Clinical observations of the surgical diabetic patients
당뇨병은 인슐린 부족으로 당질대사장애를 초래하는 만성 질환으로서 최근 문화생활의 향상으로 증가하는 추세에 있고 이에따라 당뇨병을 동반한 외과적질환의 문제도 점차 증대하고 있다.
저자는 1970년 1월부터 1977년 12월까지 8년간 연세대학교 의과대학 부속 세브란스병원에 입원하였던, 당뇨병을 동반한 외과환자 100례를 대상으로 문헌고찰과 임상적 관찰결과를 보고하는 바이다.
연령별 빈도는 50대에서 가장 많았고 남녀의 비는 1:1.04이었다.
대상환자 100례중 61례가 과거력을 가지고 있었으며 그중에서 42례는 경구혈당강하제로 조절해오고 있었다.
당뇨병의 정도를 분류하면 현성(Overt diabetes)이 62례, 화학성(Chemical diabetes)이 35례, 잠재성 (Latent diabetes)이 3례 이었고 당뇨병 전기(Prediabetes)는 없었다.
수술전 처치는 선택수술(elective operation)을 시행한 85례중 65례에서 3∼4일간 조절하여 수술할 수 있었고 평균 혈당농도는 177mg%이었다.
응급수술은 15례에서 시행하였는데 그중 8례만 혈당조절이 필요하여 Regular insulin을 투여하면서 수액을 공급하여 산철증과 혈당을 교정하였다.
수술후 합병증은 10례에서 발생하였으며 창상감염이 7례로 가장 많았다.
사망자는 100례중 2례 이었다.
Since the incidence of diabetes in general population has been increased and their life spans prolonged, surgeons will see more diabetic patients in their daily practice. It is conceivable that diabetic patients have more risk than non-diabetic when they are operated upon.
The purpose of this paper is to review diabstics undregoing surgery and clarify differences, if any, between non-diabetic surgical patients.
There were 100 surgical patients with diabetes who were admitted and treated in Yonsei Medical Center during the period between January 1970 to December 1977 for 8 years.
The age distribution was peak in 6th decade and sex ratio was almost same.
Sixty one cases of the 100 subjects in this study had past history and 42 cases of them have been controlled with oral hypoglycemic agents.
On the classification of the diabetic patients by stage, overt diabetes was 62 cases, chemical 35 cases, latent 3 cases.
On admission, the blood glucose level was above 200 mg% in 45 patients and below 100 mg% in 5 cases.
Preoperative management was performed in 65 out of the 85 patients who had elective surgery with insulin for 3-4 days.
But no preoperative treatment was done exeept diet control in 15 cases.
The controlled blood sugar level was 177 mg% in average.
Although the chemical or latent diabetic patients did not need special disbetic control, the overt diabetes demanded to be managed with insulin for higher glucose value in blood.
Preoperative complications were developed in 10 patients.
Seven cases of them developed main wound infection, and two cases had transient hypoglycemic episodes.
Mortality rate was 2 percent.
These results are quite acceptable numbers comparing with non-diabetic patients. It is, therefore, emphasized that careful monitoring of diabetes and judicious management in the pre and postoperative period are the most important.