合并糖尿病的腹部外科病人围手术期处理

目的 探讨合并糖尿病的腹部外科病人的围手术期处理措施。方法 对86例合并糖尿病的腹部外科手术病人作回顾性分析。结果 86例中，择期手术51例，限期手术17例，急诊手术18例。治愈率88．4％(76／86)，好转率7．0％(6／86)，病死率4．6％(4／86)。术后并发症发生情况：切口感染4例，肺部感染3例，泌尿系统感染2例，酮症酸中毒3例，其中合并败血症2例、真菌感染2例。结论 对合并糖尿病的腹部外科病人，围手术期严格控制血糖、作好必要的肠道准备、合理使用抗菌药物、选择合理的手术时间及麻醉方式、有效的营养支持，是获得理想的外科治疗效果的有效措施。     

糖尿病患者腹部外科围手术期处理

目的:探讨糖尿病患者腹部外科围手术期处理的方法.方法:对86例患者手术前血糖控制在6.1～11.1 mmol/L,分别采取外科手术治疗.结果:86例中治愈84例,死亡2例.切口感染5例,肺部感染4例,泌尿系感染5例,心律失常7例,低血糖昏迷1例,高渗非酮症昏迷1例.结论:糖尿病患者围手术期应严格控制血糖,术前做好必要的肠道准备,控制合并的其他疾病.     

老年结直肠癌并糖尿病的围手术期处理

目的探讨老年结直肠癌合并糖尿病患者围手术期的处理。方法对28例老年结直肠癌合并糖尿病患者的手术进行了回顾性分析。结果限期手术22例,急诊手术6例。治愈率71.4%(20/28),好转率25%(7/28),病死率3.6%(1/28)。术后并发切口感染5例,肺部感染2例,心律失常2例,泌尿感染2例,真菌感染1例,吻合口瘘1例,无酮症酸中毒。结论对合并糖尿病的老年结直肠癌患者给手术带来不利因素,但强调围手术期严格控制血糖,作好必要的肠道准备,合理使用抗生素,选择合理的手术时间及麻醉方式,有效的营养支持,是获得理想的外科治疗效果的有效措施。     

合并糖尿病的腹部手术病人89例治疗分析

目的　探讨合并糖尿病的腹部手术病人的外科治疗措施。方法　对我院普外科 1 991年～ 2 0 0 2年治疗的 89例合并糖尿病的腹部手术病人作回顾性分析。结果　 89例中 ,择期手术 6 8例 ,限期手术 1 3例 ,术前空腹血糖控制在 6 .7～ 1 0 .0mmol/L ;急诊手术 8例 ,术前空腹血糖 8.3～ 1 3.9mmol/L。术中血糖控制在 8.3～ 1 3.9mmol/L ,术后血糖控制在 7.8mmol/L以下。术后并发症发生率 :切口感染 3例 ,肺部感染 2例 ,泌尿系感染 1例 ,左下肢深静脉血栓形成 2例。无酮症酸中毒 ,无死亡病例。结论　合并糖尿病病人的腹部手术只要围手术期严格控制血糖、作好必要的肠道准备、选择合理的手术时间及麻醉方式完全可以达到理想的外科治疗效果     

260例老年腹部外科患者围手术期护理观察

目的:探讨60岁以上老年患者进行腹部外科手术的围手术期护理要点.方法:回顾性分析2007年1月～ 2011年12月腹部外科60岁以上老年患者260例的围手术期资料,在强化术前护理准备、严密术后病情观察及心理护理方面进行归纳.结果:老年患者合并高血压、糖尿病几率较高,术后易出现心脑血管病、肺部感染、泌尿系感染、切口感染裂开等并发症.结论:加强围手术期护理是使老年患者安全度过围手术期从而取得手术治疗成功所必需的环节.     

老年髋部骨折合并糖尿病患者的围手术期综合护理体会

目的探讨老年髋部骨折合并糖尿病患者的围手术期护理体会。方法对48例合并糖尿病的老年髋部骨折患者实施心理、饮食、运动、糖尿病教育等围术期护理措施。结果本组48例患者均顺利完成手术,术后2例泌尿系感染,1例小腿深静脉血栓形成,均经对症处理后痊愈,无压疮、切口感染等并发症发生,无死亡病例。结论老年糖尿病患者的手术风险大,实施围手术期综合护理可有效提高手术成功率,减少并发症发生,改善患者生活质量。     

