围术期血糖控制最新进展

The Development of Perioperative Blood Glucose Control

围术期手术和麻醉应激皆可引起糖尿病及非糖尿病患者血糖升高,机制与应激激素和细胞因子加速外周组织的胰岛素抵抗有关。高血糖对机体影响主要是术后感染,其原因是高血糖降低糖尿病患者白细胞的趋化、吞噬及氧化爆发作用,促进中性粒细胞分泌致炎细胞因子的功能,并影响多形核细胞的免疫功能。血糖升高可延长危重患者的住院时间,增加病死率。血糖调控的主要药物有口服降糖药和静脉降糖药,口服降糖药因其代谢半衰期长,血糖浓度难以调整,一般情况下,围术期停用口服降糖药;静脉输注短效胰岛素。输注胰岛素的方法随着自动化的发展,已发展为增强型计算机控制预测模型,该方法可安全有效地调控围术期血糖浓度。

Perioperative surgical and anesthetic stress Jieke cause diabetes and non-diabetic patients with elevated blood sugar,mechanism and stress hormones and cytokines to accelerate peripheral tissue insulin resistance.The major impact of hyperglycemia on the body is a postoperative infection,the reason is to reduce high blood sugar diabetes leukocyte chemotaxis,phagocytosis and oxidative outbreaks role in promoting the secretion of neutrophil function induced by inflammatory cytokines and influence the polymorphonuclear cells the immune function.Hyperglycemia in critically ill patients prolong hospital stay and increase mortality.The main blood sugar control drugs oral hypoglycemic drugs and intravenous hypoglycemic agents,oral hypoglycemic agents because of its long metabolic half-life,blood glucose concentration is difficult to adjust,under normal circumstances,perioperative out oral hypoglycemic agents; intravenous infusion of short-acting insulin.Method of infusion of insulin along with the development of automation has been developed for the enhanced computer-controlled prediction model,This method can be safe and effective control of perioperative blood glucose levels.