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ID:19926999
大小:935.51 KB
页数:43页
时间:2018-10-07
《糖皮质激素与高血糖PPT精品医学课件》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、类固醇性糖尿病Steroiddiabetes概述流行病学机制诊断治疗History1855–Addison'sdisease1856–Adrenalglandsessentialforlife1930–Cortex>medulla1932–Cushing’ssyndrome1949–Henchetal(Steroidsinrheumatoidarthritis)1952–AldosteronePromotenormalintermediarymetabolism:GluconeogenesisStimulateproteincatabolismS
2、timulatelipolysisIncreaseresistancetostressby:RaisingbloodglucoselevelModestriseinBPAlterbloodcelllevelsinplasma:Decreaseineosinophils,basophils,monocytesandlymphocytesbyredistributionfromcirculationtolymphoidtissueIncreaseinthenumberofRBC,platelets,neutrophilsActionsofGlucoc
3、orticoidsAntiinflammatoryaction:(Complexmechanism)SuppressionofimmunityIndirectinhibitionofphospholipaseA2Alterotherendocrinesystems:DecreaseinACTHandTSHIncreaseinGHEffectsonothersystems:Increasedproductionofgastricacid,pepsinEffectsonCNSBonelossMyopathyActions…Cont.常用糖皮质激素剂量
4、换算、作用、半衰期及效能—————————————————————————————————————药物等效剂量 糖皮质激素作用 抗炎效价钠潴留作用 生物学半衰 期(小时)—————————————————————————————————————低效可的松25mg 0.8 2 8~12 8~36氢化可的松20mg 1 1.0 >2
5、 8~12中效强的松5mg 4 3.5 1 12~26强的松龙5mg 4 4.0 1 12~36甲基强的松龙4mg 5 5.0 0 12~36去炎松4mg 5 5.0 0 12~36高效倍他米松0.6mg 25 30.0 0 36~54地塞米松0.75mg 25
6、 30.0 0 36~54—————————————————————————————————————AdverseeffectsPsychiatricSleepdisturbance/activationMooddisturbancePsychosisSkin/softtissueCushingoidappearanceAbdominalstriaeAcneHirsutismOedemaNeurologicNeuropathyPseudomotorcerebriCardiovascularHypertension
7、OccurwithprolongeduseofhighdosesCushing’sdiseaseMSKOsteoporosisAscepticnecrosisofboneMyopathyEndocrineDiabetesmellitusAdrenalcortexsuppressionImmunologicLymphocytopeniaImmunosuppressionFalse-negativeskintestOpthalmicCataractNarrow-angleglaucomaDevelopmentalGrowthretardation糖皮
8、质激素因其多种生物学作用被广泛用于临床多种疾病的短期或长期治疗“双刃剑”:发挥治疗作用的同时,也不可避免的引起一些副作用,血糖异常便是其
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