2型糖尿病患者实施人工关节置换围手术期的风险探讨

Perioperative risks during artificial joint replacement for patients with type 2 diabetes mellitus

人工关节置换并发症主要有感染、无菌性松动、假体的脱位、断裂、深静脉血栓形成。2型糖尿病导致微血管病变,组织血供减少,造成全身和局部抵抗力降低,多合并心肾脑血管并发症,行人工关节置换感染概率高,并发症多,易发生伤口愈合障碍。术后肺部感染、尿路感染也较一般人群发病率增加,创口愈合时间均有不同程度的延迟。深静脉血栓形成也是2型糖尿病人工关节置换术的常见并发症之一,增加了围手术期治疗的复杂性。血糖的不稳定易触发循环功能的不稳定,使麻醉过程中的不确定因素增加,因此有效地控制血糖是降低2型糖尿病人工关节置换术风险的关键。

Complications of artificial joint replacement include infection, aseptic loosening, prosthesis dislocation and breakage, and deep venous thrombosis. Type 2 diabetes mellitus induces capillary pathological changes, tissue blood supply decrease, leading to general and local resistance reduction. Type 2 diabetes mellitus is always complicated by heart, renal, or cerebrovascular complications, which contributes to high infection rate and frequent complications after artificial joint replacement. In addition, incidence of postoperative pulmonary infection and urinary tract infection is increased, and wound healing is delayed. Deep venous thrombosis is a common complication of diabetic patients following artificial joint replacement, which increases the complexity of perioperative treatment. Blood glucose instability may induce circulation function instability and increase indefinite factors during anesthesia. Therefore, blood glucose control is important to reduce risks in artificial joint replacement for diabetic patients.