更健康、更自由的生活幻燈片

糖尿病的藥物治療主講:北大一院馮晉光教授主辦:河北北方學(xué)院附屬第二醫(yī)院更健康、更自由的生活－胰島素泵治療美敦力（中國）有限公司糖尿病業(yè)務(wù)如果你還不了解美敦力，請?jiān)试S我來介紹一下。美敦力是一家在全球居于領(lǐng)先地位的醫(yī)療技術(shù)公司，致力于位慢性病患者提供終身的解決方案。在過去的歲月里，美敦力已經(jīng)為逾500萬的患者提供了專業(yè)的醫(yī)療產(chǎn)品及治療，幫助他們改善了生活品質(zhì)。背景音樂：1、無心快語2:45

2、電話訴衷情3:45美美敦敦力力公公司司成成立立于于1949年，EarlBakken是一名電子工程師，公司創(chuàng)始之初，只是一個(gè)服務(wù)性公司，第一個(gè)月因維修冰箱掙了8美元。后來醫(yī)生希望Earl嘗試去設(shè)計(jì)新的設(shè)備，美敦力積極響應(yīng)開始了它的生產(chǎn)業(yè)務(wù)。History

and

Background1949年成立，成立之初為一家醫(yī)療設(shè)備服務(wù)公司創(chuàng)始人Earl

Bakken

在1957年發(fā)明了第一臺有9伏電池驅(qū)動(dòng)的攜帶式的體外起搏器。Other

key

dates:1960

開發(fā)出第一臺可以長期使用的埋植式起搏器–圖片展示的是一種早期的埋植設(shè)備1967

在歐洲的阿姆斯特丹設(shè)立第一個(gè)歐洲區(qū)的服務(wù)中心1970’s

在波多黎各、加拿大、法國建立制造廠1990’s

收購15個(gè)公司，并快速成長Early

2000’s

增加了糖尿病治療、胃腸動(dòng)力、泌尿系失常治療技術(shù)業(yè)務(wù)History

and

Background第一臺佩戴式電池驅(qū)動(dòng)的體外起搏器早期的植入式起搏器（右圖）1960,美敦力公司的創(chuàng)始者貝肯寫下公司宗旨：應(yīng)用生物科學(xué)工程理論，研究、設(shè)計(jì)、制造并銷售可減輕病痛、恢復(fù)健康、延長壽命的儀器和裝置，以此促進(jìn)人類的福祉。Medtronic

Mission:完全的被員工所理解–最近的調(diào)查顯示，90%的員工清楚地了解公司的宗旨被譯為10種語言40多年來未修改一個(gè)字History

and

Background公司宗旨應(yīng)用生物科學(xué)工程理論，研究、設(shè)計(jì)、制造并銷售可減輕病痛、恢復(fù)健康的儀器和裝置，以此促進(jìn)人類的福祉。Medtronic

Leadership:Art

Collins

，美敦力的主席和CEO.1992年加入美敦力.Medtronic

Today

領(lǐng)導(dǎo)人從從起起搏搏器器業(yè)業(yè)務(wù)務(wù)開開始始，，美美敦敦力力公公司司已已逐逐步步發(fā)發(fā)展展成成為為心心血血管管、、神神經(jīng)經(jīng)產(chǎn)產(chǎn)品品、、脊脊椎椎疾疾病病、、泌泌尿尿科科、、耳耳鼻鼻喉喉、、糖糖尿尿病病治治療療產(chǎn)產(chǎn)品品領(lǐng)領(lǐng)域域的的領(lǐng)領(lǐng)先先者者。。穩(wěn)定的增長2003財(cái)政年度凈銷售額為76億美元Medtronic

Today拓展業(yè)務(wù)公司保持了長期的穩(wěn)步增長。過去5年的年增長率達(dá)到17.5%事實(shí)上，美敦力公司已連續(xù)18年保持銷售收入和利潤的增長。Medtronic

