德克萨米他相关的高血糖症与糖尿病患者的关节整形术后的传染性并发症无关
Ian A Jones1, Julian Wier2, Kevin C Liu2
1Department of Anaesthesiology & Pain Medicine, University of Washington, Seattle, Washington.
The Journal of arthroplasty
|January 14, 2024
概括
在接受全关节整形手术 (TJA) 的糖尿病患者中使用甲不会增加感染风险. 事实上,它可能会降低选择糖尿病患者其他术后感染的风险.
科学领域:
- 整形外科手术 整形外科手术
- 内分泌学 在内分泌学.
- 传染性疾病 传染性疾病
背景情况:
- 手术后感染是全关节整形术 (TJA) 的严重并发症.
- 在接受TJA的糖尿病患者中使用德克萨米他是有争议的,因为感染风险存在担忧.
- 这项研究调查了在接受TJA的糖尿病患者中德克萨米他与感染风险之间的关联.
研究的目的:
- 为了评估经过TJA的糖尿病患者中术前甲和感染风险之间的关联.
- 为了确定德克萨米他是否会增加糖尿病患者周围假肢关节感染 (PJI),手术部位感染 (SSI) 或TJA后其他感染的风险.
主要方法:
- 使用大型国家数据库 (2016-2021) 进行回顾性队列研究.
- 包括接受初级,选择性全膝关节整形术 (TKA) 或全关节整形术 (THA) 的成年患者.
- 将接受外科手术期间德克萨米他治疗的患者与未接受外科手术期间德克萨米他治疗的患者进行比较,分析90天感染风险.
主要成果:
- 在糖尿病患者中,甲并没有增加PJI或SSI的几率.
- 在糖尿病患者中,甲显著降低了其他术后感染 (尿道感染,肺炎,败血症) 的几率.
- 在特定的血糖范围观察到这种风险降低:TKA为110-248 mg/dL,THA为≤172 mg/dL.
结论:
- 证据支持,在接受TJA的糖尿病患者中,由于感染的担忧,不扣留德克萨米他.
- 短期外科手术期间的德克萨米他可以降低某些糖尿病TJA患者的感染风险.
- 焦点应该转移到优化在糖尿病患者中使用德甲,而不是质疑其适当性.
相关概念视频
Diabetes Mellitus: Type 2 and Gestational
2.4K
Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
2.4K
Oral Hypoglycemic Agents: Glinides
156
Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively...
156
Insulin: Dosing Regimen and Adverse Effects
175
Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
175
Oral Hypoglycemic Agents: Biguanides and Glitazones
204
Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...
204
Oral Hypoglycemic Agents: α-Glucosidase Inhibitors
176
α-glucosidase inhibitors, including acarbose (Precose), miglitol (Glyset), and voglibose (Voglib) (primarily available in Asia), are drugs that control blood sugar levels by delaying the digestion of starch and disaccharides. They achieve this by inhibiting α-glucosidase enzymes in the intestine, which slow the absorption of carbohydrates in the intestine, which in turn leads to a prolonged release of the glucoregulatory hormone GLP-1 from intestinal L-cells.
Acarbose and miglitol are...
Acarbose and miglitol are...
176
Diabetes: Management and Pharmacotherapy
285
The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
285


