肝移植围手术期糖尿病防治的初步研究

目的研究肝移植围手术期糖尿病对患者的影响及防治措施。方法回顾性分析131例肝移植患者临床资料，观察患者围手术期糖尿病的发生及对术后并发症的影响，探讨移植术后新发糖尿病与原发疾病、术后免疫抑制药物等因素的关系。结果移植术后新发糖尿病发生率为19．3％（21／109），与糖尿病家族史和术后使用大剂量激素有关，与非糖尿病患者相比，围手术期糖尿病患者急性排斥反应、细菌感染、高血压等并发症的发生率显著升高（P〈0．05），术前及术后早期（2周内）将血糖降至正常可减少感染的发生。结论围手术期出现糖尿病会增加肝移植患者术后并发症的发生率，应该有效控制血糖以减少感染并发症的发生，同时肝移植术后早期应避免使用大剂量激素.

The prevention and management of perioperative diabetes mellitus in patients undergoing liver transplantation

Objective To investigate the influence of perioperative diabetes mellitus ( DM ) on patients undergoing liver transplantation and the prevention and management. Methods We reviewed the clinical data of 131 patients after liver transplantation and observed the impact of DM on post-operative complications. We also analyzed the relationship between new-onset diabetes mellitus ( PTDM) after liver transplantation with primary liver disease and the use of immunosuppressant. Result Twenty-one out of 131 patients suffered PTDM (19. 3% ) , the occurrence of PTDM was associated with previous history of DM and high dosage of corticosteroid (P < 0. 05). Patients with DM were prone to acute graft rejection, bacterial infection and high blood pressure (P< 0.05). We could decrease the rate of infection by controlling blood glucose within normal range before and early after liver transplantation ( within two weeks). Conclusion Perioperative DM increased the complications after liver transplantation, effective control of blood glucose may help to reduce the occurrence of infection, high dose of corticosteroid should be avoided early after liver transplantation.