Today穩(wěn)步增長凈銷售5年的年增長率達(dá)到17.5%(dollarsin

billions)不斷的更新產(chǎn)品在醫(yī)療工業(yè)中非常重要，美敦力曾被稱為“革新機(jī)器”。我們不斷探尋新的治療疾病的新方法。去年我們投入了7億美元用于研發(fā)，相當(dāng)于全年銷售收入的10%。用戶和患者總在尋找更新的治療產(chǎn)品，所以產(chǎn)品的銷售周期很短，我們的年收入中，2/3是來自于最近兩年的新產(chǎn)品。Medtronic

Today注重研發(fā)$749

million

in

FY010%

of

sales·2/3的年收入是來自于最近兩年上市的新產(chǎn)品。美敦力成功地將它的業(yè)務(wù)擴(kuò)展到全球:我們的業(yè)務(wù)遍布120個(gè)國家美敦力在全世界擁有30,000名員工，250個(gè)辦事機(jī)構(gòu)–生產(chǎn)，銷售辦事處,研發(fā)中心,教育中心,總部辦公室在加利福尼亞、波多黎各、愛爾蘭、上海、中國等地設(shè)有生產(chǎn)基地;亞洲的中心在香港;歐洲的總部和生產(chǎn)基地在瑞典;為臨床醫(yī)生建立了22教育中心30,000名雇員120個(gè)國家超過250個(gè)分支機(jī)構(gòu)Medtronic

Today全球策略美敦力的歐洲/中東/非洲業(yè)務(wù)的總部位于瑞典。美敦力于1967年在歐洲設(shè)立辦事機(jī)構(gòu)，目前歐洲的雇員已超過5000人。Medtronic

Today全球策略美敦力歐洲部總部在瑞典

歐洲的人口占世界人口的25%

2002年，美敦力歐洲部的收入超過10億美金Medtronic

EuropeTolochenaz,

Switzerland美敦力在亞太地區(qū)業(yè)務(wù)發(fā)展同樣迅速，1976年開始設(shè)立亞太總部，現(xiàn)在在這個(gè)區(qū)域擁有1200名雇員。1997年，在中國上海開設(shè)了辦事處和起搏器工廠亞太區(qū)的具有巨大的發(fā)展?jié)摿Γ驗(yàn)閬喬珔^(qū)擁有世界上60%的人口Medtronic

Today全球策略BangkokBeijingBrisbaneGuangzhouHong

KongJakartaKawasakiKuala

LumpurManilaMelbourneSeoulShanghaiSingaporeSydneyTaipeiTokyo美敦力的亞太區(qū)業(yè)務(wù)通過我們的全球策略，目前我們每年可以450萬人提供治療這就是時(shí)說每7秒鐘就有一個(gè)人的生活猶豫美敦力的產(chǎn)品或治療而得到改善。為了改善更多人的生活，我們要不斷的探索未來，探索更好的治療方法。Medtronic

