In recent years, the number of surgical patients with combined hyperglycemia has gradually increased and tends to be younger. Many surgeons often ignore the combined hyperglycemia in surgical patients or know little about the new progress in this field, which leads to untimely diagnosis and treatment, causing pain to patients and affecting the effect of surgical treatment. Therefore, in order to improve the treatment effect of combined hyperglycemic surgical patients, surgeons should master the types and diagnostic criteria of combined hyperglycemia in surgical patients, the relationship between stress and disorders of glucose metabolism, the effect of hyperglycemia on critical surgical patients and the treatment methods of surgical hyperglycemic diseases. 1, the type and diagnostic criteria of hyperglycemia in surgical patients There are often two conditions of hyperglycemia in surgical patients, one is the appearance of hyperglycemia in patients with a history of diabetes, and the other is the appearance of hyperglycemia in patients without a history of diabetes, such as hyperthyroidism, post-gastrojejunostomy, chronic liver disease, pancreatic cancer, Cushing’s syndrome, pheochromocytoma and trauma, severe infection, severe pancreatitis, cerebrovascular accidents, major surgical operations, acute renal failure and other critical diseases. Hyperglycemia that occurs when a patient is in a stressful situation is called stress hyperglycemia. The World Health Organization (WHO) sets the range of fasting hyperglycemia at 6.0-7.0mmol/L and the range of 2h post-load hyperglycemia at 7.8-11.1mmol/L. Those who exceed this upper limit are considered diabetic hyperglycemia. Stress hyperglycemia level still does not have a clear limit. Generally, it is considered that stress hyperglycemia can be diagnosed when the fasting blood glucose >7.0mmol/L or random blood glucose >11.1mmol/L is measured randomly for more than 2 times after hospitalization. However, according to the results of Van denBerghe’s insulin intensive therapy test, stress hyperglycemia can be diagnosed when the blood glucose concentration is >6.0mmol/L. The problems associated with hyperglycemia in diabetic patients have been reported in detail and have attracted sufficient attention from surgeons, so this article will not address them at this time. A series of problems caused by stress hyperglycemia in surgical critical care patients, which some surgeons know little about, still need to be paid attention to. 2, stress and glucose metabolism disorder When trauma, serious infection, major surgery, severe pancreatitis and other critical illnesses endanger the body, the body is in a state of stress, followed by a series of reactions, among which there are high metabolic performance, for high blood sugar and protein catabolism accelerated. The production of hyperglycemia is related to the following factors: stimulation of neuroendocrine response, including increased secretion of catecholamines, glucocorticoids, growth hormone, glucagon and insulin, but in the supernormal response, the antagonist hormone predominates, triggering hyperglycemia; increase in the level of insulin antagonist hormone and decrease in the number of target cell receptors, affecting the biological effect of insulin; accelerated protein catabolism, a large number of amino acids from peripheral tissues into the liver, stimulating gluconeogenesis. During stress, pyruvate dehydrogenase activity decreases and lactic acid in blood increases, which increases gluconeogenesis. 3, the effect of hyperglycemia on critical surgical patients Although stress hyperglycemia is an acute momentary hyperglycemia, it can also produce harmful pathophysiological effects and cause the same complications as hyperglycemia in diabetic patients, such as difficulty in wound healing, aggravating the pathological effects of the primary disease, affecting or delaying recovery; inducing a variety of complications, such as increased infection rate, polyneuropathy, multi-organ failure and even death. Van den Berghe et al. controlled hyperglycemia with insulin and other drugs in 1,548 critically ill patients admitted to the intensive care unit with hyperglycemia, which reduced the morbidity and in-hospital morbidity and mortality rates of critically ill patients in the unit and reduced the risk of complications. umpierrez et al. reviewed 2,030 patients with hyperglycemia at the time of admission significantly affected the prognosis, and compared with patients with pre-existing diabetes, new-onset The morbidity and mortality rate of patients with hyperglycemia was 16%, and that of the former was 3%, which was significantly higher than the former, indicating that stress hyperglycemia needs more attention from us. 4.Treatment of surgical hyperglycemia patients Critical hyperglycemia is mostly transient, often gradually relieved with the lifting of the stressor and the improvement of peripheral insulin resistance. The principle of treatment should be firstly to actively cure the primary disease and strictly control the input of exogenous glucose, and those whose blood glucose still continues to rise after the above treatment should be treated with exogenous insulin to control the blood glucose between 4.0-6.1retool/L. Intensive insulin therapy can not only control blood glucose, but also improve the immune function of the body accordingly, reduce the incidence of infection and improve the prognosis of patients. It is more important to be alert to the occurrence of hypoglycemia in the process of treating hyperglycemia, because the danger of hypoglycemia is more serious than that of not occurring. The application of exogenous insulin is a common cause of hypoglycemia. To prevent the occurrence of hypoglycemia, we should pay attention to: (1) closely monitor blood glucose and pay attention to the clinical manifestations of hypoglycemia, such as increased heart rate, irritability and excessive skin sweating; (2) advocate small-dose insulin pumping to correct hyperglycemia; (3) strengthen comprehensive treatment, improve nutritional status, actively control infection and correct severe liver and kidney insufficiency.