妇科疾病合并糖尿病的围手术期处理

PERIOPERATIVE MANAGEMENT OF GYNECOLOGICAL DISEASES COMPLICATED WITH DIABETES

目的:探讨妇科疾病合并糖尿病病人的围手术期处理原则,减少并发症的发生。方法:回顾性分析78例妇科疾病合并糖尿病病人的临床资料。结果:全部病例术后24h内血糖均高于术前,其中全麻及手术时间120min以上对血糖的影响分别明显大于连续硬膜外麻醉及手术时间120min以下者,术后并发症发生率15.4%(12/78),以肺部感染和泌尿系感染为主,经治疗全部恢复。结论:糖尿病病人术前要做全面检查并积极控制血糖至理想水平。手术麻醉宜选用硬膜外麻醉,手术时间最好控制在120min,给予术后镇痛,术后禁食期间要给予支持治疗并补钾,促进切口愈合,同时加强易感染部位的护理,使糖尿病病人安全度过围手术期。

Objective：To discuss the principles of the perioperative management of gynecological patients with diabetes, so as to reduce the complications as possible. Methods：The clinical data from 78 gynecological patients with diabetes undergoing gynecological operation in our hospital were analyzed retrospectively. Results： The blood sugar levels of 78 patients increased within 24h after operation. Effects of general anesthesia with operation time longer than 120rain on the blood sugar levels of patients were more significant than those of epidural anesthesia with operation time shorter than 120min. The incidence rate of post - operative complications was 15.4% （ 12/78 ）. The main post - operative complications were pulmonary infection and urinary infection, and they all recovered well after treatment. Conclusion：Before operation, a overall examination with diabetes patients was made and actively controled the blood sugar to the ideal level. Epidural anesthesia is proper for patients with diabetes. Operation finished within 120min can avoid high blood sugar after operation. After operation,it＇s possible to give analgesic sufficiently, offer sufficient supporting treatment in starvation period, especially maintaining normal blood potassium, promote wound healing, enhance nursing with parts which was easy infected so as to make the patients undergoing the perioperative period safely.