pcu manual ncd
TRANSCRIPT
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2554
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2 17 1. 1) 2) .. 3) .. 4).. 5) 6)
7) .. 8) .. 9) 2.1) 2) 3) .. 4) .. 5) 6)
.. 7) : 8)
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1 : 2 : 3 :
4 : 5 : 6 : 7 :
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3
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30
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71
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1 :
2 : 3 :
4 : 5 :
-
()
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1
2
3
4
5 ()
18
6
7 8
13
17
37
38
64
72
7677
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30
69
70
98
99
100
101
102
102
103
103
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1
2
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5 6 7
8 9 101112
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2.8.. 2543 4.4.. 2573 .. 2543 171 366 .. 2573
Inter ASIA .. 2543 35 9.6 2.4 (, 2548)
1 -
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4
(Macrovascular disease) (Microvascular disease)
(Morbidity )(Mortality) (Disability Adjusted Life Year : DALY) 3 DALY
(7) 5 DALY(3)
3.5 2
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2
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2
1 (:IDDM)
2 (: NIDDM)
: () (Pancreas)
2
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11
:1.
2.
(Hyperglycemia)
3.
4.
5.
2
2 90 2 2
3
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1. 2 Insulin resistance 2
2
2. 2 (Postprandial hyperglycemia)
3.
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2 2 (
) -
1.(Diabetic retinopathy)
Endothelium
Basement membrane
Basement membrane Macula Blurredvision Retina
2
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2.(Diabetic nephropathy)Glomeruli
Nephron Albumin Filtrate Proximaltubule Renal failure
3. (Diabeticneuropathy)
4. (Coronary vascular disease)
5. (Cerebrovascular disease)
6.(Peripheral vascular
disease)7.(Diabetic ulcer)8.
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3 .1
()1. 8
(Fasting plasma glucose FPG) 126 /2
2.
(Random
plasma glucose) 200 / ( )
3.2
3
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1. 35 2. BMI > 25 /2
36 (90 ) 32 (80 ) -
3. 4. 5. (Triglyceride > 250
/ Cholesterol < 35 /)
6.
4
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1
1.3
2.
1. 1
2.
1.1
2.
3.
1.
2.
Normal
Impaired glucose
tolerance
(IGT)
()
()
FPG < 110 mg/dl
FPG 110 -125 mg/dl
> 126 mg/dl
> 200 mg/dl
Category
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11111
35 ()
.. (8 )
FBS 126 mg%
FBS>200 mg%
3 1
< 126 mg/dl > 126 mg/dl1.(/)- /(DM//Stroke)/
2. (//)
1.(/)- /(DM//Stroke)/
2. (:///)
/
(
)
Stroke(
)
DM DM
1
1.
2.(/)- (DM//Stroke)
2. (:///)
Stroke3 1. 2. 3. 3
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4
9 9
1.5
2.
3.
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4.5.6.7.8.9.
5
1
2 (body mass index, BMI
=
- 100
-= - 100 - (10% )
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() < 23
() 23-24.9 () 25
(./) = ()
()2
2
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9
: 5
5 1.2.
3.
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4.(dietary fiber)
5.
:
50 - 60
:
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:
(high biological value protein) 20
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12 - 15
lean meat
1 (50 )
250 2 - 3
- 3
:
87
80 (casein)
(whole milk)
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2 - 3 (low fat milk) (skim milk)1 - 2
:
A , D , E K 30
(saturated fattyacid)
3
1.(monounsaturated fatty acid)
2.(polyunsaturated fatty acid)
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5.6.
7.
(nonnutritive sweeteners)
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(aspartame) (low calories nutritivesweeteners) 1 4 200
2 (asparticacid) (phenylalanine)
(saccharin) 2
300 (cyclamate)
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(exercise) (physical activity) (sport)
30 - 45
(general physical fitness)
5
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- 3
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(exercise training)
(intensity) (frequency) (duration) (warm up) (cool down)
3 30
3 - 5
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6
2222 2
DM
< 140 mg/dl > 140 mg/dl
3 1
4-8
80-120 mg/dl
1. /
/2. (/)- (HT/DM//Stroke///)3. (:///)
1. /
//2.(/)- (HT/DM//Stroke///)3. (:///)
1. > 200 mg/dl 1 2. < 80 mg/dl 1 3. > 140 mg/dl 2 4. 80-140 mg/dl 1() * 80-120 mg/dl 1 () 1
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1.
Glucocorticoid
-
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4
2.
-Body Mass Index (BMI)
-(V/A)(
)
( )( )
3. Fasting plasma glucose
Total cholesterol, Triglyceride, HDL-cholesterol Serum creatinine
(Urinalysis) EKG (
10 )
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4.
()
4
2
Lipid profiles
1 - 2
2-3
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1.
3 1.1
(Insulin secretagogue) Sulfonylurea
Glipizida , Glibenclamide1.2 (Insulin sensitizer)
Biguanide Metformin
1.3 Alpha - glucosidase (Alpha- glucosidase inhibitor) Acarbose
2.
