极度肥胖合并2型糖尿病患者的围手术期管理流程
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中国医科大学附属第四医院 第四普通外科,辽宁 沈阳 110032

作者简介:

张天一,中国医科大学附属第四医院住院医师,主要从事减重代谢外科方面的研究。

通信作者:

王勇,Email: wy750604@163.com

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Perioperative management process of extremely obese patients with type 2 diabetes
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The Fourth Department of General Surgery, the Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China

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    摘要:

    极度肥胖合并2型糖尿病诊断标准为体质量指数(BMI)≥50 kg/m2,空腹血糖(FPG)>7.0 mmol/L,且口服葡萄糖耐量试验(OGTT)餐后各时段胰岛素及C-肽分泌水平均高于空腹状态。对极度肥胖合并2型糖尿病患者来说,代谢手术几乎是唯一有效的治疗手段。因此,围手术期的科学管理是保证手术安全性,提高远期疗效的关键。围手术期的风险包括手术本身的风险、肥胖相关疾病的风险和血糖异常的风险。降低这些围手术期风险需要明确以下问题:⑴ 是否存在有效干预措施;⑵ 经过多长时间干预、能达到什么效果;⑶ 如果不能达到预期效果,有无备用解决方案。笔者通过梳理近年来的国内外文献,整理出极度肥胖患者合并2型糖尿病的围手术期管理流程,为临床治疗提供参考。

    Abstract:

    The diagnostic criteria for super obesity with type 2 diabetes mellitus include that body mass index (BMI) is above 50 kg/m2, fasting plasma glucose (FPG) is greater than 7.0 mmol/L, and insulin and C-peptide secretion levels at each time point of oral glucose tolerance test (OGTT) are higher than those in fasting state. Metabolic surgery is almost the only effective treatment for patients with super obesity and type 2 diabetes. Therefore, the scientific perioperative management is the key to ensuring the safety of operation and improving the long-term results. Perioperative risks include the risk of the procedure itself, the risk of obesity-related diseases, and the risk of abnormal blood sugar. To reduce the perioperative risks, the following questions are required to be clarified: (1) whether there are effective interventions; (2) how long the intervention will last and what effect it will achieve; (3) whether there is an alternative solution if the expected effect cannot be achieved. Here, the authors put together the perioperative management process for patients with super obesity and type 2 diabetes by reviewing and extracting data from the domestic and foreign literature in recent years, so as to provide a reference for clinical treatment.

    表 1 Table 1
    图1 肥胖相关的围手术期风险排查流程Fig.1 Perioperative risk screening process related to obesity
    图2 SO合并T2D患者的血糖管理流程图Fig.2 Management process of extremely obese patients with type 2 diabetes
    图3 SO合并T2D患者术后在院期管理流程图Fig.3 Postoperative management process of extremely obese patients with type 2 diabetes
    图1 肥胖相关的围手术期风险排查流程Fig.1 Perioperative risk screening process related to obesity
    图2 SO合并T2D患者的血糖管理流程图Fig.2 Management process of extremely obese patients with type 2 diabetes
    图3 SO合并T2D患者术后在院期管理流程图Fig.3 Postoperative management process of extremely obese patients with type 2 diabetes
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引用本文

张天一,王勇.极度肥胖合并2型糖尿病患者的围手术期管理流程[J].中国普通外科杂志,2022,31(10):1285-1292.
DOI:10.7659/j. issn.1005-6947.2022.10.003

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  • 收稿日期:2022-08-09
  • 最后修改日期:2022-09-18
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  • 在线发布日期: 2022-10-31