骨科糖尿病患者的围手术期处理

骨科患合并糖尿病日渐增多,围手术期糖尿病的处理成为骨科手术成败的关键因素,1995年以来我科共收治骨关节疾病合并糖尿病患55 例,其中施行手术治疗31 例,现总结报告如下.     

糖尿病患者骨科选择性手术的围手术期处理

糠尿病是骨科手术时常见的并存疾病之一 ,随着社会老龄化的发展 ,饮食结构 ,生活习惯的改变 ,国内糖尿病的发生率逐年上升[1] 。老年人因骨质疏松极易造成骨折 ,骨科疾病兼有糖尿病的患者比例也明显增加。近 3年来本院共收治骨科各类选择性手术兼并有糖尿病的患者共 37例。现总结报告如下。1　临床资料从 1997年 9月～ 2 0 0 0年 9月共收治病例 37例。其中糖尿病坏疽 ,下肢严重感染需行截肢术 8例 ,骨折兼并糖尿病 2 9例。其中股骨颈骨折 9例、股骨粗隆部骨折 12例、髌骨骨折 4例、踝部骨折 2例、肱骨骨折 2例。男 16例 ,女 2 1例 ,年龄最大…     

骨科病人并存糖尿病的特点及其围手术期处理

目的：明确糖尿病病人围手术期血糖控制的安全方法．方法：对66例骨科病人并存糖尿病时围手术期诊断与治疗进行回顾性分析。结果：糖尿病以I型多见，老年病人占75．8％，病情隐匿或急诊，术前漏诊6例，术后因高渗性非酮症昏迷死亡1例，2例发生低血糖昏迷．结论：静脉应用普通胰岛索是围手术期糖尿病病人血糖控制的安全有效的方法．     

糖尿病病人的围手术期处理

糖尿病（ｄｉａｂｅｔｅｓｍｅｌｉｔｕｓ，ＤＭ）是以高血糖为主要特征的全身代谢性疾病。约２％外科手术病人并存ＤＭ，４０岁以上者并存率更高。ＤＭ病人手术危险性较非ＤＭ病人明显增加，病死率增高２倍以上，其危险性与血糖升高程度、高血糖持续时间以及重要器官受累...     

糖尿病病人围手术期的处理

糖尿病是属于内科范畴的疾病，但在很多情况下与外科治疗关系密切。如发生重症软组织感染内科治疗无效的糖尿病足，糖尿病合并胆道结石、肠梗阻、溃疡病，内科治疗无效的消化道出血，以及重症外伤、骨折等都需要外科手术。而糖尿病本身常并存许多并发症和代谢紊乱是外科手...     

糖尿病病人围手术期的处理

目的 总结糖尿病病人围手术期的处理经验。方法 对２２０例并存在糖尿病的择期手术病人术前全部停用口服降糖药而采用胰岛素皮下注射,血糖控制在６￣１０ｍｍｏｌ／Ｌ,急诊手术者前血糖控制在１３ｍｍｏｌ／Ｌ以下。结果 急诊手术１２４例,死亡１６例;择期手术９４例,术中、术后未发生严重并发症。结论 掌握血糖水平及其围手术期处理原则,可使患者安全度过手术期。     

糖尿病病人围手术期的风险与处理

糖尿病是以遗传因素为背景，再加上年龄增长、肥胖、运动减少、饮食变化等多种因素的综合作用而发病。作为促使糖尿病的上述因素由于生活现代化而急剧增加，我国也和世界上大多数从穷到富的发展中国家一样，糖尿病的患病率在急剧增高。糖尿病能引起大量的并发症，其中包括...     

门诊糖尿患者健康教育管理模式的探讨

目的探讨适宜门诊糖尿病患者的健康教育管理模式,以提高健康教育效果。方法组建糖尿病管理中心,对糖尿病管理中心的400例门诊糖尿病患者实行会员登记制度,提供优惠的服务,预约随访,开展形式多样的健康教育、定期举办知识竞赛和联谊会。结果健康教育后患者对糖尿病相关知识掌握程度及各项生化指标显著优于教育前（均P〈0．01）。结论门诊糖尿病患者健康管理模式为患者提供了系统学习糖尿病知识的课堂;个体化教育是强化糖尿病知识,提高自我管理能力的重要方式;预约随访保证了教育的连续性。     

门诊糖尿患者健康教育管理模式的探讨

目的 探讨适宜门诊糖尿病患者的健康教育管理模式,以提高健康教育效果.方法 组建糖尿病管理中心,对糖尿病管理中心的400例门诊糖尿病患者实行会员登记制度,提供优惠的服务,预约随访,开展形式多样的健康教育、定期举办知识竞赛和联谊会.结果 健康教育后患者对糖尿病相关知识掌握程度及各项生化指标显著优于教育前(均P<0.01).结论 门诊糖尿病患者健康管理模式为患者提供了系统学习糖尿病知识的课堂;个体化教育是强化糖尿病知识,提高自我管理能力的重要方式;预约随访保证了教育的连续性.     

