糖尿病性神經(jīng)病變的防治

1、會(huì)計(jì)學(xué)1糖尿病性神經(jīng)病變的防治糖尿病性神經(jīng)病變的防治現(xiàn)在認(rèn)為主要與糖尿病引起的糖、脂肪、磷脂等代謝障礙及由于周圍神經(jīng)等的滋養(yǎng)血管的動(dòng)脈硬化、中外膜肥厚、玻璃樣變性甚至閉塞等血管性障礙有關(guān)。致使神經(jīng)纖維節(jié)段性脫髓鞘性變化，軸索膨脹變性、纖維化及運(yùn)動(dòng)終板腫瘤等。病變主要見(jiàn)于周圍神經(jīng)、后根，亦可見(jiàn)于興奮髓后索及肌肉。缺血 生化代謝異常生化代謝異常疼痛覺(jué)植物神經(jīng)溫度覺(jué)運(yùn)動(dòng)振動(dòng)位置覺(jué)觸覺(jué)/壓力周圍神經(jīng)系統(tǒng)：糖尿病感覺(jué)性多發(fā)性神經(jīng)?。何改c系功能紊亂胃腸系功能紊亂心血管系運(yùn)動(dòng)障礙心血管系運(yùn)動(dòng)障礙心血管系運(yùn)動(dòng)障礙心血管系運(yùn)動(dòng)障礙心血管系運(yùn)動(dòng)障礙心血管系運(yùn)動(dòng)障礙眼功能障礙眼功能障礙中樞神經(jīng)系統(tǒng)中樞神經(jīng)系統(tǒng)中樞神

2、經(jīng)系統(tǒng)癌性周圍神經(jīng)病結(jié)節(jié)病系統(tǒng)性紅斑狼瘡（SLE）Sjogrens綜合征血管源性神經(jīng)病POEMS綜合征（Crow-Fukase綜合征）(1) 嚴(yán)格控制糖尿病嚴(yán)格控制糖尿病（4）代謝療法）代謝療法(5)對(duì)癥治療對(duì)癥治療clonidinelidocaineTramadolTramadol GabapentinGabapentin加巴噴丁加巴噴丁 dextromethorphandextromethorphan. .右美沙芬右美沙芬-Transcutaneousnervestimulation-calcitoninManagement of Small Fiber NeuropathiesManag

3、ement of Large Fiber Neuropathies注意糖尿病足的護(hù)理與預(yù)防！Clinical statusDrugDosageSide effectsOrthostatic hypotension直立性低血壓9 a f l o u r o hydrocortisone, mineralocorti-coid 9a-氟氫可的松0.5-2 mg/dayC o n g e s t i v e heart failure, hypertensionClonidine, a2 a d r e n e r g i c agonist可樂(lè)定0,1-0,5 mg, at bedtimeHypo

4、tension, sedation, dry mouthO c t r e o t i d e , somatostatin analogue善得定0 . 1 - 0 . 5 mg/kg/dayInjection side pain, diarrhoeaD i a b e t i c diarrheaMetranidazole, broad spectrum antibiotics2 5 0 m g , 3 t i m e s / d a y , m i n i m u m 3 weeksO r t h o s t a t i c hypotensionC l o n i d i n e ,

5、a2 a d r e n e r g i c agonist可樂(lè)定0 . 1 m g , 2 - 3 times/dayCholestyramine, b i l e a c i d sequestrant消膽胺4 g , 1 - 6 times/dayL o p e r a m i d e , opiate-receptor agonist洛哌丁胺2 m g , f o u r times/dayToxic megacolonO c t r e o t i d e , s o m a t o s t a t i n analogue善得定5 0 m g , 3 times/dayA g g r a v a t e n u t r i e n t malabsorption (at higher doses)CystopathyBethanechol, acetylcholine r e c e p t o r agonist烏拉膽堿1 0 m g , 4 times/dayDoxazosin, a1 adrener