【正文】 on, sudomotor dysfunction, impaired neurovascular function, “brittle diabetes,” and hypoglycemic autonomic failure. 糖尿病自主神經(jīng)病變的常見臨床表現(xiàn)包括：靜息時心動過速、運(yùn)動不耐受、便秘、胃輕癱、勃起機(jī)能障礙、泌汗功能障礙、神經(jīng)血管功能受損，“脆性糖尿病”、低血糖性自主神經(jīng)功能衰竭 Cardiac autonomic neuropathy may be indicated by resting tachycardia (100 bpm), orthostasis (a fall in systolic blood pressure20 mmHg upon standing), or other disturbances in autonomic nervous system function involving the skin, pupils, or gastrointestinal and genitourinary systems. 靜息時心動過速（100bpm）、靜息狀態(tài)（站立時收縮壓下降超過20mmHg以上）、或者(hu242。zhě)其他一些自主神經(jīng)功能的紊亂包括皮膚、瞳孔、胃腸和泌尿生殖系統(tǒng)等可能提示心臟自主神經(jīng)病變的存在,第五十七頁，共六十三頁。,58,D. Neuropathy screening and treatment (171,172) D.糖尿病神經(jīng)病變篩查與治療 Diabetic autonomic neuropathy 糖尿病性自主神經(jīng)(z236。 zhǔ sh233。n jīnɡ)病變,Gastrointestinal disturbances (e.g., esophageal enteropathy, gastroparesis, constipation, diarrhea, fecal incontinence) are common, and any section of the gastrointestinal tract may be affected. Gastroparesis should be suspected in individuals with erratic glucose control. 胃腸道功能紊亂(如：食道性腸病、胃輕癱、便秘、腹瀉、大便失禁)是最常見的，同時胃腸道的任何部位都有受累的可能。血糖控制不穩(wěn)定的病人應(yīng)該首先懷疑胃輕癱的可能 Diabetic autonomic neuropathy is also associated with genitourinary tract disturbances, including bladder and/or sexual dysfunction. 糖尿病自主神經(jīng)病變同樣(t243。ngy224。ng)也可伴隨泌尿生殖系統(tǒng)功能紊亂，包括膀胱功能和性功能障礙 In men, diabetic autonomic neuropathy may cause loss of penile erection and/or retrograde ejaculation. 在男性，糖尿病自主神經(jīng)病變可能引起陰莖勃起功能障礙和逆行射精,第五十八頁，共六十三頁。,59,D. Neuropathy screening and treatment (171,172) D.糖尿病神經(jīng)病變篩查與治療(zh236。li225。o) Symptomatic treatments 對癥治療,The first step in management of patients with DPN should be to aim for stable and optimal glycemic control. 治療糖尿病患者遠(yuǎn)端對稱性多神經(jīng)病變的第一步是穩(wěn)定和理想的血糖控制 Most patients will require pharmacological treatment for painful symptoms: many agents have efficacy confirmed in published randomized controlled trials, though none are specifically licensed for the management of painfulDPN. See Table 10 對于疼痛的癥狀絕大多數(shù)患者都需要藥物治療，發(fā)表的隨機(jī)控制試驗證實許多治療方法都是有效的，但是還沒有一種被特別批準(zhǔn)(pī zhǔn)專門用于治療DPN疼痛癥狀的藥物（見表10）,第五十九頁，共六十三頁。,60,D. Neuropathy screening and treatment (171,172) D.糖尿病神經(jīng)病變篩查與治療(zh236。li225。o) Symptomatic treatments 對癥治療,三環(huán)類藥物,抗驚厥劑,P物質(zhì)(w249。zh236。)抑制劑,5羥色胺和去甲(q249。 jiǎ)腎上腺素再攝取抑制劑,阿米替林,去甲替林,丙米嗪,加巴噴丁,卡馬西平,普加巴林,辣椒辣素,第六十頁，共六十三頁。,61,D. Neuropathy screening and treatment (171,172) D.糖尿病神經(jīng)病變篩查與治療(zh236。li225。o) Treatment of autonomic neuropathy 自主神經(jīng)病變的治療,A wide variety of agents are used to treat the symptoms of autonomic neuropathy, including metoclopramide for gastroparesis and several medications for bladder and erectile ysfunction. These treatments are frequently used to provide symptomatic relief to patients. 多種多樣的治療方法或藥物被用于治療糖尿病自主神經(jīng)病變的癥狀，包括甲氧氯普胺治療胃輕癱、多種藥物治療膀胱和勃起功能障礙。上述這些治療方法經(jīng)常被用于改善病人的癥狀 Although they do not change the underlying pathology and natural history of the disease process, their use is recommended due to the impact they may have on the quality of life of the patient. 即使這些治療不能改變潛在的病理變化和疾病的自然進(jìn)程，但由于這些治療能改善病人的生活質(zhì)量，故還是(h225。i shi)推薦使用的,第六十一頁，共六十三頁。,62,Summary 總結(jié)(zǒngji233。),DPN篩查非常重要，在診斷DM時及以后至少每年篩查一次 篩查的常用方法有：針刺痛覺、溫度覺、音叉振動覺（使用128Hz音叉）、10g單絲壓力覺以及踝反射 強(qiáng)調(diào)自主神經(jīng)病變的各種表現(xiàn)，提高醫(yī)務(wù)保健人員的注意以防止(f225。ngzhǐ)對糖尿病神經(jīng)病變的漏診 治療DPN的第一步也是很重要的一步就是首先要穩(wěn)定而且理想的控制血糖 目前DPN的發(fā)病機(jī)制尚未明確，學(xué)術(shù)界只認(rèn)同是多因素的結(jié)果，所以對因治療是非常困難，故象醛糖還原酶抑制劑、α硫辛酸等病因治療藥物在此版診療標(biāo)準(zhǔn)中未被提及 凡是能改善病人生活質(zhì)量的各種治療方法都是推薦使用的,第六十二頁，共六十三頁。,內(nèi)容(n232。ir243。ng)總結(jié),Basic Medical Knowledge 基礎(chǔ)醫(yī)學(xué)知識。本資料摘自中華醫(yī)學(xué)雜志2005年7月27日第85卷第28期?？蓪?dǎo)致反復(fù)感染、難愈合性潰瘍和足趾(z zhǐ)或足截肢，美國報告15%截肢。所有病人在被診斷為糖尿病時必須利用簡單的臨床試驗來篩查遠(yuǎn)端對稱性多神經(jīng)病變(DPN)，并且從那時以后至少每年篩查一次（A）。任何一個異常均需給于病足所需的特殊靴鞋、或者讓預(yù)防專家或足醫(yī)進(jìn)行會診（B）。62,第六十三頁，共六十三頁。,