(1)2017年广州市花都区中考物理一模试卷.doc
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1、cy of diabetes control should be assessed again at the time of listing for surgery, ideally with a recorded HbA1c 69 mmol.mol1 in the previous three months. If it is 69 mmol.mol1, elective surgery should be delayed while control is improved. In a small numberof cases it may not be possible to improv
2、e diabetic control pre-operatively, particularly if the reason for surgery, such as chronic infection, is contributing to poor control, or if surgery is semi-urgent. In these circumstances, it may be acceptable to proceed with surgery after explanation to the patient of the increased risks. Patients
3、 should be managed as a day case if the procedure is suitable and the patient fulfils the criteria for day-case surgery management. Well-controlled diabetes should not be a contra-indication to day-case surgery.外科门诊病人手术期间应对患者血糖控制水平进行充分的评估,理想状态是术前三个月HbA1c控制在 69 mmol.mol-1(8.5%)当HbA1c 69 mmol-1 时,手术应延
4、迟到血糖控制有所改善的时候。有一小部分的情况患者的血糖可能在术前难以控制,特别是需要手术的病因本身就引起血糖控制不佳,如慢性感染;或者手术比较紧急。这种情况下,需要和病人沟通解释因此带来的风险,患者接受,可以进行手术。在程序适宜的情况下管理病人以满足日间手术的标准。糖尿病的良好控制不应该是日间手术的禁忌。Patients with poorly controlled diabetes at the time of surgery will need close monitoring and may need to start a variable-rate intravenous insuli
5、n infusion (VRIII). Recommendation: Patients with diabetes should be identified early in the pre-operative pathway.无法很好控制血糖的糖尿病患者在手术期间需要严密的监测及采用可调节的静脉胰岛素输注(VRIII)提示:伴有糖尿病的患者应在手术前应进行提前鉴定Pre-operative assessment 术前评估 Appropriate and early pre-operative assessment should be arranged. A pre-operative as
6、sessment nurse may undertake the assessment with support from either an anaesthetist or a diabetes specialist nurse. It should occur sufficiently in advance of the planned surgery to ensure optimisation of glycaemic control before the date of proposed surgery. The aim is to ensure that all relevant
7、investigations are available and checked in advance of the planned surgery, that the patient understands how to manage his/her diabetes in the peri-operative period, and that the period of pre-operative fasting is minimised.应安排适当的或早期的术前评估。进行术前评估护士可能需要来自麻醉师或糖尿病专科护士的支持。术前评估应在计划手术之前以确保手术日期前血糖得到控制优化。术前评
8、估的目的是:在计划手术前确保获得所有相关检查以及进一步的检查;使患者了解在围手术期如何管理他 / 她的糖尿病;减少术前禁食时间。 Recommendation: Tests should be ordered to assess co-morbidities in line with National Institute for Health and Care Excellence (NICE) guidance on pre-operative testing 22. This should include urea and electrolytes and ECG for all pati
9、ents with diabetes; however, a random blood glucose measurement is not indicated.建议:检查遵循NICE指南,应该包括尿检、糖尿病患者电解质及心电图检查;然而,随机血糖测量未注明。Planning admission (including day surgery)The aim is to minimise the fasting period, ensure normoglycaemia (capillary blood glucose (CBG) 610 mmol.l1) and minimise as far
10、 as possible disruption to the patients usual routine. Ideally, the patient should be booked first on the operating list to minimize the period of fasting. If the fasting period is expected to be limited to one missed meal, the patient can be managed by modification of his/her usual diabetes medicat
11、ion (see below). Patients should be provided with written instructions from the pre-operative assessment team about management of their diabetes medication on the day of surgery, the management of hypo- or hyperglycaemia in the peri-operative period, and the likely effects of surgery on their diabet
12、es control. Patients should be advised to carry a form of glucose that they can take in case of symptoms of hypoglycaemia that will not cause surgery to be cancelled, for example a clear, sugar-containing drink (glucose tablets may be used instead, but some anaesthetists may feel they should not be
13、taken within 6 hof the start of anaesthesia). Patients should be warned that their blood glucose control may be erratic for a few days after the procedure.术前管理(包括日间手术)其目的是尽可能地缩短周期,确保血糖正常(6-10mmol.l-1 )尽可能少地打乱患者的日常护理。理论上,患者应列入手术队列计划以尽可能减少禁食期。如果禁食期需要限制患者一次进餐,需要相应调整他/她日常的用药。术前评估团队需要对病人的手术期间用药管理、围手术期间的高
14、血糖或者低血糖以及手术可能对糖尿病控制带来影响的可能因素给予指导,应该给患者列一个可摄入糖的列表,以预防万一出现的低血糖带来手术取消,举个例子详加说明,比如含糖饮料(或者糖块也可以,但是麻醉师要求麻醉前六小时不能摄入)患者应该被警告在术后可能有几天的血糖波动。 Recommendation: When possible, admission should be planned for the day of surgery, with both the patient and the ward staff aware of the planned peri-operative diabetes
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