并存高血糖肝癌患者的围手术期处理
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傅熙博 E-mail:fuxibo@sina.com

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Perioperative management of liver cancer patients with concomitant hyperglycemia
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    摘要:

    目的:探讨合并高血糖的肝癌患者行肝切除手术的围手术期处理措施。
    方法:对98例合并高血糖的肝癌行肝切除患者的临床资料进行回顾性分析。
    结果:患者术前空腹血糖均控制在6.1~11.1 μmol/L,尿酮体(-);术中血糖控制在6.8~11.2 μmol/L;术后使用胰岛素控制血糖。98例均顺利施行了手术。手术恢复良好,仅发生切口感染7例(7.14%),肺部感染3例(3.06%),泌尿系感染3例(3.06%),腹腔脓肿1例(1.02%),肺部感染病例中1例(1.02%)合并酮症酸中毒。
    结论:肝癌患者肝功异常可能诱发高血糖或加重原有糖尿病。对合并高血糖的患者,围手术期严格控制血糖,加强营养支持,积极处理感染、酮症酸中毒等并发症,是外科手术治疗成功的关键。

    Abstract:

    Objective: To investigate the perioperative management of liver cancer patients with concomitant hyperglycemia undergoing hepatectomy.
    Methods:The clinical data of 98 liver cancer patients with concomitant hyperglycemia were analyzed retrospetively.
    Results:Of the 98 patients, the fasting blood glucose (BG) was controlled within 6.1-11.1 μmol/L, and ketonuria was negative before operation; intraoperation, the BG was controlled within 6.8-11.2 μmol/L; and the BG was controlled by insulin postoperatively. The 98 patients underwent operation uneventfully and all recovered. After operation,  surgical incision infection occurred in 7 cases (7.14%); pulmonary infection occurred in 3 cases (3.06%), among them 1 combined with ketoacidosis (1.02%);  urinary system infection occurred in 3 cases (3.06%) and abdominal abscess occurred in 1 case (1.02%).
    Conclusions: Hepatic dysfunction of liver cancer patients may cause hyperglycemia or aggravate diabetes. For those with concomitant hyperglycemia, the perioperative management including tight blood glucose control, nutritional support enhancement, and aggressive treatment of complications such as infection and ketoacidosis is the important basis for successful surgical treament.

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傅熙博| 贺金云| 张玉会| 付庆才| 何忠野| 郝志强.并存高血糖肝癌患者的围手术期处理[J].中国普通外科杂志,2011,20(7):680-682.
DOI:10.7659/j. issn.1005-6947.2011.07.005

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  • 收稿日期:2010-09-12
  • 最后修改日期:2011-06-29
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  • 在线发布日期: 2011-07-15