问题 多项选择题 案例分析题

患者男,42岁。2型糖尿病史6年,身高176cm,体重98kg,血压160/100mmHg,实验室检查:FBG11mmol/L,2hPBG18mmol/L,HbAlc10.8%,空腹C肽3.96ng/ml。合并高血压、血脂异常、脂肪肝及睡眠呼吸暂停综合征。现降糖治疗方案:二甲双胍0.5g,每日3次;格列美脲2mg,每日2次;阿卡波糖50mg,每日3次。

该患者术后应常规进行哪些方面的监测和随访()

A.饮食和运动情况

B.血糖

C.血脂

D.电解质

E.甲状腺激素

F.甲状旁腺激素

G.维生素及微量元素

H.代谢性骨病

答案

参考答案:A, B, C, D, F, G, H

解析:

1.胃转流术(也叫胃旁路术)是目前应用最广泛、手术难度相对低、安全性相对较高的治疗2型糖尿病的术式,可调节胃绑带术、胃底折叠术、袖状胃成形术为限制性手术,虽然减重效果良好,但对糖尿病的长期缓解作用均不如胃转流术和胆胰转流术;可调节胃绑带术还存在套管所致的胃壁腐蚀,故临床已较少采用;胆胰转流术适用于严重病态肥胖伴有糖尿病的患者,手术难度大,远期营养并发症多,该患者BMI为31.6kg/m,故不宜采用该术式。

2.倾倒综合征是术后早期较常见的消化道并发症之一,与进餐的种类、速度有关,故宜缓慢进食并选择低升糖指数的食物。胰岛细胞增生所致的低血糖临床罕见且目前未被充分证实。贫血虽是手术的并发症,但多发生在手术半年后且与进餐无关。其术后仅2个月,发生胰岛细胞增生的可能性亦不大。

3.控制饮食和适量运动是糖尿病预防和治疗的基石,即使在胃转流术糖尿病完全缓解后也不应忽视,平时应注意监测血糖、血压、血脂、电解质等代谢指标,并注意微量元素及维生素补充,避免发生贫血、脱发、夜盲、代谢性骨病等营养性并发症。甲状旁腺激素升高可早期提示血钙、维生素D缺乏及代谢性骨病,故应监测;手术对甲状腺功能影响较小,故不作为术后常规监测项目。

4.关于代谢手术治疗糖尿病的机制,目前比较肯定的是食物摄入、吸收的减少,肠道菌群及内环境的改变、胃肠激素分泌模式的改变包括GLP-1分泌的增加及ghrelin、PYY分泌的减少。

阅读理解

In times of economic crisis. Americans turn to their families for support. If the Great Depression is any guide, we may see a drop in our skyhigh divorce rate. But this won't necessarily represent. an increase in happy marriages. In the long run, the Depression weakened American families, and the current crisis will probably do the same.

  We tend to think of the Depression as a time when families pulled together to survive huge job losses, By 1932. when nearly one-quarter of the workforce was unemployed, the divorce rate had declined by around 25% from 1929 But this doesn't mean people were suddenly happier with their marriages. Rather, with incomes decreasing and insecure jobs, unhappy couples often couldn't afford to divorce. They feared neither spouse could manage alone.

  Today, given the job losses of the past year, fewer unhappy couples will risk starting separate households, Furthermore, the housing market meltdown will make it more difficult for them to finance their separations by selling their homes.

  After financial disasters family members also tend to do whatever they can to help each other and their communities, A 1940 book. The Unemployed Man and His Family, described a family in which the husband initially reacted to losing his job "with tireless search for work."He was always active, looking for odd jobs to do.

  The problem is that such an impulse is hard to sustain Across the country, many similar families were unable to maintain the initial boost in morale(士气). For some, the hardships of life without steady work eventually overwhelmed their attempts to keep their families together. The divorce rate rose again during the rest of the decade as the recovery took hold.

  Millions of American families may now be in the initial stage of their responses to the current crisis, working together and supporting one another through the early months of unemployment.

  Today's economic crisis could well generate a similar number of couples whose relationships have been irreparably(无法弥补地)ruined. So it's only when the economy is healthy again that we'll begin to see just how many broken families have been created.

小题1:In the initial stage, the current economic crisis is likely to __________.

A.tear many troubled families apart

B.contribute to enduring family ties

C.bring about a drop in the divorce rate

D.cause a lot of conflicts in the family小题2:In the Great Depression many unhappy couples close to stick together because

A.starting a new family would be hard

B.they expected things would turn better

C.they wanted to better protect their kids

D.living separately would be too costly小题3:In addition to job losses. What stands in the way of unhappy couples getting a divorce?

A.Mounting family debts

B.A sense of insecurity

C.Difficulty in getting a loan

D.Falling housing prices小题4:What will the current economic crisis eventually do to some married couples?

A.It will force them to pull their efforts together

B.It will undermine their mutual understanding

C.It will help strengthen their emotional bonds

D.It will irreparably damage their relationship小题5:What can be inferred from the last paragraph?

A.The economic recovery will see a higher divorce rate

B.Few couples can stand the test of economic hardships

C.A stable family is the best protection against poverty.

D.Money is the foundation of many a happy marriage

选择题