糖尿病痛性神經(jīng)病變的發(fā)病機(jī)制和治療課件

糖尿病痛性神經(jīng)病變的發(fā)病機(jī)制和治療糖尿病在世界范圍的流行趨勢600366millionpeoplewithDMin201122012001352025ZimmetP,etaL.Nature2001:414:782-7.2./node/10497unode=3b96844a-c026-2fd3-87e85fdz293f42e92型糖尿病成為年輕人日益增長的威脅近年來在兒童或青少年中2型糖尿病的流行呈引人注目地增高糖尿病并發(fā)癥增加2-4倍的心血糖尿病眼底死亡和中風(fēng)病變適齡成人失明的主要原因中風(fēng)心血管疾病糖尿病腎病終末期腎病的主要原因糖尿病外周神經(jīng)病變非創(chuàng)傷性下肢截肢的主要原因DiabeticNeuropathies:UpdateonDefinitions,DiagnosticCriteria,EstimationofSeverity,andTreatmentsTESFATE,MDFRCPATOZAMALIK,MDM.BouLTON,MDhasbeenshawntobestabilized,per-gycemIccontrol.ThtspolyneuropathyPETERKEIPALLVALEOFTHETORONTOD山mrEGIUSEPPELALRLA,MDNEUROPATHYEXPERTGROUPctionandneuro-DiabetesCare2010:33:2285-93MechanismsandManagementofDiabeticPainfuldistalSymmetricalP。loner。pathyDLOMONTESFAYE,indicationofthecondition.TheoccurrenceANTHONYH.DICKENSON.FHDSofdiabeticretinopathyandnephropathychanumberofthedabeticneuropathiesmayresultnpanfulsymptomatologythisthatpredisposestofootulceration(1)and/(DSPN).tisestmatedthat15-20%ofdiabeticpatientsmayhavepaimfalDSPN,bautnotalloforneuroparhepain(painfulDSPN),whichlongitudinalstudiesandclinicaltrials,quantitivesensorytestingandce由出toassessclinicalfeaturesofpainfulthefrequencyandseverityofneuropathicpadn.AlthoughtheexacpathophysldlogialprocessesDSPN-TheonsetofDSPNisusuallyharresultndabeticneuropathicpamremainenigmatic,bothperipheralandcenralmecha.gradualorinsidiousandisheraldedbensorsymptomsthatstartinthetomumbercfpharma.andthenprogressproximallytoinvolvm上htm出已dmadoritiesforpainfulneuropathynrandpathogenictherapy,hasevi-ylowerlimbsinmoreseverecases,thereisdenceofefficacybutisnothcensedintheU.S.andseveralEuopeancountries.iswithupperhmbinvolvement,withasimilarDSPNareatincreasednskoffootulcerationandrequirefooccare,education,andfpossible,progressionproximallystartinginfingers,Asthediseaseadvancesfurther,tormanifestations,suchaswastingofDiabetesCare36.1-10,2013thesmallmuselesofthehandsandliml末梢、對稱性、多神經(jīng)病變(DSPN)-50%ofDM足潰瘍和截肢最強的危險因索與視網(wǎng)膜病變和腎臟病變相關(guān)慢性高糖的暴露是腦血管病變的危險因素嚴(yán)格血糖控制可以預(yù)防微血管并發(fā)癥對稱性、長度依賴性、感覺運動性神經(jīng)病變神經(jīng)病變痛自主神經(jīng)變感覺遲鈍燒灼感體位性低血壓足潰瘍電擊/針刺痛心臟自主神經(jīng)病變感染胃輕癱深部痛腹瀉截肢感覺遲鈍便秘跌倒麻木尿失禁上肢癥狀末梢、對稱性性功能障礙夜間加重出汗運動癥狀糖尿病伴發(fā)疾病(HD,cVD,PVD,obesity,Nephropathy,DR,↑BP,↑LDL,A1c英國糖尿病學(xué)會推薦每年進(jìn)行足部檢查足部檢査應(yīng)脫鞋和襪子檢查足部畸形的部位檢查出現(xiàn)胼胝的部位尋找潰瘍的征象詢問以往是否有潰瘍●檢查足背動脈波動外周神經(jīng)的檢查(10g單絲或振動覺)檢查鞋襪詢問是否出現(xiàn)神經(jīng)痛DiabetesUKPuttingfeetfir.uk/documeNts/professionals/education%20and%2