TodayEvery

7

Seconds...As

a

result

of

our

global

reach

we

treat

more

than

4.5

million

patients

per

year

(approximately

as

many

people

as

live

in

metropolitan

Atlanta)This

means

that

every

7

seconds,

someone’s

life

is

improved

by

aMedtronic

product

or

therapyTo

improve

the

lives

of

even

more

patients,

we

are

constantlylooking

to

the

future,

looking

ahead

to

new

therapies

…Medtronic

TodayEvery

7

Seconds...As

a

result

of

our

global

reach

we

treat

more

than

4.5

million

patients

per

year

(approximately

as

many

people

as

live

in

metropolitan

Atlanta)This

means

that

every

7

seconds,

someone’s

life

is

improved

by

aMedtronic

product

or

therapyTo

improve

the

lives

of

even

more

patients,

we

are

constantlylooking

to

the

future,

looking

ahead

to

new

therapies

…Medtronic

TodayEvery

7

Seconds...We

came

up

with

this

vision

for

severalreasons:Patients

as

a

whole

are

dissatisfied

withcurrent

health

care

system,

especially

those

patients

trying

to

manage

chronic

diseaseDemographically,

the

baby

boomgeneration

is

aging

–

this

isalarge

group

of

people

who

will

develop

chronic

diseases

over

the

comingyears

–

This

is

also

a

group

of

people

who

are

taking

charge

of

their

own

health

care

like

never

before.In

addition,

there

is

a

wealth

of

information

available

to

people

now

–

much

of

it

via

the

internet

–

and

patients

are

more

apt

to

go

to

sources

such

as

the

internet,

books,

friends

and

family

BEFORE

they

turn

to

their

doctor

for

advice

…

In

fact,

more

people

would

turn

to

the

Internet

–

15%

-

than

would

go

to

traditional

sources

such

as

books.Taken

together,

we

saw

that

the

health

systemas

a

whole

is

moving

toward

more

“patient-centered

health

care”O(jiān)ur

Visionhelps

positionMedtronic

to

take

advantage

of

the

synergies

in

medical

technology

and

information

technology

to

meet

the

needs

ofthis

new

kind

of

empowered

patientOur

vision

helped

us

see

that

we

can

offer

many

kinds

ofhealth

solutions,

not

just

devices

and

productsOur

Vision以病人為中心的醫(yī)療服務(wù)+ patient

dissatisfaction+ Chronic

Disease+ Personal

Responsibility+ Wealth

of

Information= Patient

CenteredHealth

Care由由于于我我們們擁擁有有的的產(chǎn)產(chǎn)品品、、經(jīng)經(jīng)驗(yàn)驗(yàn)和和全全球球網(wǎng)網(wǎng)絡(luò)絡(luò)，，我我們們可可以以為為全全世世界界的的慢慢性性病病患患者者提提供供治治療療方方案案。。美敦力的主要產(chǎn)品覆蓋了以下領(lǐng)域：心動(dòng)過緩、心動(dòng)過速、房顫、心衰、血管疾病、心臟瓣膜指緩、體外心臟支持、微創(chuàng)心臟手術(shù)、惡性和非惡性的疼痛、運(yùn)動(dòng)失調(diào)、糖尿病、胃腸病、泌尿系統(tǒng)疾病、脊柱疾病、神經(jīng)系統(tǒng)疾病以及五官科手術(shù)等。慢性疾病的治療方案Our

expertise

as

a

company

started

byproviding

therapies

for

cardiovascular

disease,

and

we

remain

the

#1

market

leader

in

almost

all

productlines

that

treat

cardiovascular

disease

–

implantable

pacemakers

and

defibrillators,

mechanicaland

tissue

heart

valves,

catheters

and

stents

toopen

blocked

arteries

or

veins,

as

well

as

products

used

during

heart/lung

surgeries.One

area

we’re

focusing

on

is

Heart

Failure

–

This

progressive

deterioration

of

the

heart’s

capability

to

pump

affects

more

than

22

millionpeople

worldwide.Our

InSync

andInSync

ICD

cardiac

resynchronization

devices

are

the

newest

solution

to

treating

this

huge

problem–

they

provide

electricalstimulation

so

that

two

chambers

of

the

heart

can

beat

normally

and

improve

blood

flow

to

the

body.全世界有220萬患者

解決方案：起搏器、起搏電極、雙心室除顫起搏器等慢性疾病的治療方案心律失常和心衰InSync?InSync

ICD?Attain?LeadsSudden

cardiac

arrest

is

another

area

where

Medtronic

focuses

its

efforts

…Sudden

cardiac

arrest

strikes

one

American

every

two

minutes

and

is

the

leading

cause

of

death

in

the

U.S.

–

As

many

as

1,200

people

die

eachday

because

of

sudden

cardiac

arrest,

yet

many

could

be

saved

if

they

had

quicker

access

to

automated

external

defibrillators

(AEDs).

TheMedtronic

LIFEPAK?

CR

Plus

is

the

first

fullyautomatic,

external

defibrillator

for

use

in

sports

arenas,

shoppingmalls,

worksites,

airplanes,casinos

…

anywhere

people

gather.Once

a

person

has

survived

a

sudden

cardiac

arrest,

they

are

more

likelyto

survive

another

attack

if

they

receive

an

implantable

cardioverterdefibrillatororICD

(see

Medtronic

Marquis

above)

that

has

the

ability

to

deliver

a

powerful

electric

shock

and

restart

the

heart

during

suddencardiac

arrest.慢性疾病的治療方案心跳驟停解決方案植入式除顫器、體外除顫器Marquis?LIFEPAK?

