糖尿病患者的围手术期管理.pptVIP

* 可以看出甘精胰岛素作为长效胰岛素类似物，作用最持久，而且无峰值，正好与之前讲的人胰岛素分泌模式中的基础部分非常吻合，这给全天候良好控制血糖以及减少低血糖发生率提供了可能。 下面我们系统了解一下优伴系列胰岛素注射笔： 第一个是优伴2，其具有黑底白字、读书清晰、更换笔芯自如、剂量回调方便等特点 第二个是优伴经典笔，其在保留优伴2各项优势的同时，更像一支笔，更好的符合了糖尿病患者的心理需求 第三个是优伴经典微调笔，可以每次调整半个剂量，非常适用于需要严格控制剂量的1型糖尿病和儿童患者 第四个是预填充的胰岛素注射笔，使用简单方便。 使用注射装置时，请注意，笔芯和注射器要配套使用，如果不配套使用，可导致注射剂量不准、引起血糖波动，甚至导致出现重度低血糖等严重后果。 * * 根据可操作性/神经血管距离/皮下组织状况：适合注射的部位 注射部位还应考虑胰岛素在不同部位的吸收差异。 关于注射部位轮换的推荐： 在任何一个象限或等分区域内注射时，每次的注射点都应间隔至少1cm，以避免重复的组织损伤 注射部位的轮换：左右轮换 左边一周，右边一周，部位对称轮换 一次左边，一次右边，部位对称轮换 * 关于捏皮的推荐： 不能用整只手来提捏皮肤，以避免将肌肉及皮下组织一同捏起 当活塞完全推压到底后，针头在皮肤内停留至少10秒钟（采用胰岛素笔注射）； * Higher Costs: Diabetes in Hospitalized Patients Higher rate of hospitalization Longer stays More procedures, medications Chronic complications More arteriosclerotic disease More infections Complicated pregnancies * Associations Between Glucose Levels and Inpatient Outcomes Hyperglycemia is a risk factor for Mortality in critically ill patients Complications of myocardial infarction Complications of strokes Complications of vascular and cardiac surgery * Common Features Increasing Risk of Hypoglycemia in an Inpatient Setting * * Based on the high rate of hypoglycemia and no difference in mortality in major trials, and the results of NICE –SUGAR that reported increased mortality… NEW TASK FORCE. The slide shows the recommendations for target glucose levels in critically ill patients in the intensive care setting, which were released on May 8, 2009, by the American Association of Clinical Endocrinologists and the American Diabetes Association, and published online in the June issues of Endocrine Practice and Diabetes Care. They include the following: Insulin therapy should be initiated for treatment of persistent hyperglycemia, starting at a threshold of no greater than 180 mg/dL. Once insulin therapy has been started, a glucose range of 140 to 180 mg/dL is recommended for the majority of critically ill patients. Intravenous insulin infusions are the preferred method for achieving and maintaining gl