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Anesthesia for patients with diabetes mellitus

机译：糖尿病患者的麻醉

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Purpose of review: Diabetes mellitus has diverse effects on all organ systems of the body. Insulin physiology and metabolic control are far more complex than previously thought. Research continues to reveal more information about the central role of insulin in metabolism. The treatment of hypertension and nephropathy as well as hyperglycemia in patients with diabetes has emerged as being critical for prevention of long-term diabetic complications. The issue of primary importance to the anesthesiologist is whether strict glycemic and hemodynamic control during the perioperative period affect outcome. Recent findings: Maintenance of euglycemia and physiologic control of insulin responses to changes in glucose levels have been shown to prolong life and reduce complications from diabetes mellitus. The identification and treatment of prediabetic patients may significantly delay the onset of overt diabetes. Perioperative control of glucose has become tighter, but the optimum level of glucose and ideal methodof insulin delivery during surgery remain controversial. Perioperative control of blood pressure and vascular responses may be as important as glucose control for prevention of adverse perioperative events. Summary: Tight long-term control of glucose and blood pressure improve outcome in patients with diabetes. The same philosophy of management is being applied to the perioperative period. Routine measurement of intraoperative blood glucose levels and appropriate insulin administration are now standard practice, but the ideal regimen for insulin administration remains to be determined.
机译：审查目的：糖尿病对人体所有器官系统都有不同的影响。胰岛素的生理和代谢控制比以前认为的要复杂得多。研究继续揭示有关胰岛素在新陈代谢中的核心作用的更多信息。糖尿病患者的高血压和肾病以及高血糖症的治疗已经成为预防长期糖尿病并发症的关键。对麻醉医师最重要的问题是围手术期严格的血糖控制和血流动力学控制是否会影响预后。最新发现：维持血糖正常和对血糖水平变化的胰岛素生理控制可延长寿命并减少糖尿病并发症。糖尿病前期患者的鉴定和治疗可能会明显延迟糖尿病的发作。围手术期对葡萄糖的控制越来越严格，但是在手术期间葡萄糖的最佳水平和理想的胰岛素输送方法仍存在争议。围手术期控制血压和血管反应与预防不良围手术事件的血糖控制一样重要。摘要：长期严格控制血糖和血压可改善糖尿病患者的预后。围手术期也采用了相同的管理理念。术中常规测量血糖水平和适当的胰岛素给药现已成为标准做法，但胰岛素给药的理想方案尚待确定。

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