2张表概括糖尿病痛性神经病变治疗药物

2018-12-19 药学服务者 医学界内分泌频道

盘点糖尿病痛性神经病变的治疗药物。

糖尿病周围神经病变是糖尿病常见的慢性并发症,部分表现为远端对称性神经病变并伴有糖尿病痛性神经病变。糖尿病痛性神经病变的发病机制常见损伤神经异位放电,离子通道活性改变,中枢敏化,皮质抑制功能丧失等,引起的神经痛让患者备受煎熬。

那么,治疗糖尿病痛性神经病变的药物有哪些呢?

>>>>针对发病机制的药物

1. α-硫辛酸:抗氧化应激,增加神经血液供应,改善神经传导速度。长期饮酒可影响本药治疗的成功率,应建议患者戒酒;

2. 依帕司他:抑制红细胞内的山梨醇积累,改善神经功能、缓解症状。用药后,尿液可能呈褐红色或黄褐色;若连续使用12周无效,应考虑换药;

3. 甲钴胺:营养神经,促进髓鞘修复,刺激轴突再生,缓解疼痛症状。从事汞及其化合物工作的人员,不宜长期大量使用本药;

4. 前列地尔:改善微循环,提高神经细胞血液供应、提高氧供,改善神经功能。注意10%~12%的先天性心脏缺陷新生儿使用后可出现呼吸暂停。

药物具体适应证及用药用量和不良反应见下表。
 
表1 针对发病机制的药物



>>>>针对疼痛症状的药物

1. 普瑞巴林和加巴喷丁:通过与电压依赖性钙离子通道结合,阻断钙离子通道减少神经递质释放,其中美国糖尿病学会(ADA)推荐普瑞巴林作为起始症状治疗;

2. 度洛西汀和文拉法辛:均为选择性抑制去甲肾上腺素和5-羟色胺再摄取,其中ADA推荐度洛西汀作为起始症状治疗;

3. 阿米替林:抑制神经突触对去甲肾上腺素和5-羟色胺的再摄取,提高疼痛阈值缓解疼痛。该药不得与单胺氧化酶抑制药合用,停用单胺氧化酶抑制药14日后方可使用本药。

4. 卡马西平:阻断钠离子通道,稳定神经细胞膜,缓解疼痛不用于一般性疼痛,止痛效应限于神经源性疼痛。突然撤药可致癫痫发作,应于6个月内逐渐停药。

5. 曲马多:非选择性的μ、δ和Κ阿片受体完全激动药。长期使用可能引起耐药及身体依赖,有药物滥用和依赖倾向患者应短期使用。

6. 辣椒素:局部作用于周围神经轴突,导致来自所有神经元P物质减少。不推荐大面积使用;如出现严重烧灼感应停药,并用食用油除去残余药物,避免用热水清洗。

药物具体适应证及不良反应见下表。

表2 针对疼痛症状的药物



小结

糖尿病痛性神经病变的治疗药物分为针对神经病变发病机制和针对疼痛症状的药物两类。针对发病机制的药物,根据患者的病情可选择一种或多种联合使用。针对疼痛症状的药物,FDA推荐应用普瑞巴林或度洛西汀作为起始症状治疗,综合评估患者情况,也可用加巴喷丁起始治疗。在治疗期间,需密切关注患者症状改善情况、合并症、用药依从性以及药品不良反应,及时调整用药方案。

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    2019-02-25 13718711b3m

    值得借鉴与学习的临床资料,实用性非常强的临床经验,学习了,获益匪浅,感谢分享!

    0

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    2018-12-26 jyzxjiangqin

    糖尿病痛性神经病变治疗药物。

    0

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    2018-12-21 axin012
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  6. [GetPortalCommentsPageByObjectIdResponse(id=1921728, encodeId=652e1921e2878, content=<a href='/topic/show?id=4f0a6469837' target=_blank style='color:#2F92EE;'>#治疗药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64698, encryptionId=4f0a6469837, topicName=治疗药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c9d3459, createdName=周虎, createdTime=Sat May 04 21:45:00 CST 2019, time=2019-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=361483, encodeId=c03436148345, content=值得借鉴与学习的临床资料,实用性非常强的临床经验,学习了,获益匪浅,感谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/02/27/c53a212859edcad4f60a54feffff50bb.jpg, createdBy=67cf1525321, createdName=13718711b3m, createdTime=Mon Feb 25 12:52:19 CST 2019, time=2019-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=356480, encodeId=b26135648059, content=糖尿病痛性神经病变治疗药物。, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Wed Dec 26 20:19:06 CST 2018, time=2018-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1491332, encodeId=da091491332ee, content=<a href='/topic/show?id=5316e4387aa' target=_blank style='color:#2F92EE;'>#神经病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74387, encryptionId=5316e4387aa, topicName=神经病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ab48885684, createdName=axin012, createdTime=Fri Dec 21 10:45:00 CST 2018, time=2018-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1500390, encodeId=3be21500390c0, content=<a href='/topic/show?id=ecdfe438970' target=_blank style='color:#2F92EE;'>#神经病变#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74389, encryptionId=ecdfe438970, topicName=神经病变)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ea69427176, createdName=lingaifan, createdTime=Fri Dec 21 10:45:00 CST 2018, time=2018-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=355905, encodeId=c2c035590576, content=谢谢分享,非常有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaELCAs1uRBgDoWqJaBltta2Y7fTibyM6wYf94osSMg5CCm9oy7JrdcXPqh1DrCdn5IxO4BE8ZLEiaQXQ/0, createdBy=978a1675334, createdName=xiaogan8479, createdTime=Thu Dec 20 09:03:17 CST 2018, time=2018-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1042122, encodeId=bdbb1042122fb, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Wed Dec 19 22:45:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=355874, encodeId=cdc73558e408, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=82311653708, createdName=医者仁心5538, createdTime=Wed Dec 19 21:37:23 CST 2018, time=2018-12-19, status=1, ipAttribution=)]
    2018-12-20 xiaogan8479

    谢谢分享,非常有用

    0

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    2018-12-19 misszhang

    谢谢MedSci提供最新的资讯

    0

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    2018-12-19 医者仁心5538

    学习了

    0

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