Rosenberg C S
Cedars-Sinai Medical Center, Los Angeles, California.
Nurs Clin North Am. 1990 Mar;25(1):247-61.
Reports of an increased incidence of wound complications in surgical patients with diabetes mellitus may actually reflect the increased incidence of general surgical risks or metabolic abnormalities associated with diabetes mellitus. Factors such as age, obesity, malnutrition, and macrovascular and microvascular disease may contribute to wound infection and delayed wound healing especially in the type II diabetic patient. In addition, hyperglycemia caused by decreased insulin availability and increased resistance to insulin can affect the cellular response to tissue injury. Studies of the immune cells necessary for wound healing, such as PMN leukocytes and fibroblasts, as well as studies of injured tissue suggest that there is a delayed response to injury and impaired functioning of immune cells in diabetes mellitus. There is evidence that these impairments may be the result of both an inherent (genetic) defect as well as decreased insulin availability and increased blood glucose concentration. At the time of hospital admission, little can be done to affect most of the risk factors or inherent cellular defects. However, blood glucose levels can be controlled with the use of bedside blood glucose monitoring and frequent adjustment of insulin dosing. Nurses have traditionally played an important role in monitoring recovery from surgery and watching for signs of infection and wound complications. These nursing functions are especially important in the diabetic patient. In addition, frequent evaluation of the effectiveness of insulin therapy is an important nursing function throughout the perioperative period. Through improving management of blood glucose levels in surgical patients, nurses can have a major impact on the incidence of wound complications in diabetes mellitus.
糖尿病外科患者伤口并发症发生率增加的报告，实际上可能反映了与糖尿病相关的一般外科手术风险或代谢异常发生率的增加。年龄、肥胖、营养不良以及大血管和微血管疾病等因素可能导致伤口感染和伤口愈合延迟，尤其是在II型糖尿病患者中。此外，胰岛素可用性降低和胰岛素抵抗增加所导致的高血糖会影响细胞对组织损伤的反应。对伤口愈合所必需的免疫细胞（如PMN白细胞和成纤维细胞）的研究以及对受损组织的研究表明，糖尿病患者对损伤的反应延迟且免疫细胞功能受损。有证据表明，这些损伤可能是固有（遗传）缺陷以及胰岛素可用性降低和血糖浓度升高共同作用的结果。在入院时，对于大多数风险因素或固有细胞缺陷几乎无能为力。然而，通过床边血糖监测和频繁调整胰岛素剂量，可以控制血糖水平。传统上，护士在监测手术恢复情况以及观察感染和伤口并发症迹象方面发挥着重要作用。这些护理功能在糖尿病患者中尤为重要。此外，在整个围手术期，频繁评估胰岛素治疗的效果是一项重要的护理工作。通过改善外科患者的血糖管理，护士可以对糖尿病患者伤口并发症的发生率产生重大影响。
