糖尿病患者骨科围手术期若干问题探讨  

Peri-operative management of the patient with diabetes mellitus

作　　者：陈名智[1] 伍骥[1] 和宪正[1] 董树理[1] 刘志雄[1] 贾光[1] 史国珍[2] 

机构地区：[1]空军总医院骨科,北京100036 [2]空军总医院内分泌科,北京100036

出　　处：《空军总医院学报》2002年第1期16-18,21,共4页Journal of General Hospital of Air Force,PLA

摘　　要：目的　总结糖尿病患者围手术期的处理经验。　方法　对我科 1989～ 2 0 0 0年 89例 37～ 82岁糖尿病住院患者进行回顾性分析 ,血糖控制在 11m mol/L 以下 ,根据个体情况 ,使用胰岛素及抗生素。合并 2种以上疾病者 6 2例 ,78例应用连续硬膜外麻醉 ,5例局部麻醉 ,6例全身麻醉。截肢、截趾、关节离断 45例 ,钢板螺丝钉固定 2 1例 ,清创术 2 9例 ,清创术后截肢 5例。　结果　糖尿病住院患者择期手术 89例 ,死亡 2例 ,其中术前死亡 1例 ,术中、术后未发生严重并发症。　结论　控制血糖和抗感染是围手术期处理的关键因素 ,可使患者安全度过围手术期。Objective To study the Peri-operative management of the patient with diabetes mellitus. Methods There are a number of factors to take into consideration when a patient with diabetes has to have an operation. The management of the patient with diabetes is tailored to individual needs and this management needs to extend right through their time in hospital, including pre-operative, peri-operative and post-operative management. The clinical data of 89 patients aged 37～82 years with Diabetes mellitus were analyzed, 62 cases had different associated diseases. Necrectomy internal fixation and debridement under Extra epidural anesthesia Local anesthesia and General anesthesia were applied in all patients suffering from diabetes mellitus..ketoacidosis must be completely relieved before the operation and the level of glycemia reduced to 11,0 mmol/L. Results In the 89cases of Diabetes mellitus patients. 2 deaths occurred. Total mortality was 2.25%, postoperative mortality 1.12%. Conclusions The management of such patients should provide timely adequate surgical treatment of the focus of affection, correction of carbohydrate metabolism with increased doses of simple insulin, removal of intoxication.

关 键 词：糖尿病 围手术期 腿损伤 骨科手术 糖尿病足 骨折 血糖控制 预防感染 治疗方法 

分 类 号：R68[医药卫生—骨科学] R587.1[医药卫生—外科学]