合并糖尿病的胃肠外科手术围手术期处理分析(63例)  

Gastrointestinal surgery perioperative diabetes treatment analysis(report of 63 cases)

作　　者：周军[1] 褚忠华[1] 伍衡[1] 刘璐[1] 罗兴喜[1] 曾育杰[1] 

机构地区：[1]中山大学孙逸仙纪念医院胃肠外科,广州510120

出　　处：《岭南现代临床外科》2014年第3期260-263,共4页Lingnan Modern Clinics in Surgery

基　　金：广东省科技计划项目(编号:2012B050600014)

摘　　要：目的探讨糖尿病病人胃肠手术围手术期的处理经验。方法对2009年5月至2013年2月间,我科63例合并糖尿病的胃肠外科手术病人围手术期治疗进行回顾性分析,比较高血糖单因素对手术并发症和死亡率的影响以及血糖控制的临床意义。结果 63例中择期手术11例,限期手术45例,急症手术7例。治愈率88.30%(55/63),好转率9.52%(6/63),病死率3.17%(2/63)。糖尿病组手术后多数并发症与感染有关,感染相关并发症占比68.00%(17/25),其中手术切口感染最常见,其次为泌尿系感染和肺部感染;最严重的并发症为术后败血症、高糖高渗非酮性昏迷、酮症酸中毒和心肺功能不全,围手术期病人的死亡均与这些并发症有关。结论合并糖尿病的胃肠外科手术风险增大,易出现并发症,正确掌握围手术期的处理原则和方法,有利于病人平稳渡过手术及降低术后并发症的发生率。Objective To report the perioperative experience in handling the diabetic patients underwent gastrointestinal surgery. Methods During May 2009 to February 2013, the perioperative treatment of 63 cases accepted gastrointestinal surgery combined diabetic patients were retrospectively analyzed. The hyperglycemia univariate were compared against surgical complications and mortality. The clinical significance of glycemic control were assessed. Results Among the 63 cases, elective surgery were 11 cases, the deadline for surgery were 45 cases and seven cases were emergency surgery. Cure rate were 88.30% （55/63）, improvement rate of were 9.52% （6/63）, the fatality rate were 3.17% （2/63）. Most surgical complications were associated with post-operative infection, accounting for 68.00% （17/ 25）, the incision infection were the most common, followed by urinary tract infections and lung infections. The most serious complications were postoperative sepsis, high sugar hyperosmolar nonketotic coma, ketoacidosis and cardiopulmonary dysfunction. Perioperative patient deaths were associated with these complications. Conclusion Diabetes increases the risk of gastrointestinal surgery, prone to complica-tions. To perioperative correctly grasp, the principles and methods of treatment will benefit the patient to smooth out the surgery. And the incidence of postoperative complications may be greatly reduced.

关 键 词：糖尿病 围手术期处理 

分 类 号：R656[医药卫生—外科学]