进阶-06.糖尿病慢性并发症的管理_20120712.ppt

当2型糖尿病确诊时，50%的患者已存在并发症。 * 解决复杂问题的方法是首先将之简单化，因此我们将糖尿病管理拆分成下面3个部分： 糖尿病教育是糖尿病管理的重要组成部分 糖尿病教育的内容也是糖尿病管理的重要内容 糖尿病并发症与合并症的诊治流程是糖尿病管理探讨的热点 接下来，我们将对这三个分别阐述。 首先，我们来介绍糖尿病教育，糖尿病教育是糖尿病管理的重要组成部分，也是成功管理及成功自我管理糖尿病的重要方法 * 糖尿病肾病是糖尿病常见的并发症之一，在糖尿病病人群中的发生率约为20－40% 伴有终末期糖尿病肾病的5年生存率小于20% 糖尿病肾病是糖尿病致命的主要原因 糖尿病肾病主要见于糖尿病病程较长，病情较重，长期高血糖症以及伴有高血压或有吸烟嗜好的男性病人 * * 由药剂师与糖尿病专家组成的队伍所提供的有结构护理，能降低早期糖尿病肾病患者的死亡率与末期肾脏疾病数字 * * This is a normal left retina. The more prominent vessels are the veins, the lighter vessels are the arterioles. The optic disc is on the left. The macula or the part of the eye required for central vision is the darker area indicated by the top arrow and is situated two disc diameters lateral to the disc margin. * As mentioned previously, there are different grades of retinopathy within the NPDR classification. In minimal retinopathy, only one or two microaneurysms are present. In mild NPDR, there are microaneuryms as well as dot or blot haemorrhages. In moderate NPDR, hard exudates ? deposits of lipids ? are also present. The features that characterize severe non-proliferative retinopathy are: Venous beading or looping Multiple haemorrhages Multiple soft exudates or cotton wool spots which indicate areas of ischaemia A condition called intra-retinal microvascular abnormalities (IRMA). Early referral to an ophthalmologist is essential as these lesions are sight-threatening. Proliferative retinopathy is sight-threatening and requires immediate referral to an ophthalmologist for treatment. The features of proliferative retinopathy are: New vessels on the optic disc or new vessels anywhere in the retina. These are fine, fragile vessels that break and bleed easily. Pre-retinal haemorrhage. This slide shows advanced proliferative retinopathy, fibrous tissue or old scar tissue which develops from previous bleeds and can lead to retinal detachment and blindness. * 糖尿病肾病是糖尿病常见的并发症之一，在糖尿病病人群中的发生率约为20－40% 伴有终末期糖尿病肾病的5年生存率小于20% 糖尿病肾病是糖尿病致命的主要原因 糖尿病肾病主要见于糖尿病病程较长，病情较重，长期高血糖症以及伴有高血压或有吸烟