z糖尿病患者麻醉ppt课件.ppt

术中管理 如何处理术中高血糖？ 血糖超过14mmol/l需静脉给予胰岛素 单次剂量胰岛素5-10u，成人胰岛素一般1u降低血糖0.6mmol/l，或者降低1mmol/l血糖需胰岛素1.7u 持续输注胰岛素 术中管理 如何识别和处理术中低血糖？ 全身麻醉下表现为难以解释的休克和 Neuroglycopenic symptoms of hypoglycemia are the direct result of central nervous system (CNS) glucose deprivation. They include behavioral changes, confusion, fatigue, seizure, loss of consciousness, and, if hypoglycemia is severe and prolonged, death. Neurogenic (or autonomic) symptoms of hypoglycemia are the result of the perception of physiologic changes caused by the CNS-mediated sympathoadrenal discharge triggered by hypoglycemia. They include adrenergic symptoms (mediated largely by norepinephrine released from sympathetic postganglionic neurons but perhaps also by epinephrine released from the adrenal medullae) such as palpitations, tremor, and anxiety. They also include cholinergic symptoms (mediated by acetylcholine released from sympathetic postganglionic neurons) such as sweating, hunger, and paresthesias. Clearly, these are nonspecific symptoms. Their attribution to hypoglycemia requires a corresponding low plasma glucose concentration and their resolution after the glucose level is raised (Whipples triad). Common signs of hypoglycemia include diaphoresis and pallor. Heart rate and systolic blood pressure are typically raised, but these findings may not be prominent. Neuroglycopenic manifestations are often observable. Transient focal neurologic deficits occur occasionally. Permanent neurologic deficits are rare. 术中管理 如何识别和处理术中低血糖？ 全身麻醉下临床表现被掩盖，常出现难以解释的大汗、低血压、心动过速 确诊依靠血糖监测 Oral treatment with glucose tablets or glucose-containing fluids, candy, or food is appropriate if the patient is able and willing to take these. A reasonable initial dose is 20 g of glucose. If the patient is unable or unwilling, because of neuroglycopenia, to take carbohydrates orally, parenteral therapy is necessary. Intravenous glucose (25 g) should be given and followed by a glucose infusion guided by serial plasma glucose measurements. If int