糖尿病患者术前血糖水平对术后并发症的影响

【目的】了解糖尿病患者围手术期血糖水平对术后并发症的影响。【方法】根据美国ADA空腹血糖（FIG）标准，将222例糖尿病患者分为3组，A组116例，术前FIG≤6．9mmol／L；B组88例，术前FPG≤〈9．0mmol／L；C组18例，为急诊手术组；然而分析3组患者术前血糖水平与术后FPG、2HPG、尿酮体、低血糖、心律失常、抗炎时间及伤口愈合天数的变化。【结果】术后酮症：A组2例（1．72％）；B组8例（9．10％）；C组8例（88．88％）；术后低血糖反应：A组4例（4．55％）；B组6例（5．17％）；C组2例（22．22％）；术后心律失常：A组8例（6．90％）；B组5例（11．36％）；C组8例（88．88％）。其中B组和C组各有2例伤口不愈合，A组抗生素治疗天数也较B组与C组缩短。由此可见，A组患者因术前FPG及2HPG控制较满意，故术后并发症与B组和C组比较有显著性差异。【结论】对于糖尿病患者加强术前血糖控制，使FPG〈7mmol／L，2HPG〈9mmol／L以下，是保证手术效果和防止术后并发症的关键。

Effect of perioperative blood glucose level on postoperational complications in patients with diabetes mellitus

Objective] To evaluate the effect of perioperative blood glucose level on postoperational complications in patients with diabetes mellitus. Methods] A total of 222 cases of patients diagnosed according to American ADA FPG criteria as diabetes mellius were divided into 3 groups： group A （126 cases）, perioperative FPG≤6.9 mmol/L; group B （88 cases）, perioperative FPG≤9.0 mmol/L; group C （18 eases）, emergency operation group.The perioperative FPG and postoperational FPG, 2HPG, ketone, hypoglycemia, arrythrnia, antibiotics administrated, and wound healing were analysed in patients of the three groups. Results] Postoperafional ketoacidosis occurred in 2 cases in group A （1.72%）; 8 eases in group B （9.10%）; and 8 cases in group C （88.88%） .Postoperational hypoglycemia occurred in4 cases in group A （4.55%）, 6 cases in group B （5.17%） and2 cases in group C （22.22%） .Postoperational arrythmia occurred in 8 cases in group A （6.90%） 5 cases in group B （11.36%） and 8 cases in group C （88.88%）. Wound unhealing occurred in 2 cases in group B and C respectively.Antibiotics administration course was shorter in group A than in group B or C. So, better control of perioperative FPG and 2HPG in patients of group A leaded to less postoperational complications. Conclusion ] For patients with diabetes mellitus, ideal control of perioperative blood glucose （FPG 〈 7mmol/L, 2HPG 〈 9mmol/L） is critical to get operative efficacy and prevent postoperational complications.