结直肠癌伴糖尿病37例围手术期处理

目的总结结直肠癌伴糖尿病患者的围手术期处理经验。方法对我院2001~2009年期间手术治疗的37例结直肠癌伴糖尿病患者的临床资料进行回顾性分析。结果 37例患者均为2型糖尿病,行择期手术,术后发生切口感染7例(18.9%),吻合口漏1例(2.7%),骶前间隙积脓2例(5.4%),肺部感染4例(10.8%),泌尿系感染2例(5.4%),无酮症酸中毒发生。术后平均住院时间22 d,无围手术期死亡病例。结论结直肠癌伴糖尿病患者围手术期严格控制血糖,选择合理术式,应用有效抗生素、营养支持等治疗,可达到较满意的外科治疗效果。     

Pioglitazone in the Management of Diabetes Mellitus after Transplantation

Type 2 diabetes mellitus is a common problem in patients after solid organ transplantation. We studied the safety and efficacy of pioglitazone therapy in this setting. Ten patients with diabetes mellitus treated with insulin or glyburide after transplantation were studied after the addition of the thiazolidinedione pioglitazone. Serum creatinine, HBA1C, total daily insulin dose, tacrolimus dose, tacrolimus level and prednisone dose were followed for a mean of 242 days and compared to the corresponding values measured before the initiation of pioglitazone. The addition of pioglitazone caused no significant changes in serum creatinine or mean tacrolimus dose, and caused decreases in HBA1C (8.36%+/- 1.5% pre-pioglitazone, 7.08%+/- 1.5% post-pioglitazone, p = 0.018) and total daily insulin dose (125.1 +/- 28.1 units pre-pioglitazone, 80.6 +/- 22.8 units post-pioglitazone, p = 0.002). Our preliminary study suggests that pioglitazone is a safe and effective oral agent for the management of diabetes mellitus after transplantation.     

Diabetes Mellitus as Predictor of Patient and Graft Survival After Kidney Transplantation

Background

In this study, we used a single-center database to examine the risks of renal transplantation in patients with diabetes mellitus (DM). We aimed to compare 1-year outcomes of survival and morbidity after renal transplantation among recipients with and without DM.

Methods

We reviewed retrospectively 1211 adult patients who underwent renal transplantation from January 2001 to December 2010. The patients were divided into 2 groups: Those with (33%) and those without (67%) pretransplant diabetes. Unpaired Student's t tests and χ² tests were used to compare outcomes between diabetic and nondiabetic renal transplant recipients. We analyzed survival, renal function, development of proteinuria, rejection, and infection (requiring hospitalization).

Results

Patients with diabetes were older, had a greater body mass index (mean, 29.5 vs 25.3 kg/m²; P < .05), and had lower creatinine clearance (44.2 ± 11.4 vs 56.0 ± 18.2; P = .01). Forty-one patients died in hospital (3.4%; P = nonsignificant). Furthermore, survival rates were similar between these 2 groups. However, we found a trend toward decreased survival for those with DM at 1 year (80.4% vs 88.7%; P = .20). Mean follow-up time was 3.2 years. Infection rate within 6 months was greater among those with DM (19% vs 5%; odds ratio, 6.25). Freedom from rejection at 3 years was similar (75.2% vs 76.8%; P = .57). Multivariate analysis showed increased baseline creatinine level as a significant risk factor for survival. Body mass index >30 kg/m² was a significant risk factor for survival among patients with DM.

Conclusion

We found an increased risk of serious infections in patients with DM, particularly within the first 6 months. However, our data suggest that diabetes is not associated with worse 1-year survival or higher morbidity in renal transplant patients, as long as good blood glucose control is maintained.     

老年胃癌患者合并糖尿病的围手术期处理

目的探讨老年胃癌患者合并糖尿病的围手术期处理。方法对我院1990年1月至2004年2月期间收治的297例老年胃癌中41例合并糖尿病患者的临床资料进行回顾性分析。结果术后并发感染率、吻合口漏、死亡率及住院时间,血糖正常者分别为19.9%(51/256)、0.4%(1/256)、0.8%(2/256)和(19.1±4.3)d,糖尿病患者分别为34.1%(14/41)、7.3%(3/41)、7.3%(3/41)和(24.3±5.1)d,后者均明显高于前者(P均<0.05)。结论老年胃癌患者合并糖尿病术后并发症及病死率较高,其围手术期处理至关重要,应引起外科医生的高度重视。     

Repaglinide in the Management of New-Onset Diabetes Mellitus After Renal Transplantation

The purpose of this study was to investigate the use of the short-acting insulin secretion drug repaglinide in new-onset diabetes mellitus (NODM) after renal transplantation. Twenty-three Caucasian patients with NODM after renal transplantation were selected to receive repaglinide therapy and were followed for at least 6 months. A control group treated with rosiglitazone was chosen for comparison. Successful repaglinide treatment was defined as a significant improvement of blood glucose concentrations and HbA1c <7% in the absence of glucosuria and without the need for the addition of further anti-diabetic agents. After 6 months of treatment with repaglinide, 14 of the 23 patients were successfully treated. Mean HbA1c decreased from 7.6 +/- 0.6% to 5.8 +/- 0.6% in 14 patients treated successfully. In nine patients, hyperglycemia persisted, and they were switched to insulin treatment (HbA1c 8.5 +/- 2.9% at the beginning to 7.4 +/- 2.2%). Mean serum creatinine levels, cyclosporine A and tacrolimus blood levels did not change significantly following institution of repaglinide therapy. The rate of successful treatment and the degree of HbA1c decrease were similar compared to rosiglitazone-treated control patients. The data from our observational study indicate that repaglinide can be an effective treatment option in Caucasian patients with NODM after renal transplantation.