高龄大肠癌合并糖尿病19例外科治疗体会

目的　探讨高龄大肠癌合并糖尿病的外科治疗措施。方法　对我院 1 993年 1月～2 0 0 1年 1 2月外科治疗的 1 9例高龄大肠癌合并糖尿病病人作回顾性的分析。结果　 1 9例均行择期手术。术后并发症发生率 :肺部感染 2 1 % ,心律失常 1 0 .5 % ,泌尿系统感染 1 5 .6 % ,切口感染 1 0 .5 %。无吻合口瘘和酮症酸中毒发生。术后平均住院时间 2 5d ,无死亡病例。结论　对高龄大肠癌合并糖尿病者只要围手术期严格控制血糖 ,选择合理术式 ,完全可以达到理想的外科治疗效果     

并存糖尿病的腹部外科手术30例围术期处理

目的探讨30例并存糖尿病的腹部外科手术病人的围术期处理情况。方法入院后控制饮食,应用胰岛素控制血糖,作好围术期监测。结果30例病人中切口感染2例,肺部感染1例,电解质紊乱1例,死亡2例,均为急症手术。1例死于肺功能不全,1例死于严重电解质紊乱。结论腹部外科手术合并糖尿病,应积极术前准备,控制血糖在安全水平,加强营养支持及应用有效抗生素,必能减少并发症及病死率。     

并存糖尿病时腹部外科手术的围手术期处理(附50例报告)

该文报道了50例并存糖尿病的腹部外科手术病人的围手术期处理情况。其中男19例,女31例,平均年龄60岁。腹部外科疾病以胆囊炎、胆石病多见。其次是肿瘤及阑尾炎。急症手术占36%。术后并发症为20%,以切口感染、不愈合、肺功能不全、肺部感染、泌尿系感染多见。文章论述了并存糖尿病的腹部外科手术病人的临床特点及糖尿病与胸部外科手术的关系。着重讨论了该类病人的术前准备及术中术后处理。认为必要的术前准备很重要。强调围手术期必须控制血糖在安全水平,加强营养支持及应用有效抗生素。     

大肠癌合并糖尿病的围手术期处理

目的 探讨大肠癌合并糖尿病的围手术期处理措施。方法 行手术治疗的21例大肠癌合并糖尿病病人作回顾性分析。结果 本组21例均为2型糖尿病、行择期手术。术后并发症发生率为：切口感染23、2％(5／21)、吻合口瘘9．5％(2／21)、肺部感染14．3％(3／21)、腹腔感染4．8％(1／21)、无酮症酸中毒及手术死亡病例。结论大肠癌合并糖尿病只要围手术期严格控制血糖，合理应用胰岛素，可达到理想的外科治疗效果。     

Is diabetes a risk factor for patients undergoing open abdominal aortic aneurysm repair?

A number of studies have compared results after aortic procedures in diabetics vs nondiabetics but few have focused specifically on abdominal aortic aneurysm surgery. An analysis of prospective data was carried out in the Vascular Surgery Registry (Beth Israel Deaconess Medical Center, Boston, MA) and identified 421 patients (422 grafts) who underwent elective open repair of an abdominal aortic aneurysm between 1990 and 1999. The influence of diabetes mellitus on outcome was assessed by dividing the patients into two groups: 52 diabetic and 370 nondiabetic patients. Postoperative mortality was 1.7% overall (n = 7) and proportionally higher in the diabetic population, although this did not reach statistical significance (3.8% vs 1.4%, p = 0.19). However, cumulative survival at 1 year and 3 years was essentially identical for diabetic vs nondiabetic patients (91.0% vs 92.6% and 70.0% vs 73.5%, respectively) and did not diverge until 5 years after surgery (25.0% vs 50.9% respectively [p > 0.05]). Overall, major complications occurred in 11 diabetics (21.2%) vs 58 nondiabetics (15.7%, p = 0.32). Specific complications that were increased in the diabetic population included pancreatitis (5.8% vs 1.1%, p = 0.01) and pneumonia (11.5% vs 3.2%, p = 0.006). Notably, overall cardiac morbidity was not higher in patients with diabetes mellitus (1.9% vs 4.3%, p = 0.41). Our data suggest that after elective open abdominal aortic aneurysm repair, patients with diabetes mellitus may have a higher rate of certain complications when compared to patients without diabetes mellitus. These differences however, do not preclude the expectation of excellent results of open abdominal aortic aneurysm repair in patients with diabetes mellitus.     

