緊急手術前期におけるナトリウムグルコース共輸送体2阻害剤関連ユーグリケミア糖尿病ケトアシドーシス: 系統的レビュー

Dennis Perez Castillo¹, Leanne Hall², Siva Senthuran³

¹James Cook University, Townsville, Australia. dennis.perezcastillo@my.jcu.edu.au.

Journal of anesthesia

|August 31, 2025

まとめ

SGLT2阻害剤の希少な合併症である. このレビューでは,緊急手術後の危険因子と患者の特徴を強調し,早期発見と管理のための警戒を強調しています.

科学分野:

内分泌学
代謝障害
手術の合併症

背景:

術後のユーグリケミア型糖尿病性ケトアシドーシス (EuDKA) は,ナトリウム・グルコース共輸送体-2阻害剤 (SGLT2i) と関連した深刻な合併症である.
既存のガイドラインは主に選択的外科手術を扱っており,緊急処置中のEuDKAの管理にギャップを残しています.
EuDKAはケトナミアと酸性症候群を呈しますが,血清糖は正常であり,診断的に困難です.

研究の目的:

緊急手術後の EuDKA の症例を体系的に検討する.
EuDKAに関連する患者の人口統計と臨床的特徴を特定する.
この特定の外科的状況における貢献する危険因子と患者のアウトカムを調べる.

主な方法:

2024年4月までの電子データベースで体系的な文献検索が行われました
含める基準は,緊急手術を受けた患者で発生したEuDKAの症例に焦点を当てた.
データ抽出には,患者の特徴,SGLT2iの使用,手術の詳細,リスク要因,および臨床結果が含まれていました.

主要な成果:

21の出版物から30件のEuDKAが特定されました.
発症は通常,手術後3日以内に発生し,不十分なSGLT2i抑制,低血糖制御,重大手術を含むリスク要因が特定されました.
重症治療室に入院し,透析が必要であったが,死亡例は報告されなかった.

結論:

緊急手術後のEUDKAは,非典型的なプレゼンテーションのために認識されていません.
高い疑い指数を維持し,注意深く監視し,適切な手術前インスリン管理を行うことが重要です.
患者にSGLT2iを緊急手術で使用することを教えるのは,リスクを軽減するために推奨されます.

キーワード:

緊急手術ユーグリケミア型糖尿病性ケトアシドーシス (EuDKA)術後の合併症ナトリウム-グルコース共輸送体2阻害剤 (SGLT2i)2型糖尿病

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