耳鼻咽喉―头颈外科糖尿病患者的围手术期并发症及处理.docVIP

耳鼻咽喉―头颈外科糖尿病患者的围手术期并发症及处理 耳鼻咽喉―头颈外科糖尿病患者的围手术期并发症及处理 作者：刘新义 刘艳 张恩东 薛令军 纪建丽 孙瑜宁 　　【摘要】 目的 探讨糖尿病对耳鼻咽喉―头颈外科患者手术后并发症的影响以及糖尿病患者的围手术期治疗。方法 对51例接受耳鼻咽喉及头颈部不同类型手术的糖尿病患者，观察其围手术期并发症，并于术前3天改为三餐前0.5h皮下注射速效胰岛素治疗，根据血糖的测定结果，开始剂量约为4～8U;对术后禁食需要补液的患者，按葡萄糖3～4g/胰岛素1U的比例给药，并每日监测血糖指标;术后进流质或半流质饮食的患者，于三餐前皮下注射胰岛素，按血糖测定情况给药，直至围手术期结束。患者术前及术后需用有效的抗生素预防感染，并注意纠正全身各系统的功能紊乱。结果 12例患者出现术后并发症（23.5%）。其中术后伤口局部感染4例（7.8%），伤口延期愈合6例（11.8%），2例（3.9%）行全副鼻窦开放术的患者，在取出鼻腔填塞物后出现鼻腔出血，经再次填塞后出血止。未发生肺部感染及术后败血症，亦未发生酮症酸中毒及心肺功能不全。所有患者均达到预期的手术目的。结论 耳鼻咽喉―头颈外科糖尿病患者在围手术期期间应用胰岛素治疗，安全有效，只要能够合理用药、注意补充营养及维生素、严格局部换药、及时纠正全身各系统的功能紊乱，就能避免手术中的危险性并减少术后并发症的发生。 关键词 围手术期 手术 并发症 糖尿病 胰岛素 Perioperative management of otolaryngology-head and neck surgery patients with diabetes mellitus Liu Xinyi，Liu Yan，Zhang Endong，et al. Department of Otolaryngology HeadNeck Surgery，Weihai Second Municipal Hospital，Weihai，264200. 【Abstract】 Objective To explore the influence of diabetes on otolaryngology―head and neck surgical operation complications and perioperative management.Methods 51patients with diabetes accepting various otorlaryngology-head and neck-surgical operation were adopted，regardless of previous treatments.Three days before operati on they all accepted regular insulin injecti on subcutaneously half an hour before three meals.The first dosage was roughly4～8U，then adjusted according to blood sugar levels.For the fasting patients who demanded fluid replacement post-operationalˉly，we infused solution in proportion to1U insulin/3～4g glucose and monitored everyday blood sugar in the meantime.The post-operational patient on liquid or semiliquid diet injected insulin subcutaneously before three meals，applied inˉsulin according to blood sugar level until end of perioperative period.Pre and post-operational patients need effective anˉtibiotics to prevent infections，and rectifying systemic dysfuction.Results 12cases（23.5%）appeared complications post-operationally.Among them the infection of wounds was4cases（7.8%），the