糖尿病围术期处理的几个相关问题PPT.ppt

糖尿病围术期处理的几个相关问题 ;;糖尿病（diabetes mullitus, DM）;（一）概述;（二）流行病学资料;（三）糖尿病诊断标准（WHO糖尿病专家委员会报告，1999）;糖化蛋白;IDF提出糖尿病管理五个要点 （五驾马车）： 糖尿病教育， 医学营养治疗， 运动治疗， 血糖监测， 药物治疗;二 病例分享;;;;（二） 术前准备;（三） 手术过程;手术开始2小时后，患者出现了EMERGENCY;;低血糖综合征（Hypoglycemic Syndrome）;（一）概念;（二）低血糖综合征的诊断：符合Whipple三联症;提示;（三）临床表现;（四）治疗;低血糖的治疗;四 糖尿病患者围术期血糖的管理;（一）糖尿病患者术前准备标准;（二）低血糖相关风险;;;Hyperglycemia is associated with increased mortality and morbidity in critically ill patients. Although hyperglycemia is associated with worse outcomes, the treatment of hyperglycemia with insulin infusions has not provided consistent benefits. Despite early results, which suggested decreased mortality and other advantages of “tight” glucose control, later investigations found either no benefit or increased mortality when hyperglycemia was aggressively treated with insulin. ;Because of these conflicting data, the optimal glucose concentration to improve outcomes in critically ill patients is unknown. Current recommendations for perioperative glucose management from national societies are varied, but, most suggest that tight glucose control may not be beneficial, while mild hyperglycemia appears to be well-tolerated Andra E. Duncan*，Hyperglycemia and Perioperative Glucose Management，Current Pharmaceutical Design, 2012, 18, 6195-6203;Others report that intraoperative hyperglycemia, defined as the measurement of four consecutive blood concentrations greater than 200 mg/dL, was associated with significantly higher risk of mortality, as well as increased risk for cardiovascular, respiratory, renal, neurologic morbidity. Outtara A, Lecomte P, Le Manach Y, et al. Poor intraoperative blood glucose control is associated with a worsened hospital outcome after cardiac surgery in diabetic patients. Anesthesiology 2005; 103(4): 687-94;Fig. (2).Incidence of severe in-hospital morbidity between patients in whom intraoperative glycemic control was poor (4 consecutive glucose levels 200 mg/dL) or tight. CV = cardiovascul