目的：分析α-硫辛酸、前列地尔与依帕司他多药联用对糖尿病周围神经病变的临床疗效。方法笔者在青海省人民医院进修期间，对青海省人民医院从2013年5月23日至2013年11月24日收治的经肌电图（丹麦产Keypoint肌电图仪）确诊的100例糖尿病周围神经病患者，随机分为对照组和观察组；两组基础治疗均为甲钴胺、维生素B1；对照组与观察组均采用动态血糖仪（美国产型号：CGMS GOLD）监测动态血糖7 d，并监测指端全血血糖6次/天（稳豪®倍优型血糖仪：One Touch Ultralue）；观察组与对照组住院期间均采用赖脯胰岛素（300 U∶3 mL）做强化治疗，使用胰岛素泵（CSII）（美敦力Infusion Set胰岛素泵输注管）基础量加3餐均量方案，皮下持续泵入；血糖控制达标后采用个体化药物控制血糖治疗方案，餐后血糖控制在＜8 mmol/L以下，空腹血糖控制目标为4.6~6.0 mmol/L；观察组患者在对照组基础治疗上加用前列地尔、α-硫辛酸、依帕司他；通过观察治疗前后感觉-运动神经传导速度和临床自觉症状的改变综合评估疗效。患者年龄24~84岁，平均年龄60.8岁，男女比例为2.4∶1。结果通过对患者的糖尿病饮食控制治疗、动态与电子血糖监测、多种药物联合治疗、适当运动治疗、糖尿病健康教育、周围神经传导速度测定分析结果为：观察组总有效率为90%，对照组总有效率为62%；治疗前后观察组周围神经传导速度较对照组改善显著，有统计学意义；故此诊治方案适宜临床应用。结论通过分析α-硫辛酸注射液与前列地尔注射液以及依帕司他片在应用了饮食控制、赖脯胰岛素持续皮下泵入强化治疗为主的综合治疗使得患者血糖达标的基础上多药联用，在治疗糖尿病周围神经病变时通过比较两组患者治疗前后的临床症状与肌电图变化，采用了统计学分析后可知较甲钴胺联合维生素B1效果显著，值得临床推广。%Objective To observe the curative effect of alprostadil, alpha lipoic acid combined with epalrestat in treatment of diabetic peripheral neuropathy.Methods When I was in the education at Qinghai People's Hospital, having observed and reported the curative effect on 100 diabetic peripheral neuropathies cases in Qinghai People’s Hospital from May 23 2013 to November 24 2013. All by electromyography (EMG instrument:Made in Denmark: Keypoint) conifrmed , randomly divided into control group and observation group. Both foundation treatments are methylcobalamin, vitamin B1. The two groups used dynamic plasma glucose meter (Made in American product type: CGMS GOLD) 7 day dynamic monitored the blood glucose. We monitored the ifnger’s blood glucose as 6 times/day (One Touch Ultralue). The two groups were using insulin lispro (300 U∶3 mL) intensive treatment. All patients were used by insulin pump (CSII) (Medtronic Infusion Set:insulin pump infusion tube) . They were treated by basic insulin rat and 3 meals’s insulin volume. Every sufferer had continuous subcutaneous pumping still to standard plasma glucose comed. Than used individual treatment plan to controling plasma glucose. Plasma glucose controled in the<8 mmol/L; fasting blood glucose controlled in 4.4-6.0 mmol/L. The observation group patients increased the alprostadil, alpha lipoic acid, epalrestat. Through observed before and after treatment in sensory motor nerve conduction velocity and clinical comprehensive evaluation of clinical symptoms change. Age 24-84 years, mean age is 60.8 years. The male to female ratio was 2.37∶1.Results By nutritional therapy, blood glucose monitoring, drug therapy, physical therapy, nerve conduction velocity examination shows: the observation group’s total effective rate was 90%, the total effective rate of the control group was 62%. The observation group compared with the control group, peripheral nerve conduction velocity improved obviously, there was signiifcant before and after the treatment. This treatment scheme worthy of promotion.Conclusion Alprostadil, alpha lipoic acid combined with epalrestat in treatment of diabetic peripheral neuropathy curative effect is better than mecobalamin combined with vitamin B1. This treatment method is worthy of promotion.
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