第11部分

| | | height="0.11620734908136483in"} | | | height="0.26718832020997374in"} | height="0.26718832020997374in"} | height="0.2647419072615923in"} | | | height="0.11182086614173228in"} | | | height="8.641622922134733e-2in"} | height="8.64271653543307e-2in"} | height="0.26620516185476817in"} +-------------------------------------------------------+------------------------------------------------------------------------------------------+-------------------------------------------------------------------------------------------------------------------+--------------------------------------------------------+-------------------------------------------------------+-------------------------------------------------------+ | | | | | | height="8.497156605424322e-2in"} | height="8.593722659667541e-2in"} | | | | height="0.1166994750656168in"} | | | height="8.593066491688539e-2in"} | height="8.593613298337707e-2in"} | height="0.2680063429571304in"} +-------------------------------------------------------+------------------------------------------------------------------------------------------+-------------------------------------------------------------------------------------------------------------------+--------------------------------------------------------+-------------------------------------------------------+-------------------------------------------------------+ | | | | | | height="8.497156605424322e-2in"} | height="8.496609798775154e-2in"} | +-------------------------------------------------------+------------------------------------------------------------------------------------------+-------------------------------------------------------------------------------------------------------------------+--------------------------------------------------------+-------------------------------------------------------+-------------------------------------------------------+ | | | | | | height="0.39993438320209973in"} | height="8.642279090113736e-2in"} |

+-------------------------------------------------------+------------------------------------------------------------------------------------------+-------------------------------------------------------------------------------------------------------------------+--------------------------------------------------------+-------------------------------------------------------+-------------------------------------------------------+ | | | | | | height="8.496609798775154e-2in"} | height="8.593722659667541e-2in"} | | | | | height="0.2662128171478565in"} | | | | height="8.496719160104987e-2in"} | +-------------------------------------------------------+------------------------------------------------------------------------------------------+-------------------------------------------------------------------------------------------------------------------+--------------------------------------------------------+-------------------------------------------------------+-------------------------------------------------------+ | | | | | | height="8.497156605424322e-2in"} | height="8.642279090113736e-2in"} | +-------------------------------------------------------+------------------------------------------------------------------------------------------+---------------------------------------------------------+---------------------------------------------------------+--------------------------------------------------------+-------------------------------------------------------+-------------------------------------------------------+ | | | | height="8.49595363079615e-2in"} | height="8.497156605424322e-2in"} | height="8.447615923009624e-2in"} | height="8.642169728783902e-2in"} | | | height="0.11719378827646544in"} | height="1.2693569553805774e-2in"} | height="8.49595363079615e-2in"} | height="0.26800853018372706in"} | | height="1.2693569553805774e-2in"} | | | | | | | | | |

| | | | | | +-------------------------------------------------------+------------------------------------------------------------------------------------------+---------------------------------------------------------+---------------------------------------------------------+--------------------------------------------------------+-------------------------------------------------------+-------------------------------------------------------+ | | | | height="8.496500437445319e-2in"} | height="8.593613298337707e-2in"} | height="8.496062992125984e-2in"} | | +-------------------------------------------------------+------------------------------------------------------------------------------------------+---------------------------------------------------------+---------------------------------------------------------+--------------------------------------------------------+-------------------------------------------------------+-------------------------------------------------------+ | | | | height="8.49595363079615e-2in"} | height="8.59339457567804e-2in"} | height="0.38549540682414696in"} | height="8.496719160104987e-2in"} | | | height="0.11817038495188102in"} | | height="8.495734908136483e-2in"} | height="8.49595363079615e-2in"} | | | height="0.2559208223972004in"} +-------------------------------------------------------+------------------------------------------------------------------------------------------+---------------------------------------------------------+---------------------------------------------------------+--------------------------------------------------------+-------------------------------------------------------+-------------------------------------------------------+ | | | | height="8.496609798775154e-2in"} | height="8.592957130358705e-2in"} | | | +-------------------------------------------------------+------------------------------------------------------------------------------------------+---------------------------------------------------------+---------------------------------------------------------+--------------------------------------------------------+-------------------------------------------------------+-------------------------------------------------------+ | | | | height="8.496062992125984e-2in"} | height="8.495734908136483e-2in"} | | |

| | height="0.11425087489063868in"} | | height="8.447178477690288e-2in"} | height="8.497156605424322e-2in"} | | height="8.496172353455818e-2in"} | height="0.2691469816272966in"} +-------------------------------------------------------+------------------------------------------------------------------------------------------+---------------------------------------------------------+---------------------------------------------------------+--------------------------------------------------------+-------------------------------------------------------+-------------------------------------------------------+ | | | | height="8.641622922134733e-2in"} | height="8.641622922134733e-2in"} | height="0.26669838145231844in"} | height="8.496062992125984e-2in"} | 素水平。 主要不良反应 : 低血糖和体重增加。 禁忌证 : 已明确诊断的 1 型糖尿病患者 、2 型糖尿病伴酮 症酸中毒 、感染 、外伤 、重大手术等应激情况 , 严重肝肾功 能不全 、对该类药物过敏或有严重不良反应者等。 ( 3 ) 糖苷酶抑制剂 。 药理作用 : 抑制碳水化合物在小肠上部的吸收。 主要不良反应 : 胃肠道反应如腹胀 、排气等。 禁忌证 : 有明显消化和吸收障碍的慢性胃肠功能紊乱患 者 、患有由于肠胀气可能恶化的疾患 ( 如严重疝气 、肠梗阻 和肠溃疡 ) 者 、对该类药物过敏者等。 ( 4 ) 噻唑烷二酮类 ( TZDs ) 药物。 药理作用 : 增加机体对胰岛素作用的敏感性。 主要不良反应 : 体重增加和水肿 ; 增加骨折和心力衰竭 发生的风险。 禁忌证 : 有心力衰竭 ( 纽约心脏协会心功能分级 I 级以 上 )、活动性肝病或转氨酶升高超过正常上限2. 5 倍及严重骨 质疏松和有骨折病史的患者。 ( 5 ) 胰岛素 : 胰岛素治疗是控制高血糖的重要手段。 分类 : 根据来源和化学结构的不同 , 胰岛素可分为动物 胰岛素 、人胰岛素和胰岛素类似物 。根据作用特点的差异 , 胰岛素又可分为超短效胰岛素类似物 、常规 ( 短效 ) 胰岛素、 中效胰岛素 、长效胰岛素 、长效胰岛素类似物 、预混胰岛素 和预混胰岛素类似物 。 胰岛素的起始治疗 : 2 型糖尿病患者经过生活方式和口服 降糖药联合治疗 3 个月 , 若血糖仍未达到控制 目标 , 应及时 起始胰岛素治疗 。2 型糖尿病患者的胰岛素起始治疗可以采用 每 日 1 ~2次胰岛素 , 每 日 1 次胰岛素治疗者往往需要联合应 用口服降糖药。 对于 HbAlc ≥ 9 . 0% 或空腹血糖≥ 11 . 1mmolL 同时伴明 显高血糖症状的新诊断2 型糖尿病患者可考虑实施短期 ( 2周 至 3 个月 ) 胰岛素强化治疗。 表7 常用胰岛素及其作用特点