Rehman Habib-Ur, Mohammed Kamrudeen
Broomfield Hospital, Broomfield, Chelmsford, Essex, United Kingdom.
Curr Surg. 2003 Nov-Dec;60(6):607-11. doi: 10.1016/j.cursur.2003.07.002.
Diabetes mellitus is the most common metabolic disease. New classifications have recently been proposed by the American Diabetes Association (ADA) and the World Health Organization (WHO). Type 1 (formerly insulin-dependent diabetes mellitus IDDM) is immune-mediated and leads to absolute insulin deficiency. Type 2 diabetes (formerly non-insulin-dependent diabetes mellitus [NIDDM]) is a disease of adult onset and is associated with insulin resistance. Type 3 corresponds to a wide range of specific types of diabetes, including various genetic defects of beta-cell function and insulin action, diseases of exocrine pancreas, endocrinopathies, and drug-induced diabetes. Type 4 is gestational diabetes (Table 1). Diabetics undergoing surgery have increased mortality, and type 1 diabetics are particularly at risk of postoperative complications. Wound complications are increased in diabetics, and healing is severely impaired when glycemic control is poor. However, with the use of modern management plans, the major outcome measures of surgery are comparable in diabetic and nondiabetic patients. Successful management of surgery in diabetic patients requires simple and safe protocols, which are fully understood by all staff and a close liaison among the surgeons, diabetes care team, and anesthetists. There is no consensus on the optimal metabolic management of the diabetic patient during surgery. Several surveys have highlighted the inconsistency with which surgical problems are managed in diabetic patients. The aim of this article is to provide protocols to achieve sensible and practical glycemic control in diabetic patients undergoing surgery.
糖尿病是最常见的代谢性疾病。美国糖尿病协会（ADA）和世界卫生组织（WHO）最近提出了新的分类方法。1型糖尿病（以前称为胰岛素依赖型糖尿病[IDDM]）是免疫介导的，会导致绝对的胰岛素缺乏。2型糖尿病（以前称为非胰岛素依赖型糖尿病[NIDDM]）是一种成人发病的疾病，与胰岛素抵抗有关。3型糖尿病对应于多种特定类型的糖尿病，包括β细胞功能和胰岛素作用的各种遗传缺陷、外分泌胰腺疾病、内分泌疾病以及药物性糖尿病。4型糖尿病是妊娠期糖尿病（表1）。接受手术的糖尿病患者死亡率增加，1型糖尿病患者术后并发症的风险尤其高。糖尿病患者的伤口并发症会增加，血糖控制不佳时愈合会严重受损。然而，通过使用现代管理方案，糖尿病患者和非糖尿病患者手术的主要结局指标是可比的。糖尿病患者手术的成功管理需要简单安全的方案，所有工作人员都要充分理解这些方案，并且外科医生、糖尿病护理团队和麻醉师之间要密切联络。对于糖尿病患者手术期间的最佳代谢管理尚无共识。几项调查强调了糖尿病患者手术问题管理的不一致性。本文的目的是提供方案，以在接受手术的糖尿病患者中实现合理且实用的血糖控制。
