创伤骨科糖尿病患者围手术期血糖管理

Perioperative blood glucose management in diabetic patients with traumatic orthopedics diseases

近年来,糖尿病患病率呈逐年增高趋势,糖尿病是骨质疏松及骨质疏松性骨折的重要危险因素,需要接受手术治疗的骨折患者中有糖尿病史者也逐年增加,约有20%的非糖尿病患者围手术期会出现高血糖。围手术期血糖异常(包括高血糖、低血糖和血糖波动)均增加手术患者的死亡率,增加感染、伤口不愈合以及心脑血管事件等并发症的发生率,延长住院时间,影响远期预后。临床上应高度重视围手术期血糖管理,对血糖进行合理地监测和良好地控制。根据已发表的相关指南和专家共识,并结合北京积水潭医院创伤骨科的特点,规范了从术前准备到术中、术后的血糖控制,以及可能出现的糖尿病酮症和低血糖的处理,为临床上创伤骨科糖尿病患者的围手术期血糖管理提供参考。

Recently,the prevalence of diabetes has been increasing year by year.Diabetes is an important risk factor for osteoporosis and osteoporosis fractures,and the number of fractured patients with a history of diabetes who need surgical treatment is also increasing year by year.About 20%of non-diabetic patients will have hyperglycemia during the perioperative period.Perioperative abnormal blood glucose,including hyperglycemia,hypoglycemia and fluctuation of blood glucose,increases the mortality of surgical patients and the incidence of complications such as infection,wound nonunion and cardiovascular and cerebrovascular events,prolongs the hospital stay,and affects the long-term prognosis.Perioperative blood glucose management should be paid more attention in clinic,and blood glucose should be monitored reasonably and controlled well.This tutorial was established on the related published guidelines and expert consensus and combined with the characteristics of orthopedic trauma in Beijing Jishuitan hospital,which normalized the blood glucose control from the preoperative preparation to the intra-operation and post operation,and treatment of possibly diabetes ketosis and hypoglycemia,and provided certain reference for perioperative blood glucose management in orthopedic trauma patients with diabetes mellitus.