糖尿病患者外科手术麻醉的临床研究与探讨

目的:研究与探讨糖尿病患者外科手术麻醉的安全性和有效性。方法:糖尿病外科手术患者262例。其中急性胆囊炎64例,胃穿孔52例,化脓性阑尾炎71例,阑尾穿孔弥漫性腹膜炎各63例,外伤性脾破裂12例。采用硬膜外麻醉146例,全身麻醉116例。结果:所有患者均手术顺利,麻醉平稳,麻醉手术过程中血糖水平较术前均有不同程度升高,按升高的血糖量适当增加胰岛素用量,血糖控制在10-12mmol/L,尿酮体(-),无糖尿病酮症酸中毒、高渗性非酮症性高血糖昏迷及低糖症发生。术毕均及时清醒,拔管,血糖水平较平稳。结论:急诊糖尿病患者手术时采用硬膜外麻醉对血糖影响小于全麻。

Clinical Research and Discussion on Surgical Anaesthesia for Patients with Diabetes

Objective: To study the safety and effectiveness of surgical anaesthesia for patients with diabetes.Methods: Among the 260 cases of surgical patients with diabetes,there were 64 cases with acute cholecystitis,52 cases with gastric perforation,71 cases with suppurative appendicitis,63 cases with appendiceal perforation diffusion peritonitis,and 12 cases of traumatic spleen rupture.146 patients received epidural anesthesia while 116 cases chose general anesthesia.Results: All patients had operation smoothly,with smooth anesthesia.The blood sugar levels were increased to different degree during the anesthesia process when compared with that preoperative.After appropriately increasing the insulin dose according to the rise of blood sugar level,the patients’ blood sugar level were controlled in 10-12mmol/L,and Urine ketone bodies(-),without diabetic ketoacidosis,hyperosmolar non-ketotic hyperglycemic coma or Hypoglycaemia.After operation all patients awake timely,and were smoothly decannulated,also with relatively stable blood sugar level.Conclusion: Epidural anesthesia method had lighter effect on surgical patients with diabetes than general anesthesia.