中的應(yīng)用[J]. 中華護(hù)理教育，2017,（02）：116-118.

[12]孟朝琳，程嬋嬋，崔軼男，王媛媛，吳小彬，沈興平。 自我管理網(wǎng)絡(luò)支持模式在初發(fā)中青年2型糖尿病患者中的應(yīng)用[J]. 護(hù)理學(xué)雜志，2017,（01）：22-25.

[13]劉霞，楊貴云，張泓，李蕓。 動(dòng)機(jī)性訪談在老年糖尿病患者飲食治療中的應(yīng)用[J]. 中國老年學(xué)雜志，2017,（01）：202-204.

[14]倪云霞，劉素珍，李繼平，刁永書，董婷，陶琳。 護(hù)士主導(dǎo)的管理模式對(duì)社區(qū)糖尿病患者血糖控制及就醫(yī)行為的影響[J]. 中華護(hù)理雜志，2017,（02）：222-227.

[15]于鵬，溫肇霞，胡新林，尹雪燕，張凡，劉紹。青島市不同等級(jí)醫(yī)院護(hù)士糖尿病飲食管理認(rèn)知的調(diào)查分析[J]中國護(hù)理管理，2016, (11)1498- 1502.

[16]展恩欣，宋歡，柳韋華。 中文版糖尿病與吸煙信念量表的信效度研究[J]. 護(hù)理研究，2017,（01）：39-42.

[17]趙正清，張渭芳，錢進(jìn)軍，江萍，隆衛(wèi)娟，于德純。 PDCA循環(huán)結(jié)合手測量法在2型糖尿病患者飲食指導(dǎo)中的應(yīng)用[J]. 護(hù)士進(jìn)修雜志，2017,（01）：45-48.

[18]呂莉慧，丁淳，王穎。 延伸護(hù)理服務(wù)對(duì)軍隊(duì)老干部糖尿病患者保健康復(fù)的影響[J]. 醫(yī)學(xué)研究生學(xué)報(bào)，2017,（02）：186-189.

[19]溫桂敏，孫田杰，趙宏，馮會(huì)玲。 住院糖尿病患者健康飲食行為階段及其影響因素研究[J]. 護(hù)理學(xué)雜志，2017,（03）：7-11.

[20]薛亞男，尚國愛，呂倩，翟春娟，侯月穎。 健康自我管理對(duì)糖尿病足患者自我效能及心理狀態(tài)的影響[J]. 實(shí)用預(yù)防醫(yī)學(xué)，2017,（02）：137-140.

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[22] Li Hui. The role of diabetes care group in the clinical care of diabetic patients [J]. Chinese community physician, 2014, 30 (22): 143-143145.

[22] Li Xia. The application of humanized service in diabetes care [J]. Chinese and foreign medicine Study, 2016, 14 (1): 95-96

[23] Zhang Yaling. Analysis of the role of diabetes care group in the care of diabetic patients [J]. Chinese modern medicine application, 2015, 9 (21): 231-232.

[24]LiMeimei.LiuHongmei.The effect of comprehensive nursing on the clinical effect and related endocrine hormone level of patients with diabetic thyroid cancer after operation.

[25]Chinese Community Doctors.Influence of diabetes nursing home on health education of diabetic patients. 2018.Issue 17 .

[26]Hu Xiaodao. Observation on the effect of comprehensive nursing mode in elderly patients with severe erythroderma psoriasis and diabetes mellitus. Dermatology and venereal diseases 2020.2.20

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護(hù)士在糖尿病護(hù)理中的作用

　糖尿病是一組常見的代謝內(nèi)分泌病，分原發(fā)性及繼發(fā)性兩類。接下來我為大家整理了護(hù)士在糖尿病護(hù)理中的作用，希望對(duì)你有幫助哦!

　The nurse's role in diabetes care may be as a specialist or as part of general care - primary or secondary. Wherever care is given, the emphasis is always on patient self-management.

　護(hù)士在糖尿病護(hù)理中既可以發(fā)揮專家的作用，也可以只承擔(dān)其中的部分護(hù)理工作。不管是何種場所的護(hù)理，都應(yīng)強(qiáng)調(diào)病人的自我護(hù)理。

　Self-care is key to the management of diabetes. Self-care should resume as soon as possible. Nevertheless, when a person with diabetes does need assistance this needs to be from knowledgeable health professionals.

