型糖尿病胰岛素治疗进展.pptVIP

2021/3/17 * 加用抗生素 有显性蛋白尿者避免用有肾毒性的氨基糖苷类抗生素 预防血管栓塞 早作肢体活动,及时应用抗血小板凝聚药物等 防止感染 2021/3/17 * 特殊情况下的围手术期处理 心脏手术 实施体外循环的心脏手术患者需要更大剂量的胰岛素方可有效控制血糖。 为减少血糖波动,最好选择胰岛素持续静脉输注方案,并密切观察血糖的变化。 术后,可以使用极化液或其他胰岛素治疗方法,或者使用胰岛素泵控制血糖。 2021/3/17 * 微创手术 　腹腔镜等微创手术导致的应激程度并不亚于开腹等有创手术,所以胰岛素的使用原则和一般的手术相似。 老年患者 老年患者往往合并心血管疾病或其他器官功能的减退,而且对低血糖的反应性和耐受较差,容易出 现严重低血糖现象。因此,这类患者需要更频繁地检测血糖,慎重调整胰岛素剂量,并努力掌握输液量,避免液体超负荷而导致心力衰竭等。 特殊情况下的围手术期处理 * * * * 人体内除了胰岛素能够降低血糖外，其他激素都是升高血糖的。 儿茶酚胺类化合物是一类典型的生物胺，是与压力，精神活动，感情过程，学习，睡眠和记忆的影响相关的。儿茶酚胺类化合物家族包括以下成员：去甲肾上腺素，多巴胺，左旋多巴，肾上腺素和酪氨酸。 * * * * * * * * * * * * Figure 1— Postoperative morbidity and mortality in cardiothoracic cardiothoracic(CT) surgery patients with and without diabetes. Diabetic patients had higher rates of postoperative mortality (P = 0.04) and pulmonary complications (P = 0.02) but had similar rates of deep sternal wound infections, other infections, and cardiac, renal, and neurological complications than nondiabetic patients, as shown here on univariate analysis. On multivariate analysis, it was found that the presence of diabetes was not a significant factor in either pulmonary complications or mortality. DSWI, deep sternal wound infections; Infxn, infection; Neuro, neurological complications; Pulm, pulmonary complications. However, on multivariate analysis, it was found that the presence of diabetes was not a significant factor in either pulmonary complications or mortality. In this multivariate analysis, renal failure, nonelective surgery, and older age were positively associated with pulmonary complications, and renal failure, nonelective surgery, and female sex were positively associated with postoperative mortality independently of the patients diabetic status. * * * * Figure 2— Postoperative morbidity and mortality in patients undergoing CABG with and without diabetes. There were no statistically significant differences in morbidity and mortality between the groups. DSWI, deep sternal wound infections; Infxn, infection; Neuro, ne