Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Br J Anaesth. 2013 Dec;111 Suppl 1:i18-34. doi: 10.1093/bja/aet381.
The prevalence of type 2 diabetes mellitus and the potential for perioperative dysglycaemia (hyperglycaemia, hypoglycaemia, stress-induced hyperglycaemia, or glucose variability) continue to increase dramatically. The majority of investigations on perioperative glycaemic control focused on critically ill patients and concentrated on goals of therapy, level of intensity of insulin infusion, feeding regimes, concerns over hypoglycaemia, and promulgation of recent guidelines calling for less strict glucose control. Areas of perioperative glycaemic control that deserve further investigation include preoperative identification of patients with undiagnosed type 2 diabetes and other forms of dysglycaemia, determination of appropriate intraoperative glucose goals, and establishment of the impact and natural history of perioperative abnormalities in glucose homeostasis. In the heterogeneous adult perioperative population, it is unlikely that one standard of perioperative glycaemic control is appropriate for all patients. This review presents recent evidence and expert guidance to aid preoperative assessment, intraoperative management, and postoperative care of the dysglycaemic adult patient.
2 型糖尿病的患病率以及围手术期糖代谢紊乱（高血糖、低血糖、应激性高血糖或血糖变异性）的潜在风险继续显著增加。大多数关于围手术期血糖控制的研究都集中在危重症患者身上，主要关注治疗目标、胰岛素输注强度、喂养方案、对低血糖的担忧，以及最近发布的指南呼吁放宽血糖控制的标准。围手术期血糖控制领域值得进一步研究的包括术前发现未诊断的 2 型糖尿病和其他形式的糖代谢紊乱，确定适当的术中血糖目标，以及确定围手术期葡萄糖稳态异常的影响和自然病程。在异质的成年围手术期人群中，不太可能有一种标准的围手术期血糖控制适用于所有患者。这篇综述介绍了最新的证据和专家指导，以帮助术前评估、术中管理和术后对糖代谢紊乱的成年患者的护理。
