Abordagem perioperatória do doente diabético
Palavras-chave:
diabetes, hiperglicemia, abordagem perioperatória, insulinoterapia intensivaResumo
A hiperglicemia é um achado comum em doentes hospitalizados,
com ou sem diagnóstico prévio de diabetes, sendo recentemente
considerada um marcador independente de mau prognóstico e
de elevada mortalidade.
O controlo agressivo dos níveis de glicemia tem sido reconhecido em múltiplos trabalhos de referência como um importante
alvo terapêutico na doença aguda grave, associado a melhoria dos
resultados clínicos e a redução significativa da mortalidade.
Os doentes diabéticos estão sujeitos a internamentos mais
frequentes e prolongados, a maior número de intervenções cirúrgicas, associadas a elevadas taxas de morbilidade e mortalidade,
pelo que necessitam de um plano terapêutico específico, de forma
a melhorar o seu prognóstico.
A abordagem pré-operatória do doente diabético, bem como
os principais regimes de administração de insulina indicados no
período perioperatório são objecto desta revisão. Preconiza-se
a prescrição de insulinoterapia intensiva segundo protocolos
previamente estabelecidos e adaptados à realidade do doente
e da instituição.
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