糖尿病肾病心脑血管并发症的诊断与中西医结合治疗

Diagnosis of cardio-cerebrovascular complications in diabetic nephropathy and treatment with integrative traditional Chinese and western medicine

心脑血管并发症在糖尿病肾病患者中发病率高,并且是引起糖尿病肾病患者死亡的主要原因,因此,对糖尿病肾病心脑血管并发症的早期诊断与治疗对改善糖尿病患者的生存状况有重大意义。在临床诊断时,首先应通过尿微量白蛋白和眼底病变的早期筛查确诊患者存在糖尿病肾病。之后,应立即评估患者是否存在心脑血管的并发症。西医治疗注重血压、血糖、血脂等多途径的干预,综合防控糖尿病患者所并存的多重危险因素。血糖的有效控制是延缓心脑血管并发症的前提,但要谨防低血糖的发生。中医理论认为糖尿病肾病的心脑血管并发症多表现为气血两虚证,兼有血瘀、痰湿等证候特点,化瘀散结治法应贯穿治疗始终。治疗本病多寻络虚通补之法,善用虫类搜剔之药,同时注重引经药物的使用,使药达病所,提高疗效。此外要结合病人的体质进行辨证,考虑到病人的病情千变万化,要灵活运用多种治则。

The incidence of cardio-cerebrovascular complications is high in diabetic nephropathy （DN） , which are also the main cause of death in DN patients. Therefore, its early diagnosis and treatment is of great significance for improving the survival of patients with diabetes mellitus. A definite diagnosis of DN should be first made through early screening of the microalbuminuria and the fundus lesions, after which whether cardio-cerebrovascular complications exists should be evaluated immediately. Western medicine treatment lays emphasis on muhi-means of intervention in blood pressure, blood glucose, blood lipid, preventing and controlling multiple risk factors in diabetes mellitus. Effective control of blood glucose is the premise of delaying the onset of cardio- cerebrovascular complications, although hypoglycemia should be alert to. From the theory of traditional Chinese medicine, the cardio-cerebrovascular complications in DN are characterized by deficiencies of Qi and blood, blood stasis, and phlegm damp syndromes, whose treatmentshould be based on removing blood stasis and dispersing phlegm. The treatment of this disease is usually by means of supplementing connection for collateral insufficiency, using active insects medicine as well as guiding medicine so that the medicine can be given a full play to their functions. In addition, according to the patients＇ physique differentiation and various changes of condition, flexible use of various therapeutic principles should be considered.