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Нервно-мышечные болезни

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Современные принципы ведения больных с диабетической полинейропатией


https://doi.org/10.17650/2222-8721-2012-0-2-7-19

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Аннотация

Примерно каждый 3-й пациент с сахарным диабетом (СД) страдает диабетической дистальной симметричной сенсомоторной полинейропатией (ДССП), которая представляет собой серьезную проблему для здравоохранения, так как может сопровождаться мучительной нейропатической болью и приводить к снижению качества жизни больных. Нейропатическая боль значительно нарушает сон, негативно влияет на повседневную активность и удовлетворенность жизнью. Лечение базируется на 4 основных принципах: 1) интенсивная терапия СД и коррекция факторов риска заболевания, 2) лечение, основанное на патогенетических механизмах, 3) симптоматическое лечение, 4) воздействие на факторы риска и предотвращение осложнений полинейропатии. Недавние экспериментальные исследования свидетельствуют о многофакторной структуре патогенеза диабетической нейропатии. С клинической точки зрения важно отметить, что на основе этих патогенетических механизмов могут быть разработаны новые терапевтические подходы. Некоторые из них в настоящее время оцениваются в ходе клинических испытаний. Лечение хронической болевой ДССП остается сложной задачей для врача. В связи с этим важно отметить следующие практические правила: выбор препарата и подбор дозы необходимо проводить индивидуально на основе оценки эффективности терапии и развития побочных эффектов; об отсутствии эффекта можно судить лишь спустя 2-4 нед лечения с использованием адекватной дозировки. Возможно применение комбинированной анальгетической терапии, однако ввиду частой полипрагмазии у пациентов с СД необходимо обязательно учитывать возможные лекарственные взаимодействия. Употребление алкоголя, а также известные факторы риска сердечно-сосудистых заболеваний, такие как висцеральное ожирение, артериальная гипертензия, гиперлипидемия и курение, играют определенную роль в развитии и прогрессировании диабетической нейропатии, в связи с чем особенно важно их своевременное предотвращение или лечение.

Об авторе

Dan Ziegler

Россия


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Для цитирования:


Ziegler D. Современные принципы ведения больных с диабетической полинейропатией. Нервно-мышечные болезни. 2012;(2):7-19. https://doi.org/10.17650/2222-8721-2012-0-2-7-19

For citation:


. . Neuromuscular Diseases. 2012;(2):7-19. (In Russ.) https://doi.org/10.17650/2222-8721-2012-0-2-7-19

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