Vanhaeverbeek M
Laboratory Experimental Medicine, Montigny-le-Tilleul.
Acta Clin Belg. 1997;52(5):313-9. doi: 10.1080/17843286.1997.11718594.
The peri-operative tight control of glycaemia for the diabetic patient is a matter of controversy. Diabetes per se is not a risk factor for post-operative morbidity or mortality, after adjustment for co-morbidities like atherosclerosis. Controlled studies have shown the advantages of tight control of glycaemia in two acute complications of atherosclerosis, i.e. myocardial infarction and cerebro-vascular accident. As these diseases have high prevalence in diabetes, and constitute the majority of post-operative problems of diabetic patients, when metabolic or infections are mastered, peri-operative tight control of glycaemia (6-10 mmol/l; 100-180 mg/dl) is presented as a probable necessity, when the pre-operative probability of macroangiopathy is high. This objective is best reached by a team associating anaesthesiologist and diabetologist, organising rules adapted to each hospital, including frequent capillary glycaemia controls and IV perfusions of glucose and insulin. Controlled clinical studies have to be done in this field.
糖尿病患者围手术期严格控制血糖是一个有争议的问题。在对动脉粥样硬化等合并症进行调整后，糖尿病本身并非术后发病或死亡的危险因素。对照研究显示了严格控制血糖在动脉粥样硬化的两种急性并发症，即心肌梗死和脑血管意外中的优势。由于这些疾病在糖尿病中患病率很高，并且构成了糖尿病患者术后问题的主要部分，当代谢或感染得到控制时，在术前大血管病变可能性较高的情况下，围手术期严格控制血糖（6-10毫摩尔/升；100-180毫克/分升）似乎是必要的。这一目标最好由麻醉师和糖尿病专家组成的团队来实现，制定适合每家医院的规则，包括频繁的毛细血管血糖监测以及葡萄糖和胰岛素的静脉输注。在这一领域必须开展对照临床研究。
