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2018, vol. 75, br. 6, str. 552-557
Da li kontrola glukoze u krvi ima efekta na uspeh terapije bolne dijabetesne neuropatije?
aVojnomedicinska akademija, Klinika za neurohirurgiju, Beograd
bVojnomedicinska akademija, Institut za medicinska istraživanja, Beograd
cVojnomedicinska akademija, Centar za kliničku farmakologiju, Beograd + Vojnomedicinska akademija, Klinika za endokrinologiju, Beograd
dVojnomedicinska akademija, Klinika za neurologiju, Beograd
eUniverzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd + Vojnomedicinska akademija, Klinika za neurologiju, Beograd
fUniverzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd + Vojnomedicinska akademija, Klinika za endokrinologiju, Beograd

e-adresaolijovan@mail.ru
Sažetak
Uvod/Cilj. Dijabetesna neuropatija (DN) je osnovna komplikacija dijabetesa, udružena sa poremećajem glikoregulacije i metabolizma, oštećenjem malih krvnih sudova i povišenim kardiovaskularnim rizikom. U istraživanju je praćen uticaj glikoregulacije na efikasnost lečenja bolne dijabetesne neuropatije (BMDN) rezistentne na medikamentno minimalno invazivnom terapijom. Metode. Kod bolesnika (n = 53, oba pola, starosti 68,3 ± 12,6) sa BMDN primenjena je minimalno invazivna terapija - lokalnim anesteticima (0.5% prokain hidrohlorid, 1% lidokain, 0.25% levobupivakain) ultrazvučno vođenim blokovima. Neuropatija je potvrđena u skladu sa važećim kriterijumima Evropske federacije neurološkog udruženja (EFNU). Glikoregulacija je preko vrednosti glikemije i glikozilirani hemoglobina (HbA1c), pre lečenja, nakon ciklusa terapije i posle jednog meseca od završetka terapije. Neuropatski bol potvrđen je skalama Leeds assessment of neuropathic symptoms and signs (LANSS) ili Dopleur neuropathique (DN4) ili pain DETECT skale za utvrđivanje bola. Intenzitet bola je ocenjeni su vizuelnom analognom skalom, neuropatskom skalom simptoma bola i listom simptoma neuropatskog bola. Primenjena je perineuralna blokada lokalnim anesteticima, pod kontrolom ultrazvuka. Efikasnost terapije određivana je procentom smanjenja bola: > 50% - odličan rezultat, 30%-49% - dobar rezultat i < 30% - terapija ne deluje. Ispitana je korelacija glikoregulacije (glikemije i nivoa HbA1c) i ishoda lečenja. Rezultati. Svi bolesnici su imali povišenu vrednost glikemije i HbA1C na početku lečenja (8,23 ± 2,77 mmol/L i 8,53% ± 2,48%, redom), na kraju terapije (8,43 ± 2,46 mmol/L i 8,85% ± 2,87%, redom) i posle meseca praćenja (8,49 ± 2,22 mmol/L i 8,51% ± 2,09%, redom). Prestanak bola nije bio u vezi sa smanjenjem glikemije [skale za procenu bola redom pre terapije: 81,53 ± 11,62 mm; 62 ± 13,04; 53,40 ± 17,63; jedan mesec posle terapije: 29 ± 9,23 mm; 13,79 ± 6,65; 11,83 ± 7,93; i jedan mesec kasnije; 26,15 ± 8,41 mm; 12,68 ± 6,03; 9,81 ± 7,64]. Nije bilo korelacije između poremećaja glikoregulacije i odličnog terapijskog odgovora.
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O članku

jezik rada: engleski
vrsta rada: izvorni naučni članak
DOI: 10.2298/VSP160613367J
objavljen u SCIndeksu: 09.08.2018.
metod recenzije: dvostruko anoniman
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