[ppt模板]低血糖

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1、低血糖癥蔡曉頻1Whipple三聯(lián)癥1938年提出低的血糖數(shù)值低血糖癥狀自主神經(jīng)興奮（饑餓，心悸，出汗，惡心，震顫，焦慮）中樞神經(jīng)系統(tǒng)功能受損（乏力，抽搐，昏迷）糾正血糖后癥狀緩解2010-5-212最常見(jiàn)原因糖尿病相關(guān)DCCT：1型糖尿病患者10~30%經(jīng)歷1次嚴(yán)重低血糖UKPDS：胰島素治療的2型糖尿病患者1.2%發(fā)生嚴(yán)重低血糖1型與2型相似2010-5-213糖穩(wěn)態(tài)的調(diào)節(jié)胰島素胰高糖素腎上腺素生長(zhǎng)激素皮質(zhì)醇調(diào)節(jié)受損（藥物，糖尿病，肝衰竭，腎衰竭）2010-5-214低血糖分類(lèi)空腹低血糖反應(yīng)

2、性低血糖（餐后低血糖）2010-5-215空腹低血糖病因藥源性高劑量水楊酸，β阻滯劑，磺胺藥，奎寧，奎尼丁，喹諾酮類(lèi)器官衰竭（肝，腎，內(nèi)分泌?。┠[瘤（非胰島細(xì)胞腫瘤，胰島細(xì)胞瘤，胰島細(xì)胞增生）自身免疫（IAA,IRA）2010-5-216反應(yīng)性低血糖傾倒綜合癥（核素胃排空試驗(yàn)）糖尿病前期胰島細(xì)胞增生2010-5-217胰島細(xì)胞瘤Approximately90%ofinsulinomasaresingleandbenign;10to15%,usuallymultipleadenomas,areas

3、sociatedwithmultipleendocrineneoplasia2010-5-218胰島細(xì)胞瘤Whentheclinicalsuspicionispresent,diagnosisdependsonthedemonstrationofhyperinsulinemichypoglycemia.2010-5-219胰島細(xì)胞瘤定性診斷Ifspontaneoushypoglycemiaisnotencountered,supervisedprolongedfastingmayberequir

4、ed.Inthepresenceofaninsulinoma,thesemiautonomousbasalinsulinsecretioninhibitshepaticglucoseefflux,leadingtofastinghypoglycemia.Thefindingofhypoglycemia(plasmaglucose<2.2mmol/Lor40mg/dL)associatedwithinappropriatelevelsofinsulin(>6μU/mL),C-peptide(>0.

5、2nmol/L),andproinsulin(>20pmol/L)isusuallyconsidereddiagnostic2010-5-2110胰島細(xì)胞瘤定性診斷Prolongedfastingwithdemonstrationofhypoglycemiaalthoughrecognizedasthegoldstandardofdiagnosis,isuncomfortabletothepatientandispotentiallyhazardous.Ginetal.reportedonthe

6、useofeuglycemichyperinsulinemicclamptodiagnosinsulinoma.PatientswithinsulinomashowedlackofC-peptidesuppressionduringthreesuccessive90-minuteexogenousinsulininfusionsofupto8mU/kg/min,incontrasttocontrolsubjects,whoselevelsprogressivelyfellto0.3±0.1ng/

7、mLbythethirdphase.UsingC-peptidelevelatphase3of0.3ng/mLasthecut-offpoint,patientswithinsulinomaweredistinguishedfromcontrolsubjectswithasensitivityof100%.Thetestlastedonly270minutesandallpatientsremainedeuglycemicthroughoutthestudy.2010-5-2111胰島細(xì)胞瘤定位

8、診斷Preoperativelocalizationoftumorsusingconventionalimagingmodalitiessuchasultrasonographyandcomputedtomographyhavebeendisappointing,withidentificationofonly20to50%oftumors2010-5-2112超聲Transabdominalultrasonographyhasareportedsensitivitybetween7to79%，