Gastric hormones
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2.1 (Short-acting insulin) Regular insulin (RI) 30-60 2-4 4-6
2.2 (Intermediate-acting insulin) Protamine stabilized insulin (NPH)
Lente 2 10 - 16
3
2-8
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3
2.5 - 20
/(1 - 2 /)2.5 - 20
/(1 - 2 /)
30
500 - 3,000
/
(1 - 3 /)150 - 300
/(3 /)
Beta cell
Insulin
Minidiab
Daonil
Glucophage
Glucobay
Glipizide
Glibenclamide
Metformin
Acarbose
1.Insulin
secretagogue- Sulfonylurea
short acting
Long acting
2.Insulin
sensitizer
- Biguanide
3.Glucosidase
Inhibitor
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4
..
. .
Short acting
Regular (Solution)
Intermediate acting
NPH (Isophane)
Lente (Insulin zinc suspension)
Humalin R, Actrapid
Humalin N, Insulatard
Monotard
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1.
2.
3.
4.
5.
(home ward)
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1. :1.1
1.2
1.3
2. :2.1
. ()
2.2
.
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2.3 Diabetic chart
3. :3.1
3.2
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7
1.
2.
1.
2.
1.
2.
3.
1.2.
1.
2.
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1.
2.
1.
2.
1.
1.
2.
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3.
1.
2./
3.
1.2.3.
4.5.
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3.- - /- - -
1.
2.
3.
4.
1.
2.
3.
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4.
5.(.)
1.
2.
1.
2.
/
3.
1.2.
1.
2.
3.
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1.
1.
2.
3.
1.
1.2.
3.
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6.
1.
2.
3.
1.
2.
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1./
1.
2.
3.
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1. 2.
()
3.
4.
5.
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1. . . :
; 2548.2. . .
: ; 2548.3.
.
. : (1977) . 2551.
4. / 40 2550. 6 2551
http://www.kuntaluk.com/kuntaluk1/uploadfile/20070323094842.doc
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5. , . . :; 2532 :32 - 73
6. American Diabetes Association : Clinical Practice
recommendation 2003. Physical activity/exercise and
diabetes mellitus. Diabetes Care 2003 ; 26 (suppl 1) :
S73-7
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.. 2541 - 2545
3.3 - 5.1 13 - 60 1360
33
60
1 -
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1.
2.
3.
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2.1
()
2
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()
2.2.2.2
2.2.2.3
2.2.2.4
50
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2.2.3 (EnvironmentRisk Factors)
2.2.3.1
2.2.3.2
2.2.3.3 130
140 100
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2.2.4. (Dietary RiskFactors)
2.2.4.1 (Sodium)
2.2.4.2 (Lipids)
2.2.4.3 (Alcohol)
blood cortisol
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catecholamine renin-angiotensinantidiuretic hormoneAlcohol withdrawal Adrenergic hormone 10
2.2.4.4
2.2.4.5
1 5 30 - 60
2
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3
Hypertension () 140/90
Isolated systolic hypertension
140
90
3.1
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5 ()
- 18
1. 1 2.
3. /
1. 6 2. 3.
1. 2-3
2.
3.
1. /
2. 3.
Optimal -
normal
()
High normal
()
Grade 1Hypertension
(Mild)
()
Grade 2
(Moderate)
()Grade 3
()
180
Category SBP
/
/
/
/
110
SBP - Systolic Blood Pressure; DBP - Diastolic Blood Pressure; SBP DBP Isolated Systolic Hypertension SBP
DBP
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3.2
3.2.1
30
5 2
3.2.2 Digital
Arm cuff(Bladder) 80 Arm cuff 12 - 13 . X 35 .
3.2.3 3.2.3.1 Arm cuff
2 - 3 Brachial artery
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3.2.3.2 SBP (Rubber bulb)Brachial artery 2-3 / SBP
3.2.3.3
Stethoscope Brachial artery SBP 20 - 30 (Korotkoff I)SBP (Korotkoff V)DBP
3.2.3.4 2 1-2 + 5 2 5 3 + 5
3.2.3.5 2 35 (Coarctation of aorta)
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1 SBP SBP 20 Orthostatic hypotensionOrthostatic hypotension SBPSBP
3.3 (Automatic blood pressure measurement device)
3.3.1 ()3.3.2
3.3.3 3
3.3.4
Sphygmomanometer 5 135/85
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3.3.5 Isolatedoffice hypertension (White coat hypertension)
Cuff
Cuff -
Diastolic Bias
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33 33 3
18 ()
BP < 120-129/80-84
mmHg
BP 130/85-
140/90 mmHg
BP >140/90
mmHg
BP > 140/90 mmHg
+BP > 160/110mmHg
1 2-3 6
> 140/90< 140/90
/
(
)
Stroke
1.(/)- /(HT//Stroke)/
2. (//)
1.(/)/(HT//Stroke)/2.
(: ///)
HT
6
HT
1. 2.
