Barker P, Creasey P E, Dhatariya K, Levy N, Lipp A, Nathanson M H, Penfold N, Watson B, Woodcock T
Joint British Diabetes Societies Inpatient Care Group.
British Association of Day Surgery.
Anaesthesia. 2015 Dec;70(12):1427-40. doi: 10.1111/anae.13233. Epub 2015 Sep 29.
Diabetes affects 10-15% of the surgical population and patients with diabetes undergoing surgery have greater complication rates, mortality rates and length of hospital stay. Modern management of the surgical patient with diabetes focuses on: thorough pre-operative assessment and optimisation of their diabetes (as defined by a HbA1c < 69 mmol.mol(-1) ); deciding if the patient can be managed by simple manipulation of pre-existing treatment during a short starvation period (maximum of one missed meal) rather than use of a variable-rate intravenous insulin infusion; and safe use of the latter when it is the only option, for example in emergency patients, patients expected not to return to a normal diet immediately postoperatively, and patients with poorly controlled diabetes. In addition, it is imperative that communication amongst healthcare professionals and between them and the patient is accurate and well informed at all times. Most patients with diabetes have many years of experience of managing their own care. The purpose of this guideline is to provide detailed guidance on the peri-operative management of the surgical patient with diabetes that is specific to anaesthetists and to ensure that all current national guidance is concordant.
糖尿病影响10% - 15%的外科手术人群，接受手术的糖尿病患者并发症发生率、死亡率更高，住院时间更长。糖尿病外科患者的现代管理重点在于：全面的术前评估及优化其糖尿病病情（定义为糖化血红蛋白<69 mmol.mol⁻¹）；判断患者在短时间禁食期（最多错过一餐）内能否通过简单调整原有治疗方案进行管理，而非使用可变速率静脉胰岛素输注；当唯一选择是后者时，如急诊患者、预计术后不能立即恢复正常饮食的患者以及糖尿病控制不佳的患者，要安全使用可变速率静脉胰岛素输注。此外，医护人员之间以及他们与患者之间的沟通必须始终准确且信息充分。大多数糖尿病患者有多年自我管理护理的经验。本指南的目的是为麻醉医生提供关于糖尿病外科患者围手术期管理的详细指导，并确保所有现行国家指南保持一致。