CR

PlusMedtronic

also

develops

treatments

and

therapies

for

Vascular

diseases

–

those

that

affect

the

coronary,

peripheral

and

cerebral

vesselsFor

instance,

we

have

therapies

to

treat

coronary

artery

disease,

whichis

the

result

of

the

build

up

of

fatty

deposits

(plaque)

in

the

coronaryarteries.

The

blockage

in

the

coronary

artery

prevents

blood

fromreaching

the

heart

muscle.

Our

therapies

include

catheters

(see

the

Zipperabove)

used

to

open

blocked

arteries

duringballoon

angioplastyprocedures,

and

stents

–

small

“scaffolds”

that

are

inserted

into

the

artery

after

it

has

been

unblockedWe

also

have

a

therapy

–

the

AneuRx

endovascular

graft

stent

–

for

potentially

fatal

abdominal

aortic

aneurysms,

which

are

“bulges”oraccumulations

of

fatty

deposits

on

the

large

artery

that

runs

from

the

heart

downthrough

the

abdomenOur

focus

is

on

minimally

invasive

therapies

–

whichresult

in

fewer

hospital

stays

for

the

patient

and

potentially

faster

recovery慢性疾病的治療方案心血管疾病-Vascular冠狀動(dòng)脈疾病---支架傳輸系統(tǒng)、球囊、導(dǎo)引及診斷導(dǎo)管、導(dǎo)絲及遠(yuǎn)端拴賽保護(hù)系統(tǒng)外周血管疾病---腎支架系統(tǒng)、血管內(nèi)支架成形術(shù)及遠(yuǎn)端拴塞保護(hù)系統(tǒng)Zipper?

TechnologyAneuRx?stent

graftMedtronic

established

its

second

focus

area

–

therapies

for

Neurological

diseases

–in

the

mid1980s.

We

are

a

pioneer

in

this

field

and

havemanyinitiatives

underwayto

restore

people

to

normal

brain

function

and

chemistry.Our

implantable

neurostimulationand

infusion

systems

treat

disorders

through

electrical

stimulation

or

drugs

delivered

inprecise

amounts

tospecific

sites

in

the

brain

and

spinal

cord.Medtronic

has

therapies

to

treat

spasticity,

tremor,

chronic

pain,

incontinence

and

Parkinson’s

disease.OurActiva

Parkinson"s

Control

Therapy

is

one

of

the

most

significant

advances

in

the

treatment

of

Parkinson"s

disease

in

more

than

30years

offering

an

innovative

treatment

approach

–

electricallystimulating

targeted

areas

of

the

brain.On

the

far

horizon,

we

are

exploringnew

treatments

for

other

diseases

including

epilepsy,

depression,

and

other

neurological

disorders.慢性疾病的治療方案神經(jīng)科疾病運(yùn)動(dòng)失調(diào)--用植入式腦神經(jīng)刺激儀治療帕金森病、嚴(yán)重震顫和張力障礙慢性疼痛--用植入式腦神經(jīng)刺激儀或藥物輸注系統(tǒng)治療SynchroMed?Activa?Another

area

of

focus

is

restorative

neurosurgeryand

spinal

surgery,

where

we

have

spinal

systems

that

allow

physicians

to

treat

virtually

any

ofthe

more

than

1

million

spinal

surgery

patients

worldwide.We

continue

to

pioneer

less

invasive

surgical

procedures–

for

example,

surgery

for

scoliosis

which

reduces

the

need

for

the

large

scar

down

thepatient’s

backMedtronic

is

also

the

leading

innovator

inrestorative

neurosurgery

–

treating

congenital

spine

disorders

and

creatingspinal

fixation

systems

or“cages”

that

allow

the

bone

to

fuse

together

more

naturallyDrawing

on

our

interest

in

biologics,

we

have

pioneered

the

INFUSE

Bone

Graft,

which

uses

genetically

engineered

protein

to

stimulate

bonegrowth

to

encourage

the

bone

to

heal

itself

after

injury.慢性疾病的治療方案脊柱疾病脊柱側(cè)凸--胸腰脊柱治療系統(tǒng)退行性脊椎盤疾病--頸部、胸部、腰部脊柱植入，骨移植替代以及骨形態(tài)蛋白INFUSE?

