U pacjenta z cukrzycą, który ma zaplanowaną operację, stężenie glukozy we krwi powinno być zmierzone przed zabiegiem, w trakcie oraz po jego zakończeniu z częstotliwością 1-2 godzin, do chwili kiedy będzie możliwe rozpoczęcie stosowanego wcześniej modelu terapii.
Co szczególnie istotne, w dniu zabiegu operacyjnego nie należy podawać insuliny podskórnie. Dobrze, aby pacjent z cukrzycą został skierowany na operację jako pierwszy. Jest to ważne, ponieważ niewątpliwie zminimalizuje to reakcję stresową u pacjenta, która ma związek na zwiększenie stężenia glukozy we krwi.
Jak powinno wyglądać leczenie cukrzycy w okresie okołooperacyjnym?
Zarówno przed, jak i po operacji pacjentowi z cukrzycą należy podawać glukozę drogą dożylną, w ilości 5-10 g na godzinę oraz insulinę drogą dożylną 0,3-0,4 j./1 g glukozy.
W dniu operacji stosuje się dożylny wlew 5-10% glukozy z insuliną krótko działającą wraz z preparatem chlorku potasu (10-20 m Eq na każdy litr glukozy – GIK). Przykładowo można zastosować:
- 500 ml 10% roztworu glukozy, który będzie zawierał 16 j. insuliny krótko działającej i 10 mmol chlorku potasu,
- 500 ml 5% roztworu glukozy, który będzie zawierał 8 j. insuliny krótko działającej i 5 mmol chlorku potasu.
Decyzję o tym, jaka dawka będzie najbardziej odpowiednia dla pacjenta podejmuje lekarz, kierując się aktualnym stężeniem glukozy.
Jak podawać GIK?
Wlew dożylny powinien rozpocząć się w godzinach porannych. Należy go kontynuować w sposób ciągły z szybkością 80 ml /h. Można zastosować oddzielne podawanie insuliny i glukozy. Wówczas należy kierować się schematem:
- roztwór 5-10% glukozy we wlewie dożylnym z szybkością 100-150 ml na godzinę. W tym przypadku należy zabezpieczyć 800-1000 kcal na dobę,
- wlew insuliny za pomocą pompy infuzyjnej – 50 j. insuliny w 50 ml 0,9 NaCl (1 j./ml).
Co ważne, należy utrzymać stężenie glukozy we krwi w granicach 100-180 mg/dl (5,6-10,0 mmol/l).
U pacjentów z cukrzycą w okresie pooperacyjnym, u których stan przed zabiegiem był wyrównany pod względem metabolicznym, po zagojeniu rany można wrócić do modelu terapii stosowanego przed zabiegiem.
Źródło: Głuszek S., Chirurgia podstawy, PZWL Wydawnictwo Lekarskie 2019, s. 422
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