急性梗阻性化脓性胆管炎合并糖尿病引发严重腹腔感染的治疗

急性梗阻性化脓性胆管炎（AOSC）是临床中凶险的急腹症之一,又称为急性重症胆管炎.若该病合并糖尿病,其发生腹腔感染的危险性大大增加,并进一步引发胆汁漏、肠瘘等,导致生命危险.而腹腔感染的处置得当与否对患者预后非常关键.2013年5-7月解放军第四二五医院收治1例AOSC合并糖尿病患者,因家属早期拒绝手术、手术前后血糖控制不严格致反复腹腔感染、脓肿形成,引发胆汁漏、肠瘘等严重并发症.患者经3次手术、禁食、胃肠减压、肠外营养及应用生长抑素、加强抗感染等治疗后痊愈出院.     

老年患者择期开腹手术后感染风险因素分析

目的探讨老年患者择期开腹手术后发生感染并发症的危险因素。方法对2010年5月至2012年2月期间笔者所在医院收治的159例接受择期开腹手术的老年患者的临床资料进行回顾性分析。其中38例（23.90％）术后出现感染并发症（感染组）,121例无感染并发症（无感染组）,比较2组患者术前相关生理学指标、健康状况指标、手术指标以及术后感染并发症及死亡情况的差异。结果本组159例患者术后感染并发症发生率为23.90％（38／159）;术后死亡2例,术后病死率为1.26％。单因素及多因素logistic回归分析结果提示,患者术前的营养风险、糖尿病史和慢性呼吸系统疾病是术后感染并发症的独立危险因素。结论术前改善老年患者肺部疾病、糖尿病及营养状态,可能对降低术后感染并发症发生率有益。     

Morbidity in diabetic and nondiabetic patients after abdominal surgery

Morbidity after abdominal surgery was retrospectively investigated in 79 patients with diabetes mellitus and in 79 nondiabetic controls matched for type of surgery (biliary, gastric or colonic), sex, age, body weight and complicating cardiovascular disease. There were 20 complications (including 2 in each of 4 patients) in the diabetic group and 18 (2 patients with 2 complications) among the controls, with no tendency to specific complications in the diabetics. The difference in complication rate was not statistically significant. The mean blood glucose level preoperatively and in the first four postoperative days did not differ significantly between the diabetics with and those without postoperative complications. The risk of overlooking (type II error) a 25% heightened complication rate among the diabetic patients was calculated to be less than 30%, and the risk of overlooking a 50% increase was less than 8%. The authors conclude that elective abdominal surgery in diabetic patients is not burdened by clinically significant increase of postoperative morbidity.     

2型糖尿病肾脏病与2型糖尿病合并非糖尿病肾损害的临床及病理比较

目的分析比较2型糖尿病。肾脏病与2型糖尿病合并非糖尿病肾损害的临床及病理特征异同点。方法回顾性分析2008年1月至2011年4月在我科住院的患者,临床诊断2型糖尿病、并有蛋白尿,行经皮肾活检穿刺术病理检查共105例患者的临床病理资料。结果（1）非糖尿病肾损害组5I例,占48．57％,一般情况如糖尿病病程、高血压病程、代谢紊乱及肾脏损害均较2型糖尿病肾脏病轻。病理类型以原发性肾小球疾病为主,病理改变包括。肾小球损伤及小管-间质改变较2型糖尿病肾脏病组轻微。（2）2型糖尿病肾脏病患者54例,占51．43％。病理损伤的严重程度与体质量指数、血肌酐、胱抑素C、视黄醇结合蛋白、尿素氮呈正相关,而与血红蛋白、白蛋白和肌酐清除率呈负相关。结论在f临床上,对于病程长、代谢紊乱及临床肾损害指标严重的患者,考虑2型糖尿病肾脏病可能性大。     

Perioperative management of diabetic patients

Diabetes mellitus is the most common metabolic disease. New classifications have recently been proposed by the American Diabetes Association (ADA) and the World Health Organization (WHO). Type 1 (formerly insulin-dependent diabetes mellitus IDDM) is immune-mediated and leads to absolute insulin deficiency. Type 2 diabetes (formerly non-insulin-dependent diabetes mellitus [NIDDM]) is a disease of adult onset and is associated with insulin resistance. Type 3 corresponds to a wide range of specific types of diabetes, including various genetic defects of beta-cell function and insulin action, diseases of exocrine pancreas, endocrinopathies, and drug-induced diabetes. Type 4 is gestational diabetes (Table 1). Diabetics undergoing surgery have increased mortality, and type 1 diabetics are particularly at risk of postoperative complications. Wound complications are increased in diabetics, and healing is severely impaired when glycemic control is poor. However, with the use of modern management plans, the major outcome measures of surgery are comparable in diabetic and nondiabetic patients. Successful management of surgery in diabetic patients requires simple and safe protocols, which are fully understood by all staff and a close liaison among the surgeons, diabetes care team, and anesthetists. There is no consensus on the optimal metabolic management of the diabetic patient during surgery. Several surveys have highlighted the inconsistency with which surgical problems are managed in diabetic patients. The aim of this article is to provide protocols to achieve sensible and practical glycemic control in diabetic patients undergoing surgery.     

