内分泌科3个优势病种诊疗方案

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地形平坦开阔,地层由第四系全新冲积层,第四系上更新统冲层组成,局部表覆第四系全新统人工堆积层。第四系全新统冲积层厚度约25~50m,岩性主要为黏土、粉质黏土、粉土、粉砂、细砂;第四系上更新统冲积层厚度大于50m,岩性主要为黏性土、粉土、粉细砂等。管桩深度范围内地层主要为:粉土、黏土、粉质黏土,局部表层为杂填土。couplingCentreshallbechecked,thesecondpouredconcretestrengthofmorethan70%.Intheprocessofreamingorboring,apartfromthespecialprovisionsinfactory,doesnotallowanyworkthatmayaffectthecouplingCentre,suchasirrigation,tocylinderconnectionstofloodthecondenserpipesandsoon.Wellboring,hingeboltholeflangewithcouplingofvertical,notoblique.Mountingboltsshouldbeaddedlubricants,typinggentlywithasmallhammer,nottoolooseortootight,packedtheboltswiththecorrespondingsealscrewholeshouldbemarked.6.4.5.4.2couplingreamedandpairingsisclosetothediameterofboltbearinggoodhingeholes,dressedwithagoodtwocouplingboltsbeforeyoucanmovetherotor,boring-reamingholeinturn.Couplingboltsmustbetightcouplingissymmetricaldiameter,inboring,reaming,twoboltsout.Wellboring,hingeboltholeflangewithcouplingofvertical,notoblique.Duetothecouplingboltsinaccordancewithhingeholescorrespondingtothediameterofthescrewholesonebyoneafterprocessing,processingbackboltinstallationlocationcannotbechanged,soaccordingtoboltaftertheactualweightdifferenceofnutandlockwashertomatch.Generalrequirementsforcouplingtwosymmetricaldiameterbolt,nutandlockwasher'stotalweightdifferenceshouldnotbegreaterthan10gandknocksstampedmark.(SeeFigure18)Thecouplingboltsapplylubricant,andthengentlywithcopperhome,nottoolooseortootight.BoltAssemblyisfinished,symmetricaltighteningallboltsto30%,50%,70%,100%force,andcheckthecouplingflutterandbeforeconnectingthecirclegraduallychangesitsvalueshouldbelessthan0.02mm.Tighteningtorqueofthecouplingboltsshallcomplywiththetechnicalrequirementsmanufacturersdrawings,withadynamometricwrenchorlogtensiontools.Threewheelrotorswingtestcouplingconnectionsshouldbechecked:takingleave,消渴病中医诊疗方案1.概述消渴病(糖尿病BNV060E14.901)是胰岛素分泌缺陷或/和胰岛素作用障碍,导致的一组以慢性高血糖为特征的代谢性疾病。显著高血糖的症状有多尿、烦渴、多食及体重减轻。2.诊断标准2.1中医诊断标准:参照中华中医药学会《糖尿病中医防治指南》(ZYYXH/T3.1-3.15-2007)多饮、多食、多尿、体型消瘦,或尿糖增高等表现,是诊断消渴病的主要依据。有的患者“三多”症状不明显,但若中年之后发病,且嗜食膏粱厚味,形体肥胖,以及伴发肺痨、水肿、眩晕、胸痹、中风、雀目、痈疽等病症,应考虑消渴病的可能。2.2中医证候诊断标准:①阴虚热盛证症状:咽干口燥,心烦畏热;渴喜冷饮,多食易饥,溲赤便秘。舌红苔黄脉细滑数,或细弦数。②湿热困脾证症状:胸脘腹胀,或食后饱满,头身困重;体形肥胖,心胸烦闷,四肢倦怠,小便黄赤,大便不爽。舌红苔黄腻,脉滑而数。③气阴两虚证症状:咽干口燥,倦怠乏力;多食易饥,口渴喜饮,气短懒言,五心烦热,心悸失眠,溲赤便秘。舌红少津,苔薄或花剥,脉细数无力,或细而弦。④阴阳两虚,血瘀水停证症状:神疲乏力,咽干口燥,腰膝酸冷,或手足畏寒、夜尿频多;头晕眼花,心悸失眠,自汗易感,气短懒言,颜面肢体浮肿,尿多浊沫,或小便量多,男子阳痿,女子性欲淡漠,大便干稀不调。舌体胖大,有齿痕,脉沉细无力。⑤血瘀脉络证症状:胸痛,胁痛,腰痛,背痛,部位固定,或为刺痛,肢体麻木,疼痛夜甚;肌肤甲错,口唇紫暗,面部瘀斑,健忘心悸,心烦失眠。舌质暗,有瘀斑,舌下脉络青紫纡曲,脉弦,或沉而涩。