骨科手术患者并存糖尿病的围手术期处理  

Perioperative management of orthopaedic surgrery in patients with diabetes mellitus

作　　者：郭爱君[1] 孙振勇[1] 田立强[1] 

机构地区：[1]山东省临沂市沂水中心医院,山东临沂276400

出　　处：《河北医学》2002年第12期1060-1062,共3页Hebei Medicine

摘　　要：目的 :探讨骨科手术患者并存糖尿病的围手术期处理及血糖升高对手术的影响。方法 :将我院 1998年 1月至 2 0 0 1年 9月收治的骨科手术并存糖尿病患者 4 4例手术前后血糖控制情况、手术方式进行分析总结。结果 :4 4例患者手术前空腹血糖为 8.6～ 2 1.7mmol/L ,平均 14 .9mmol/L ,尿糖 (++ )～ (+ + + + ) ,经静滴普通胰岛素快速降糖 ,皮下注射中、长效胰岛素维持 ,血糖控制至 6 .7～ 9.6mmol/L ,尿糖 (- )～ (+ ) ,分别进行了手术治疗。手术病人中出现 3例切口愈合不良 ,与同期非糖尿病骨科手术相比 ,延迟愈合无显著性差异 ,恢复情况令人满意。结论 :骨科手术并存糖尿病患者经术前平均 5d的快速血糖控制和维持 ,血糖降至 6 .7～ 9.6mmol/L ,尿糖 (- )～ (+ ) ,并以 8.0～ 8.6mmol/L为最佳控制范围 ,可进行较大而复杂的手术 。Objective: To evaluate the perioperative management and effect of blood glucose rising on orthopaedic surgery results in patients with diabetes mellitus. Methods:The blood glucose control before and after surgery 44 patients with diabetes mellitus who had accepted the orthopaedic surgery from Janaury 1998 to september 2001 in our hospital were analysed and generalized. Results:The fasting blood glucose level of 44 patients varied from 8.6 to 21.7 mmol/L,averaging 14.9 mmol/L,urine glucose from(++)to(++++).The blood glucose was controlled to 6.7～9.6mmol/L and urine glucose to(-)～(+),with reguler insulin intravenously dripped to decrease blood glucose immediately and mid-effect and long-effect insulin subcutaneously injected to maintain it .These patients were operated on respectively.Delayed wound healing occurred only in three of 44 cases.There was no significant difference between patients with and without diabetes mellitus (P>0.05).The recovery of the patients was satisfying. Conclusions:The patients with diabetes can accept complicated orthopaedic surgery and the surgery is safe after blood glucose is immediately controlled and maintained for 5 days on average before surgery as long as the fasting blood glucose level decreases to 6.7～9.6mmol/L and the best variation is 8.0～8.6mmol/L.

关 键 词：围手术期 骨疾病 糖尿病 治疗 

分 类 号：R619[医药卫生—外科学]