　自我護(hù)理是處理糖尿病的關(guān)鍵，開始得越早越好。不過，當(dāng)糖尿病患者確實(shí)需要幫助時(shí)，就必須由知識(shí)豐富的專業(yè)健康人士提供。

　Diabetes education in the UK has, traditionally, been undertaken by diabetes specialist nurses alongside their other clinical, management and research roles. Some teaching is done on a one-to-one basis, but health professionals have come to realise that people with diabetes learn a lot from each other, so group education, to which partners and members of the family are also invited, has become the norm. It is important to invite to education sessions the person who shops for, and cooks, the family food. This may be a family member but it could be a home help or a carer in a care home.

　傳統(tǒng)上，英國的糖尿病教育是由糖尿病?？谱o(hù)理師承擔(dān)的，他們還承擔(dān)著其他臨床、治療和研究工作。有些教育是以一對(duì)一方式進(jìn)行，但健康專業(yè)人士已逐漸認(rèn)識(shí)到，糖尿病患者互相間也能學(xué)到很多東西，因此，小組教育已經(jīng)成為一種標(biāo)準(zhǔn)，它還可以邀請(qǐng)同伴或家人參加。邀請(qǐng)家庭食品采購和烹制人員加入教育也很重要。他可能是家庭成員之一，也可能是家務(wù)女工或療養(yǎng)院護(hù)理員。

　As the number of people in the community who have diabetes has increased, practice nurses and district nurses have taken on tasks that were previously in the domain of the diabetes nurse specialist. They will therefore be involved in planning and delivering diabetes education for patients. Today, many people with diabetes, especially those with type 2, will never have seen a diabetes nurse specialist, since these nurses tend to be hospital-based.

　隨著社區(qū)內(nèi)糖尿病人數(shù)的增加，執(zhí)業(yè)護(hù)士和地區(qū)護(hù)士已經(jīng)承擔(dān)了過去由糖尿病護(hù)理專家所從事的很多工作。因此，他們也將參與糖尿病教育的計(jì)劃和實(shí)施。今天，由于糖尿病護(hù)理專家都是在醫(yī)院工作，很多糖尿病患者，特別是二型糖尿病患者，都看不到這些護(hù)理專家。

　Today's technology has resulted in many changes in the way people obtain advice about health. Using telephone or the internet are now common ways of accessing health information. Consequently, more and more people are coming to health professionals armed with useful (and sometimes confusing) information that they have obtained from these sources or maybe from the radio, television and friends. Interactive health advice through digital television is being piloted in Birmingham and some health promotion agencies have touch screen programmes and interactive CD-roms.

　當(dāng)今技術(shù)的發(fā)展，使人們的健康咨詢方式發(fā)生了很大變化。**或英特網(wǎng)已經(jīng)成為獲取健康信息的常用手段。結(jié)果，越來越多的人開始求助于擁有有用(有時(shí)也是令人迷惑)的信息的健康專業(yè)人士，他們的信息或來自上述渠道，或來自電臺(tái)、電視和朋友。伯明翰正在嘗試舉辦數(shù)字電視互動(dòng)式健康咨詢節(jié)目，一些健康促進(jìn)機(jī)構(gòu)已經(jīng)接觸這些屏幕節(jié)目和互動(dòng)CD光盤。

　This increased choice for patients should be welcomed. It may mean that nurses' roles will change and that they will no longer be the first information-givers, but other important roles will develop. These will include interpreting what the information means to people individually and to their friends and relatives, and creating forums for discussions about how to put the advice into action.

　這為病人提供了更多的選擇，應(yīng)該受到歡迎。這可能意味著，護(hù)士的角色將發(fā)生變化，她們將不再是第一個(gè)提供信息的人，新的重要角色將出現(xiàn)，包括解釋信息對(duì)個(gè)人及其朋友和親屬的意義，創(chuàng)辦論壇，討論如何實(shí)施建議。

　Nurses caring for patients with diabetes need to be working towards the same objectives, therefore target-setting and determining priorities for managing their condition are important aspects of care. It is known from both the Diabetes Control and Complications Trial (DCCT, 1993) and the UK Prospective Diabetes Study Group (UKPDS, 1998) that it is possible to prevent diabetic complications, and that, if they do appear, their worsening progression can be slowed. The maintenance of good glycaemic control is therefore vital.