2.3西医诊断标准:采用中华医学会糖尿病分会《中国2型糖尿病防治指南》(2007年)糖尿病症状+任意时间血浆葡萄糖≥11.1mmol/L或空腹血浆葡萄糖≥7.0mmol/L或口服葡萄糖耐量试验(OGTT)中,2h血浆葡萄糖≥11.1mmol/L以上三条,具备其中一条,并经另一天复查可确诊。3.中医辨证治疗3.1阴虚热盛证治法:养阴清热,生津止渴。方药:白虎汤、消渴方加减。生石膏,知母,生地,麦冬,天花粉,黄连,黄芩。加减:口渴引饮无度者,加五味子,石斛以甘酸化阴,加强生津止渴之效;大便秘结者加大黄以荡涤肠胃,消热泻火;倦怠乏力,渴而汗出者加人参以益气敛寒,生津止渴。3.2湿热困脾证治法:益气健脾,清热祛湿。方药:平胃散、黄连温胆汤加减。苍术,茯苓,半夏,陈皮,枳实,黄连,栀子,厚朴。加减:小便黄赤者加黄柏泄下焦实火;心烦者加竹叶清热除烦;胸闷纳呆者加瓜蒌、藿香、佩兰,以芳香化浊,理气宽中。3.3气阴两虚证治法:益气养阴。方药:生脉散加减。太子参,麦冬,五味子,黄芪,生地,玉竹。加减:口渴多饮甚者加黄精、天花粉;气短、乏力甚者加白术、茯苓;心悸失眠者加酸枣仁、柏子仁;汗出淋漓者加浮小麦、煅龙牡。3.4阴阳两虚,血瘀水停证治法:滋阴温阳、活血利水。方药:右归饮加减。熟地,山萸肉,丹皮,泽泻,枸杞,附子,肉桂,茯苓,龟板,杜仲。加减:小便频数而量多者加桑螵蛸、覆盆子,以补肾化气,收涩缩尿;遗精早泄加金樱子、芡实以固涩;浮肿尿少者加车前子、大腹皮、桑白皮等以利水消肿。3.5血瘀脉络证治法:活血化瘀通络。方药:补阳还五汤加减。当归尾,川芎,黄芪,桃仁,红花,地龙,赤芍。加减:肢体麻木、疼痛甚者加桑枝、桂枝以温通脉络;胸痛甚者加丹参、檀香以活血行气止痛;腰痛甚者加牛膝、川断以补肾壮骨、地形平坦开阔,地层由第四系全新冲积层,第四系上更新统冲层组成,局部表覆第四系全新统人工堆积层。第四系全新统冲积层厚度约25~50m,岩性主要为黏土、粉质黏土、粉土、粉砂、细砂;第四系上更新统冲积层厚度大于50m,岩性主要为黏性土、粉土、粉细砂等。管桩深度范围内地层主要为:粉土、黏土、粉质黏土,局部表层为杂填土。couplingCentreshallbechecked,thesecondpouredconcretestrengthofmorethan70%.Intheprocessofreamingorboring,apartfromthespecialprovisionsinfactory,doesnotallowanyworkthatmayaffectthecouplingCentre,suchasirrigation,tocylinderconnectionstofloodthecondenserpipesandsoon.Wellboring,hingeboltholeflangewithcouplingofvertical,notoblique.Mountingboltsshouldbeaddedlubricants,typinggentlywithasmallhammer,nottoolooseortootight,packedtheboltswiththecorrespondingsealscrewholeshouldbemarked.6.4.5.4.2couplingreamedandpairingsisclosetothediameterofboltbearinggoodhingeholes,dressedwithagoodtwocouplingboltsbeforeyoucanmovetherotor,boring-reamingholeinturn.Couplingboltsmustbetightcouplingissymmetricaldiameter,inboring,reaming,twoboltsout.Wellboring,hingeboltholeflangewithcouplingofvertical,notoblique.Duetothecouplingboltsinaccordancewithhingeholescorrespondingtothediameterofthescrewholesonebyoneafterprocessing,processingbackboltinstallationlocationcannotbechanged,soaccordingtoboltaftertheactualweightdifferenceofnutandlockwashertomatch.Generalrequirementsforcouplingtwosymmetricaldiameterbolt,nutandlockwasher'stotalweightdifferenceshouldnotbegreaterthan10gandknocksstampedmark.(SeeFigure18)Thecouplingboltsapplylubricant,andthengentlywithcopperhome,nottoolooseortootight.BoltAssemblyisfinished,symmetricaltighteningallboltsto30%,50%,70%,100%force,andcheckthecouplingflutterandbeforeconnectingthecirclegraduallychangesitsvalueshouldbelessthan0.02mm.Tighteningtorqueofthecouplingboltsshallcomplywiththetechnicalrequirementsmanufacturersdrawings,withadynamometricwrenchorlogtensiontools.Threewheelrotorswingtestcouplingconnectionsshouldbechecke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