Perioperative management of the diabetic patient.

Diabetes mellitus is a significant global public health problem and is a major source of morbidity and mortality in the world today. Type 2 diabetes mellitus is the predominant form of diabetes worldwide and represents approximately 90% of all cases. There is an epidemic of type 2 diabetes mellitus in the world today in both developed and developing countries. Globally, it is expected that the number of people with diabetes will increase from the current 150 million to 220 million by the year 2010 and to 300 million by the year 2025. In addition, there has been an alarming increase in the incidence of type 2 diabetes in children and adolescents. It is therefore increasingly likely that diabetic patients will appear for dental and oral maxillofacial surgical treatment in both the office and ambulatory surgery clinic setting. Surgical stress often produces hyperglycemia in the perioperative period. Hyperglycemia has been shown to cause a significant increase in perioperative morbidity and mortality. It is the general consensus that strict glycemic control is beneficial and should be achieved for diabetic patients in the perioperative period. Preoperative, intraoperative, and postoperative management protocols for improved perioperative glycemic control of both type 1 and type 2 diabetics are presented.     

Deep neck infection in diabetic patients: Comparison of clinical picture and outcomes with nondiabetic patients

OBJECTIVE: To compare the difference in the clinical picture and outcomes between diabetic and nondiabetic patients with deep neck infections. STUDY DESIGN AND SETTING: We retrospectively reviewed the records of patients who were diagnosed with deep neck infections and who received treatment at the Department of Otolaryngology of National Taiwan University Hospital between 1997 and 2002. One hundred eighty-five patients were included in our study. Fifty-six patients with diabetes mellitus were enrolled for further analysis (diabetic group) and compared with the other 129 patients without diabetes mellitus (nondiabetic group) in demography, etiology, bacteriology, treatment, duration of hospital stay, complications, and outcome. RESULTS: The parapharyngeal space was the space most commonly involved in both the diabetic (33.9%) and nondiabetic groups (40.3%). Odontogenic infections and upper airway infections were the 2 leading causes of deep neck infection in diabetic and nondiabetic groups. Streptococcus viridans is the most commonly isolated organism in the nondiabetic group (43.7%). However, the most common organism in the diabetic group was Klebsiella pneumoniae (56.1%). There were 89.3% of diabetic patients, versus 71.3% of nondiabetic patients, with abscess formation ( P = 0.0136). Surgical drainage was performed more frequently in the diabetic group than in the nondiabetic group (86.0% versus 65.2%, P = 0.0142). In comparison with the nondiabetic group, the diabetic group tended to have older mean age (57.2 y versus 46.2 y, P = 0.0007), longer duration of hospital stay (19.7 days versus 10.2 days, P < 0.0001), more frequent complications (33.9% versus 8.5%, P < 0.0001), and more frequent tracheostomy or intubation (19.6% versus 6.2%, P = 0.0123). CONCLUSIONS: Patients with diabetes mellitus are susceptible to deep neck infection. We should pay more attention when dealing with deep neck infections in patients with diabetes mellitus because those patients tend to have complications more frequently and a longer duration of hospital stay. Empirical antibiotics should cover K. pneumoniae in patients with deep neck infection who have diabetes mellitus.     

胰、肾一期联合移植五例报告

目的 总结胰、肾联合移植的临床经验。方法 为5例糖尿病合并糖尿病肾病、肾功能衰竭患者施行胰、肾联合移植术，对手术技术、术后排斥反应的防治和其它非手术并发症的处理进行总结。结果 5例患者肾功能均转为正常，其中2例分别于术后第8周和第23周各发生急性排斥反应1次，经抗排斥治疗后肾功能逆转；2例手术后2周发生纯红细胞再生障碍性贫血；1例手术后第33d因供胰动脉血栓形成切除胰腺。经1年以上观察，5例患者均健康存活，其中4例胰、肾功能良好。结论 胰、肾联合移植是目前治疗糖尿病合并糖尿病肾病的有效手段；手术操作轻柔精细及术后并发症的预防对受者存活、移植物功能的恢复有重要意义。