Aniskevich Stephen, Renew Johnathan R, Chadha Ryan M, Irizarry-Alvarado Joan M
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL 32224, United States.
Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, United States.
Curr Clin Pharmacol. 2017;12(3):157-163. doi: 10.2174/1574884712666170810115847.
Given the prevalence of diabetes mellitus in modern society, health care providers are frequently tasked with managing glucose control in the perioperative period. When determining perioperative diabetes management, the clinician must balance the need to maintain relative euglycemia at the time of surgery with preventing hypoglycemia or hyperglycemia in a fasting surgical patient. This balance requires an understanding of the pharmacology of these medications, the type of surgery, and the patient's degree of diabetic control.
We discuss the various medications used in the treatment of diabetes mellitus and the current recommendations regarding perioperative care.
A review of the current literature present on Pubmed and Medline was conducted between the years 2000-2016. The reference lists of each selected article were also reviewed for additional sources of information.
Perioperative control of blood glucose levels is associated with less morbidity and improved surgical outcomes in patients with and without DM. Preoperatively, clinicians need to thoughtfully adjust diabetic medications on the basis of patient comorbidities, the duration of the fasting period, and the duration of surgery. Intraoperative and postoperative strategies typically use insulin to maintain blood glucose levels in the range of 80 to 180 mg/dL.
鉴于现代社会糖尿病的患病率，医疗保健提供者经常承担围手术期血糖控制管理的任务。在确定围手术期糖尿病管理方案时，临床医生必须在手术时维持相对正常血糖水平的需求与防止禁食手术患者发生低血糖或高血糖之间取得平衡。这种平衡需要了解这些药物的药理学、手术类型以及患者的糖尿病控制程度。
我们讨论用于治疗糖尿病的各种药物以及当前关于围手术期护理的建议。
对2000年至2016年间发表在PubMed和Medline上的当前文献进行了综述。还对每篇所选文章的参考文献列表进行了审查，以获取更多信息来源。
围手术期血糖水平的控制与糖尿病患者和非糖尿病患者的发病率降低及手术结果改善相关。术前，临床医生需要根据患者的合并症、禁食时间和手术时长，审慎调整糖尿病药物。术中和术后策略通常使用胰岛素将血糖水平维持在80至180mg/dL范围内。