　護(hù)理糖尿病患者的護(hù)士必須有共同的工作目標(biāo)，因此，制訂目標(biāo)和決定病情優(yōu)先處理順序便成為護(hù)理的重要因素。研究表明，糖尿病并發(fā)癥可以預(yù)防。如果確實(shí)出現(xiàn)并發(fā)癥，其惡化進(jìn)程也可以減緩。關(guān)鍵是要控制血糖。

　The target for glycated haemoglobin (HbA1c) for those with type 1 diabetes is 7.5% (for type 1) and below 7% for those with type 2. Blood pressure is known to be a factor in diabetic complications and should be below 140/80mmHg for both type 1 and type 2 diabetes - the lower the better, but without feeling the symptoms of hypotension, such as dizziness. Total cholesterol should be below 5 mmol/L, with an HDL of greater than 1.0, and LDL less than 3. If there are complications, these targets may be set even more tightly to prevent their worsening. Patients need to know what the recommended levels are for these tests so they can ask for the results of the investigations and make sense of the information they are given. In this way they will be able to see for themselves if they need more treatment and whether or not they need to make changes to lifestyle and food choices.

　一型糖尿病患者的糖化血紅蛋白目標(biāo)是7.5%，二型為低于7%.血壓是導(dǎo)致糖尿病并發(fā)癥的一個(gè)因素，兩種糖尿病的血壓都應(yīng)低于140/80mmHg，且越低越好。當(dāng)然應(yīng)以不出現(xiàn)低血壓癥狀為宜，如頭暈。全膽固醇應(yīng)低于5mmol/L，HDL高于1.0，LDL低于3.如有并發(fā)癥，制定目標(biāo)時(shí)應(yīng)更加仔細(xì)，以防止加劇。病人應(yīng)知道這些化驗(yàn)的建議值以便索要檢查結(jié)果，弄懂信息意義。這樣，他們就能自己清楚是否需要更多的治療，是否需要改變生活方式及飲食。

Screening for complications 并發(fā)癥的篩檢

　Routine screening for diabetic complications is often the nurse's responsibility. This will include urine testing for protein as a check on renal function, taking blood for lipid estimations, measuring blood pressure, examining the eyes and the feet.

　糖尿病的常規(guī)篩檢通常是護(hù)士的責(zé)任，包括腎功能的蛋白尿檢，血脂檢查，測血壓及檢查眼睛與雙腳。

　Screening for retinopathy: This is performed when pupils are dilated, either by fundoscopy or retinal photography. The nurse's role is to explain what will happen during the procedure and what the findings mean. The nurse may also measure visual acuity. Some patients may need to be referred for laser photocoagulation, and again, the nurse should be able to offer information and reassurance.

　視網(wǎng)膜病篩檢：眼底鏡或視網(wǎng)膜鏡檢查，擴(kuò)張瞳孔。護(hù)士的作用是解釋操作時(shí)會(huì)發(fā)生的情況與檢查結(jié)果的意義。護(hù)士還可以檢查視敏度。有的病人可能需要進(jìn)行激光凝固，因此，護(hù)士應(yīng)能提供信息，安慰病人。

　Screening for neuropathy: Patients with normal circulation, gait, and vision are at low risk of neuropathy. Advice about foot hygiene and the wearing of sensible shoes should be offered to these patients. When patients cannot feel their feet and their circulation is impaired through peripheral vascular disease, the risk of neuropathy is greatly increased. These patients will need to be advised not to rely on how their feet feel but to look at them every day to check for any damage and to seek assistance urgently if a problem occurs. This may need to be done by someone else if vision is a problem. Putting a mirror on the floor can be helpful for self-examination.

　神經(jīng)病變篩檢：循環(huán)、步態(tài)和視力正常的病人神經(jīng)病變風(fēng)險(xiǎn)小。應(yīng)向病人提出足部衛(wèi)生建議，提供合適的鞋子。當(dāng)病人雙足無感覺，外周血管病引起循環(huán)障礙時(shí)，神經(jīng)病變危險(xiǎn)就大幅增加。就要建議這些病人不要依賴足部感覺，而應(yīng)每天檢查雙腳，看有無損傷，并在發(fā)生問題時(shí)立即尋求幫助。如視力不良，則需要由他人幫助進(jìn)行。在地板上放一面鏡子也有助于自我檢查。

　Temperature sense can be diminished in patients with neuropathy, so they must be advised not to use hot water bottles and to take care when stepping into a bath or sitting close to a source of heat.

　患有神經(jīng)病變的病人，溫度覺降低，因此必須勸告他們不要使用熱水瓶，告誡他們在踏進(jìn)浴盆或坐在熱源邊上時(shí)要小心。

　Neuropathy is assessed by checking the foot pulses (dorsalis pedis and post-tibial). If they are not palpable, a referral for vascular assessment and treatment may be necessary. An assessment using a hand held Doppler can be useful to detect whether there is peripheral vascular insufficiency. Patients whose foot pulses are reduced or absent should be told that this puts their feet at risk and that they should take extra precautions to protect their feet. This may mean seeking care from a podiatrist, being fitted for special shoes with appropriate insoles, inspecting their feet daily and acting on any abnormalities discovered.

