【正文】 62,第六十三頁，共六十三頁。所有病人在被診斷為糖尿病時(shí)必須利用簡單的臨床試驗(yàn)來篩查遠(yuǎn)端對稱性多神經(jīng)病變(DPN)，并且從那時(shí)以后至少每年篩查一次（A）?？蓪?dǎo)致反復(fù)感染、難愈合性潰瘍和足趾(zng)總結(jié),Basic Medical Knowledge 基礎(chǔ)醫(yī)學(xué)知識。,內(nèi)容(n232。),DPN篩查非常重要，在診斷DM時(shí)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。i shi)推薦使用的,第六十一頁，共六十三頁。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。,61,D. Neuropathy screening and treatment (171,172) D.糖尿病神經(jīng)病變篩查與治療(zh236。)抑制劑,5羥色胺和去甲(q249。o) Symptomatic treatments 對癥治療,三環(huán)類藥物,抗驚厥劑,P物質(zhì)(w249。,60,D. Neuropathy screening and treatment (171,172) D.糖尿病神經(jīng)病變篩查與治療(zh236。li225。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。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。 zhǔ sh233。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。 zhǔ sh233。ng)相關(guān)區(qū)域的檢查來實(shí)現(xiàn),第五十六頁，共六十三頁。o) Diagnosis of neuropathy 神經(jīng)病變的診斷,Loss of 10g monofilament perception and reduced vibration perception predict foot ulcers. 10g單絲壓力覺的喪失和音叉振動覺的降低預(yù)示著足部潰瘍的發(fā)生 A minimum of one clinical test should be carried out annually, and the use of two tests will increase diagnostic ability. 每年必須最少使用一項(xiàng)臨床檢查來檢測神經(jīng)病變，二項(xiàng)臨床檢查可以提高診斷率 Focal and multifocal neuropathy assessment requires clinical examination in the area related to the neurological symptoms. 局灶性和多病灶性神經(jīng)病變的判定需要神經(jīng)系統(tǒng)癥狀(zh232。,56,D. Neuropathy screening and treatment (171,172) D.糖尿病神經(jīng)病變篩查與治療(zh236。o) Diagnosis of neuropathy 神經(jīng)病變的診斷,Patients with diabetes should be screened annually for DPN using tests such as pinprick sensation, temperature and vibration perception (using a 128Hz tuning fork), and 10g monofilament pressure sensation at the distal plantar aspect of both great toes and ankle reflexes. 糖尿病病人每年必須進(jìn)行遠(yuǎn)端對稱性多神經(jīng)病變的篩查，常用的檢查方法有：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 Combinations of more than one test have 87% sensitivity in detecting DPN. 聯(lián)合應(yīng)用多于(duō y,55,D. Neuropathy screening and treatment (171,172) D.糖尿病神經(jīng)病變篩查與治療(zh236。nz224。li225。wǒ)足部護(hù)理的教育和穿著專用鞋的治療是整體治療的重要組成部分（B） ● A wide variety of medications is recommended for the relief of specific symptoms related to autonomic neuropathy and are recommended, as they improve the quality of life of the patient. (E) 為了改善病人的生活質(zhì)量，只要能緩解自主神經(jīng)病變相關(guān)特殊癥狀的多種治療方法都是被推薦使用的（E）,第五十三頁，共六十三頁。ny236。自主神經(jīng)病變同樣很少需要神經(jīng)電生理檢查，同時(shí)該檢查對自主神經(jīng)病變的治療及結(jié)果可能也沒有太多的影響（E）,第五十二頁，共六十三頁。任何一個(gè)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(hu236。ny236。n)篩查一次（A） ● Electrophysiological testing is rarely ever needed, except in situations where the clinical features are atypical. (E) 除非病人的臨床表現(xiàn)不典型而需要神經(jīng)電生理檢查外，其他情形很少需要這種檢查（E） ● Once the diagnosis of DPN is established, special foot care is appropriate for insensate feet to decrease the risk of amputation. (B) 一旦DPN診斷成立，對于無感覺足的特殊足部護(hù)理是適當(dāng)?shù)牟⑶疫€可以降低其截肢的危險(xiǎn)性,第五十一頁，共六十三頁。li225。,50,第五十頁，共六十三頁。)糖尿病學(xué)會,References：DIABETES CARE, VOLUME 30, SUPPLEMENT 1, JANUARY 2007,第四十八頁，共六十三頁。,48,Standards of Medical Care in Diabetes 糖尿病診療(zhěnli225。n chu225。zu236。li225。n)的治療,第四十六頁，共六十三頁。o) Treatment of Diabetic Neuropathy,補(bǔ)充(bǔchōng)神經(jīng)營養(yǎng) 神經(jīng)生長因子(NGF) 神經(jīng)節(jié)苷脂(GS),摘自《臨床薈萃》2006年12月5日第21卷第23期 糖尿