Современные направления в лечении периоперационной гипергликемии у хирургических больных с сахарным диабетом: обзор литературы
№ 4 (2021) , ПЕРИОПЕРАЦИОННОЕ ВЕДЕНИЕ ПАЦИЕНТОВ
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ПЕРИОПЕРАЦИОННОЕ ВЕДЕНИЕ ПАЦИЕНТОВ

Современные направления в лечении периоперационной гипергликемии у хирургических больных с сахарным диабетом: обзор литературы

https://doi.org/10.21320/1818-474X-2021-4-33-47
Опубликован 19.01.2022
Владимир Николаевич Куклин
Отделение анестезиологии и интенсивной терапии, Университетская клиника Ахюс, Лоренскуг, Норвегия
https://orcid.org/0000-0003-1873-0231
Ю. Матри
Отделение анестезиологии и интенсивной терапии, Университетская клиника Ахюс, Лоренскуг, Норвегия
https://orcid.org/0000-0002-5225-4614
Н.П. Барлоу
Отделение анестезиологии и интенсивной терапии, Университетская клиника Ахюс, Лоренскуг, Норвегия
https://orcid.org/0000-0002-0701-9017
Щ.Х. Твейт
Отделение анестезиологии и интенсивной терапии, Университетская клиника Ахюс, Лоренскуг, Норвегия
https://orcid.org/0000-0003-0988-0000
Я.Э. Квернберг
Отделение анестезиологии и интенсивной терапии, Университетская клиника Ахюс, Лоренскуг, Норвегия
https://orcid.org/0000-0003-0081-8964
Э.-М. Рингвольд
Отделение анестезиологии и интенсивной терапии, Университетская клиника Ахюс, Лоренскуг, Норвегия
https://orcid.org/0000-0002-0356-8086
В. Даль
Отделение анестезиологии и интенсивной терапии, Университетская клиника Ахюс, Лоренскуг, Норвегия
https://orcid.org/0000-0001-7915-9388
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Ключевые слова

сахарный диабет
хирургия
пропофол
севофлуран
инсулин
отделение реанимации и интенсивной терапии

Как цитировать

Куклин В.Н., Матри Ю., Барлоу Н.П., Твейт Щ.Х., Квернберг Я.Э., Рингвольд Э..-М., Даль В. Современные направления в лечении периоперационной гипергликемии у хирургических больных с сахарным диабетом: обзор литературы. Вестник интенсивной терапии имени А.И. Салтанова. 2022;(4):33–47. doi:10.21320/1818-474X-2021-4-33-47.
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Аннотация

Многочисленные клинические исследования демонстрируют прямую взаимосвязь между наличием длительной и/или стресс спровоцированной гипергликемией и развитием послеоперационных осложнений. Частота выявления периоперационной гипергликемии регистрируется в 20–80 % всех клинических случаев в зависимости от вида планового хирургического вмешательства, и при этом самый высокий показатель наблюдается в кардиохирургии. Наиболее изученными патофизиологическими молекулярными механизмами осложнений длительной гипергликемии у больных сахарным диабетом (СД) являются активация биохимических каскадов полиола, диацилглицерина/протеинкиназы C, гексозамина, повышенное образование продуктов гликирования и развитие окислительного стресса. Неконтролируемая гипергликемия, спровоцированная стрессом, как во время, так и после операции, приводит к увеличению осмотического диуреза с последующим дисбалансом внутрисосудистой жидкости и электролитов, усилению процесса глюконеогенеза и глюкогенолиза, расщеплению жиров на свободные жирные кислоты и глицерин, белков — на аминокислоты и увеличению продукции провоспалительных цитокинов. Все эти изменения могут приводить к развитию диабетического кетоацидоза, дизрегуляции иммунной системы и инсулинорезистентности. Клинические исследования влияния разных типов наркоза на уровень гликемии указывают на то, что пропофол может иметь небольшое преимущество в поддержании стабильного уровня глюкозы крови (ГК) по сравнению с ингаляционными анестетиками. В настоящее время проводятся два больших клинических исследования, сравнивающих влияние различных типов анестезии на периоперационный гликемический статус у пациентов с СД. В заключение данного обзора мы представили несколько важных практических рекомендаций, которые, по нашему мнению, могут помочь практическим анестезиологам-реаниматологам оптимизировать контроль и лечение периоперационной гипергликемии у пациентов с СД.
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