糖尿病（DM）手术ppt课件.ppt

Surgery In Diabetes Mellitus (DM) Walid Sayed Abdelkader Hassanen Specialist of internal Medicine March 2010 * * Surgery In Diabetes Mellitus Hyperglycemia leads to impaired wound healing , deficient formation of granulation tissue. The chemotactic , phagocytic, and bacterial activity of the neutrophil is deficient , there is impaired hormonal host defense mechanism and abnormal complement function. * Metabolic sequelae in a surgical patient Increased glycogenolysis Increased gluconeogenesis hyperglycemia Decreased glucose utilization: Lipolysis with increased FFA Protein breakdown Increased nitrogen loss Increased urea production Increased sodium retension potassium execretion and alteration of water metabolism ( increased ADH and increased aldosterone secretion ) * Determinents of the management plan Type of DM Treatment, diet, oral antidiabetic drugs, insulin Metabolic status Vascular status: cardiac, renal, cerebral Surgery: Type: emergency or elective Minor or major procedure Type of anesthesia Post operative oral intake * Pre-operative management Metabolic stress of surgery and anesthesia cause increased elaboration of catecholamins, glucocorticoids, glucagon, and growth hormone, all producing their metabolic effects resulting in hyperglycemia in the pre-operative period. The glycemic control is aimed to achieve a fasting plasma glucose of 140 mg % and post prandial plasma glucose of 200 mg %. Insulin dependent diabetic patients can be admitted 2-3 days prior to surgery to achieve satisfactory control. * Cont. In NIDDM patients if the control is good with oral antidiabetic drugs , these drugs are stopped on the day of the surgery and intravenous fluids and insulin are given , if not are advised to stop drugs one week b