Stroke 3 1. 2. 3. 3
1.2.(/
)- /(HT//Stroke)/2. (:///)
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4 44 44
: ***
HT
2-3 1
< 140/90 mmHg< 130/80 mmHg
1.///
2.(/)(HT/DM//Stroke/)3. (: ///)
* ()1. > 240 mg/dl TG > 160
2. BMI > 25, > 36 ,> 32 3. DM///Stroke/4. ()5. > 55
1. > 180/110 mmHg 2. > 160/100 mmHg 2 3. > 140/90 mmHg 3 4. < 140/90 mmHg 1() * < 140/90 mmHg1() 6
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4
4.1
( 6)
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5 - 20 10
8 - 14
2 - 8
4 - 9
2 - 4
(Body massindex) = 18.5 - 24.9 /
2 (2 2 30 3
--
SBP
6
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4.2. 6
Diuretics , Beta-blockers , Calcium antagonists, ACE inhibitors,
Angiotensin II antagonists alpha-adrenergic blockers( 3) Diuretics Beta-blockers Calcium antagonists ACE inhibitors Alpha-adrenergic blockers Angiotensin II antagonists
4.2.1
1
2.
()
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4.2.2
4.2.2.1 Diuretics stroke
Hydrochlorothiazide 25
Systolic hypertension
4.2.2.2 Beta - blockers Diureticsdihydropyridine calcium antagonists
Atenolol 25 - 100 /1
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4.2.2.3 ACE inhibitors 1
angioedema Enarapril2.5 - 40 /
4.2.2.4 Calcium antagonists
Stroke Systolic
hypertension Amlodipine 10 / ? - 1
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7
-
-
2
Diuretics
Beta-Blockers
ACE Inhibitors
C a l c i u m
Antagonists
Systolic hypertension
- Angina (
)
- (Tachyarrhythmias)
Angina
Systolic hypertension
Heart block
Heart block
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8
CHF
Withdrawal syndrome
Hepatotoxicity
Depression
Active peptic ulcer
congestive heart failure
ACE inhibitors,
ARBs
- blocker
Diuretic
Pregnancy
Bilateral renal
artery stenosis
Hyperkalemia
A-V (grade 2 3)
block
Asthma
Obstructive
airway disease
Peripheral
artery disease
Gout
- blockers
Clonidine
Methyldopa
Reserpine
CCBs
HCTZ (25 )
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130/80 DM ,CKD), > 160/110 , BP < 90/60
Pulse < 60 /
1. 2.
, ,,, ,-
1. 2.
1.
2.
1. , ,
,
2. :
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4.3.2 1
1. Fasting plasma glucose
2. Serum total cholesterol, HDL-C, LDL-C,
triglyceride
3. Serum creatinine
4. Serum uric acid
5. Serum potassium
6. Hemoglobin hematocrit7. Urinalysis (dipstick testurine sediment)8. Electrocardiogram
4.4
4.4.1 /4.4.1.1
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/
4.4.1.2
4.4.1.3
4.4.1.4
4.4.1.5
4.4.1.6
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4.4.1.7 -3
4.4.1.8
4.4.2 4.4.2.1
4.4.2.2
4.4.2.3
4.4.2.4 4.4.2.5
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4.4.2.6
4.4.3
1)
2)
"" ""3)
4)
5) 6) 7)
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8)
9)4.4.4
4.4.4.1
4.4.4.2
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4.4.4.3
4.4.4.4
4.4.4.5
4.4.4.6
4.4.5
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4.4.6 8-10
-
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1-2
4.4.7
1.2.
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3.4.
4.4.7.1 1)
90
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2)
4.4.7.2
1) 2)
3) 2 4)
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4.4.7.3
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4.4.8
4.4.8.1 (Flaccid Stage)
1)
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2)
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(Shoulder Subluxation)
4.4.8.2 (Spastic Stage)
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1)
2)
3)
4)
5)
-
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4.4.9
4.4.9.1
1)
(Hemiplegia) (Paraplegia/ Quadriplegia)
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2)
3)
4.4.9.2
1)
1
3 1 : 12 6 1 : 20 1.50
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1.80
2
5
1.2 1.8
5
12
-
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99
6
2) -
0.85 -.090 -
1/2
0.45
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100
2
0.60
7
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3) 0.85 -
0.90 16 - 19
85
8
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9
10
-
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11
12
-
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4)
0.30 - 1.2
85 90 50
4.4.10 4.4.10.11)
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1)45
2)
3)()
-
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2)
1) 45
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2)
3)
4)
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4.4.10.21)
2) 30
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3)
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4.4.10.3
4.4.10.4-
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4.4.11 10-20 2
4.4.11.1
1.
2. 3. 4.
6.
5.
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1.
2. 3.
4.
1.
2. 3.
4.
90
-
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1. 2.
3.
1.
2. 3.
4.
-
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/
1.2.
3.
1.2.
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4.4.11.2
4.4.11.3
1.
2. 3.
4.
1.
2.3.
4.
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4.4.11.4
1. 2.3.
1.
2.
3.
4.
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1. 2.
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5
1.
2.
1.
2.
1.
2.
3.
1.2.
1.
2.
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119
1.
2.
1.
2.
1.
1.
2.
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3.
4.
(.)
1.
2./
3.
1.
2./
3.
1.
2.3.
4.5.
1.
2.3.
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1.
2.
3.
4.
1.
2.
3.
1.
2.
3.
1.2.
3.
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