急性卒中的血糖管理PPT课件.pptVIP

Striking Differences in Glucose and Lactate Levels Between Brain Extracellular Fluid and Plasma in Conscious Human Subjects: Effects of Hyperglycemia and Hypoglycemia Brain levels of glucose and lactate in the extracellular fluid (ECF), which reflects the environment to which neurons are exposed, have never been studied in humans under conditions of varying glycemia. The authors used intracerebral microdialysis in conscious human subjects undergoing electrophysiologic evaluation for medically intractable epilepsy and measured ECF levels of glucose and lactate under basal conditions and during a hyperglycemia-hypoglycemia clamp study. Only measurements from nonepileptogenic areas were included. Under basal conditions, the authors found the metabolic milieu in the brain to be strikingly different from that in the circulation. In contrast to plasma, lactate levels in brain ECF were threefold higher than glucose. Results from complementary studies in rats were consistent with the human data. During the hyperglycemia-hypoglycemia clamp study the relationship between plasma and brain ECF levels of glucose remained similar, but changes in brain ECF glucose lagged approximately 30 minutes behind changes in plasma. The data demonstrate that the brain is exposed to substantially lower levels of glucose and higher levels of lactate than those in plasma; moreover, the brain appears to be a site of significant anaerobic glycolysis, raising the possibility that glucose-derived lactate is an important fuel for the brain. * * 低血糖引起脑损害的临床表现 其临床表现主要有肾上腺素样作用和中枢神经功能不全症状两类。前者为临床医生所熟悉，表现为饥饿感、心悸、多汗、头晕、眼花、颤抖、无力等。中枢神经系统的表现包括行为异常、烦躁不安、定向力下降、视力障碍、木僵、昏迷和癫痫、意识障碍等。 * * 2型糖尿病患者常合并代谢综合征的一个或者多个组分的临床表现，如高血压、血脂异常、肥胖症等。随着血糖、血压、血脂等水平的增高及体重增加，2型糖尿病并发症的发生风险、发展速度以及其危害将显著增加。因此，应针对2型糖尿病患者采用科学、合理、基于循证医学的综合性治疗策略，包括降糖、降压、调脂、抗凝、控制体重和改善生活方式等治疗措施。其中降糖治疗又包括饮食控制、合理运动、血糖监测、糖尿病自我管理教育和应用降糖药物等综合性治疗措施。 2型糖尿病理想的综合控制目标视患者的年龄、合并症、并发症等不同而异，详见表1。治疗未能达标不应视为治疗失败，控制指标的任何改善对患者都将有益，将会降低相关危险因素引发并发症的风险，如HbA1c水平的降低与糖尿病患者微血管并发症及神