腹部外科手术合并糖尿病的围手术期处理

目的：探讨腹部外科手术合并糖尿病的围手术期的处理措施。方法：对84例合并糖尿病的腹部外科手术病人做回顾性分析。结果：糖尿病人以2型多见,老年患者占70.2%（59/84）,病情隐匿,术前漏诊3例。84例中择期手术51例,限期手术18例,急诊手术15例。术后发生糖尿病酮症酸中毒3例,切口感染6例,肺部感染5例,泌尿系感染3例,真菌感染1例,败血症1例,多脏器功能衰竭死亡1例。腹部切口。哆开2例。结论：对腹部外科手术合并糖尿病的患者,围手术期严格控制血糖,做好必要的肠道准备,合理使用抗生素,选择合理的手术时间和麻醉方式,有效的营养支持是外科手术治疗成功的关键。

Perioperative Management of Diabetes Mellitus in Patients Subject to Abdominal Surgery

Objective ：To investigate the perioperative management to the patients with diabetes mellitus in abdominal surgery. Methods： Eighty - four patients with diabetic patients undergoing various surgical procedures of the perioperative management were retrospectively analyzed. Results：The associated diabetes occurred frequently in type 2, elderly patients （70. 2% ）. Three cases were missed diagnosis owing to the insidious diabetic courses. In total eighty - four eases, 15 cases were subjected to emergency surgery, 18 cases were subjected to Iimitative operation, 51 cases were subjected to selective operation. After surgery, three cases suffered from the ketoacidosis, six cases from the infection of the incisions, five case from pulmonary infection, three cases from the infection of urinary system, one case from the fungal infection, one case suffered from the septicemia, one died of multiple visceral organ failure, and two cases from disruption of abdom- inal wound. Conclusions：For the patients with diabetes mellitus subject to abdominal surgery the blood sugar should be strictly controlled, antibiotics properly used, the opportunity for surgeny and the means of anaesthesia properly chosen, and effective nutrition support given.