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1、糖尿病慢性并发症的护理宝安区人民医院内分泌科Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.一、糖尿病慢性并发症的分类大血管 - 冠心病- 脑血管疾病- 周围血管病变 微血管 - 视网膜病
2、变- 肾病- 神经病变 糖尿病足Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.糖尿病慢性并发症及其后果并发症发生率（与非DM)相比 严重后果冠心病 3 5 倍中老年2DM主要死因高血压
3、2 5 倍心脑血管危险因素，加重肾 病脑血管病 2 4 倍致死，致残糖尿病肾病 尿毒症，2DM主要死因糖尿病视网膜病变 10 倍以上眼科主要致盲之一白 内障 3 5 倍严重影响视力周围神经病变 20 倍痛苦糖尿病足病痛苦，致残Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose
4、Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.糖尿病肾病变 一：概述糖尿病肾病是导致肾功能衰竭的常见原因。早 期糖尿病的特征是尿中白蛋白 排泄率轻度增加，逐 步进展至大量白蛋白尿和血清肌酐水平上升，最终 发生肾功能衰竭，需要透析或肾移植。Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. C
5、opyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.糖尿病肾病 糖尿病重要的微血管病变之一； 糖尿病常见并发症之一； 糖尿病患者主要的致死原因之一Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspo
6、se Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.白蛋白排泄量正常微量白蛋白尿大量白蛋白尿终末期肾病死亡糖尿病肾病 引起肾功能衰竭的最常见原因Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 200
7、4-2011 Aspose Pty Ltd.糖尿病肾病的临床分期（1） I期：肾小球高滤过，肾脏体积增大 II期：尿微量白蛋白正常，但肾脏基底膜增厚。 III期：早期糖尿病肾病，以持续性微量白蛋白尿为标志。尿微量白蛋白（20-200ug/min）Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-20
8、11 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.糖尿病肾病的临床分期（2） IV期：临床糖尿病肾病。临床蛋白尿200ug/min （或尿白蛋白排泌量300mg/24h；或尿蛋白 0.5g/day),可伴有水肿、高血压 V期：终末期肾功能衰竭。有氮质血症和肾功能衰竭。 BUN,Cr 显著升高。Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides fo
9、r .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.二、诊断要点1. 确诊糖尿病 2. 临床表现 蛋白尿 水肿 高血压 肾功能不全 贫血 3. 辅助检查 尿常规 血清肌酐浓度检查Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET
10、3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.三、 治疗要点 改变生活方式 低蛋白饮食 控制血糖 控制血压 纠正血脂紊乱 控制蛋白尿 透析治疗和移植Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile
11、5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.四、护理措施（一）1. 饮食护理 三大营养物质的合理塔配 限制蛋白质的摄入 限钠以减轻水肿及高血压（3g/d) 控制含钾食物 限制水的摄入：水的入量以前日尿量加500ml。Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5
12、 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.护理措施（二）2. 病情观察 监测体重，每日2次 记录24h出入量 观察血压、水肿、尿检结果、肾功能变化 观察有无贫血、电解质紊乱、酸碱失衡、尿素氮升高等情况。Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides fo
13、r .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.护理措施(三)3. 保护肾脏 尽量避免有肾毒性的药物 预防和治疗尿路感染 定期检查 心理护理：保持思想乐观,情绪稳定.Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5
14、Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.糖尿病视网膜病变一.临床分期单纯型 I 有微动脉瘤或并有小出血点II 有黄白色“硬性渗出”或并有出血斑III 有白色“软性渗出”或并有出血斑增殖型 IV 有新生血管或并有玻璃体出血V 有新生血管和纤维增殖VI 有新生血管纤维增殖，并发视网膜脱离Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Prof
15、ile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.单纯性糖尿病视网膜病变硬性渗出小出血点Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5
16、 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.增生性视网膜病变视盘区可见 新生血管Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Lt