　神經(jīng)病變可通過檢查足動(dòng)脈搏動(dòng)(足背和脛骨后)進(jìn)行評(píng)估。如摸不到搏動(dòng)，就應(yīng)安排血管評(píng)估和治療。手提式多普勒儀器有助于發(fā)現(xiàn)是否存在外周血管供應(yīng)不足。足動(dòng)脈搏動(dòng)減少或無法捫及的，就告知其雙腳已有危險(xiǎn)，應(yīng)加倍小心保護(hù)雙腳。這可能意味著要尋求足醫(yī)的護(hù)理，選用合適的填有鞋墊的鞋子，每天檢查雙腳，并對(duì)發(fā)現(xiàn)的任何異常采取措施。

　Absent or reduced vibration sense is the first sign of neuropathy. This is measured by a tuning fork. If the vibration sense is absent or reduced, there is a risk of foot damage.

　振動(dòng)覺缺失或減弱是神經(jīng)病變的第一體征?？赏ㄟ^音叉進(jìn)行檢查。如振動(dòng)覺缺失或減弱，就有足部損傷危險(xiǎn)。

　To prevent amputations in patients with peripheral disease it is important to ensure early referral to a vascular surgeon. Early referral to an orthotist for special shoes can prevent amputation in the neuropathic foot.

　為防止外周病患者截肢，重要的一點(diǎn)是要確保盡早安排血管外科醫(yī)生。盡早安排矯形支具師制作特定的鞋子能夠預(yù)防神經(jīng)病變足的截除。

　Nutrition advice: As for anybody, the usual advice for healthy eating is to have at least five pieces of fruit and vegetables a day; to restrict alcohol to fewer than three units a day for women or four units a day for men, and to limit salt intake. Calorie restriction is important if the individual is overweight, and advice should be given about having less fat overall, with proportionately more monosaturated and polyunsaturated fat. If the cholesterol level is above target, a referral should be made to the GP for possible treatment with a statin.

　營養(yǎng)建議：對(duì)任何人而言，通常的健康飲食建議是：至少每天五片水果和蔬菜;減少酒精，女士一天少于三個(gè)單位，男子少于四個(gè)單位;限鹽;如患者體胖，應(yīng)限制熱量攝入，少吃鹽，少吃脂肪，但可按適當(dāng)比例增加單飽和和多不飽和脂肪。如膽固醇高于指標(biāo)，應(yīng)安排全科醫(yī)生用抑制素進(jìn)行治療。

　Patients who are having difficulty achieving their targets on nutrition should be given an opportunity to see a dietitian (preferably a diabetes specialist dietitian).

　達(dá)到營養(yǎng)指標(biāo)有困難的病人，應(yīng)給予機(jī)會(huì)去看營養(yǎng)師((最好是糖尿病?？茽I養(yǎng)師

Conclusion 結(jié)論

　When screening for complications and running diabetes clinics, nurses need to be aware that psychological and social issues will have a bearing on how patients view their diabetes and whether they are likely to make lifestyle changes.

　當(dāng)進(jìn)行糖尿病篩檢及糖尿病門診時(shí)，護(hù)士要知道精神和社會(huì)因素對(duì)病人對(duì)自身糖尿病的看法和如何改變生活方式有很大影響。

　The role of the patient with diabetes is as an active decision-maker and the role of the nurse in this case is to provide information, direction and support. The nurse will be assessing risk, so that appropriate interventions can be made at appropriate times. In addition, the nurse should regard every annual review or screening visit as an opportunity to find out what information the patient has and to fill in any gaps, supported by educational materials. Exploring why patients may not feel able to make changes to their lifestyle and to undertake suggested treatments may help the nurse to suggest actions that such patients are likely to follow.

　糖尿病人應(yīng)是一個(gè)積極的決策者，護(hù)士則是資料、指導(dǎo)和支持的提供者。護(hù)士對(duì)風(fēng)險(xiǎn)進(jìn)行評(píng)估，就可以在適當(dāng)?shù)臅r(shí)候采取適當(dāng)?shù)拇胧?。而且，護(hù)士應(yīng)將每次的年度復(fù)查或篩查視為發(fā)現(xiàn)病人掌握何種信息、彌補(bǔ)欠缺的好機(jī)會(huì)。探索為什么病人會(huì)覺得自己無法改變自己的生活方式，無法了解建議的治療，這有助于護(hù)士向這類病人提供他們愿意接受的行動(dòng)建議。