BoneGraftFixation

Systems慢性疾病的治療方案糖尿病領(lǐng)先的糖尿病解決方案胰島素輸注設(shè)備動(dòng)態(tài)血糖監(jiān)測系統(tǒng)“人工胰腺”MiniMed?

CGMSMiniMed?Insulin

PumpIn

early

2000,

we

tooka

look

atthe

future

of

health

care

and

crafted

a

new

Vision

for

how

we

will

do

business

…We

crafted

this

new

vision

because

as

a

company,

Medtronic

constantly“reinvents”

itself

to

build

on

strengthsMiniMed內(nèi)容簡介使用胰島素泵的益處胰島素泵的適用癥開始胰島素泵治療前的準(zhǔn)備基礎(chǔ)量的建立和調(diào)整餐前大劑量及追加量的給予日常管理胰島素泵的簡介Continuous

SubcutaneousInsulin

Infusion(糖尿病治療技術(shù)的發(fā)展注射胰島素尿糖試紙血糖感應(yīng)器人工胰腺199919221900s19771978驗(yàn)?zāi)?776血糖儀胰島素泵療法胰島素泵發(fā)展歷程在過去的20年中，超過30家公司進(jìn)行過胰島素泵的研制和生產(chǎn)正常胰腺的胰島素釋放每天2次注射胰島素-胰島素的療效與血糖控制時(shí)間缺乏一致性-治療的靈活性受到挑戰(zhàn)短效+中效胰島素Injections每天注射胰島素4次若胰島素、運(yùn)動(dòng)或飲食可以預(yù)測，治療將會(huì)更加靈活生活方式的靈活性問題甘精胰島素+速效胰島素Injections每日多次注射胰島素治療的缺點(diǎn)只降低注射期間的血糖。不能完全按血糖變化曲線控制血糖。容易產(chǎn)生低血糖。不能處理黎明現(xiàn)象。不能有效控制并發(fā)癥?；颊咄纯喽啵缽男圆?。不能有效提高生活質(zhì)量。胰島素泵給藥特點(diǎn)胰島素的輸注與胰島素的需求相配和根據(jù)胰島素的需求設(shè)置多段基礎(chǔ)率通過餐前大劑量功能隨時(shí)補(bǔ)充胰島素胰島素泵治療的基本原理基礎(chǔ)率：預(yù)設(shè)的持續(xù)輸注的短效胰島素滿足代謝需要大劑量提供進(jìn)食碳水化合物所需的胰島素補(bǔ)充大劑量–解決高血糖增加基礎(chǔ)率，防止黎明現(xiàn)象12

am12

amMeal

Bolus12

pm654321運(yùn)動(dòng)時(shí)使用減量的基礎(chǔ)率血糖控制接近正常的益處大規(guī)模的流行病學(xué)研究揭示－－嚴(yán)格的血糖控制，顯著降低并發(fā)癥的風(fēng)險(xiǎn).延遲并發(fā)癥的發(fā)生

15.3年為病人贏得

5.1年的壽命DCCT研究：胰島素泵組比每日多次注射組的HbA1C低0.2---0.4%當(dāng)HbA1c=7.2%，微血管并發(fā)癥風(fēng)險(xiǎn)顯著減少:76%的視網(wǎng)膜病變60%的神經(jīng)病變56%的腎病胰島素泵的藥代動(dòng)力學(xué)優(yōu)點(diǎn)只使用短效或超短效胰島素–與中長效胰島素相比，其吸收更可預(yù)測(變異率僅為

3%)定期更換注射部位–減少因注射部位不同而造成吸收變異消除皮下胰島素池個(gè)體化的胰島素輸注，更好地配合生理需要*

Lauritzen:

Diabetologia

1983;

24:326-9使用胰島素泵的益處（一）幫助糖尿病病人控制血糖接近正常的一個(gè)有效措施：延緩視網(wǎng)膜病變的發(fā)生和進(jìn)展；減少糖尿病腎病的危險(xiǎn)性；減少糖尿病神經(jīng)病變的危險(xiǎn)性；減少糖尿病病人心血管和外周血管并發(fā)癥；使用胰島素泵的益處（二）