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| 非糖尿病患者非心肺转流冠状动脉旁路移植术围术期血糖波动与术后早期预后的相关性 |
| Association between perioperative glycemic variability with postoperative short-term prognosis in non-diabetic patients undergoing off-pump coronary artery bypass grafting |
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| DOI：10.12089/jca.2022.10.008 |
| 中文关键词: 糖尿病 血糖波动 预后 冠状动脉旁路移植术 |
| 英文关键词: Diabetes Glycemic variability Prognosis Coronary artery bypass grafting |
| 基金项目:河南省医学科技攻关计划省部共建项目（SB201901098）；河南省医学科技攻关计划联合共建项目（LHGJ20200104）；河南省医学教育研究项目（Wjlx2022030） |
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| 中文摘要: |
目的 探讨非糖尿病患者非心肺转流冠状动脉旁路移植术（OPCABG）围术期血糖波动与术后早期预后的相关性。
方法 回顾性分析择期行OPCABG的非糖尿病患者844例，男627例，女217例，年龄28～80岁，BMI 16～43 kg/m2，ASA Ⅱ—Ⅳ级。采用围术期血糖最大差值（MGD）作为反映血糖波动的指标。根据MGD将患者分为两组：L组（MGD＜7.7 mmol/L，n=511）和H组（MGD≥7.7 mmol/L，n=333）。收集患者术前检验结果、术中情况、术后并发症（急性肾损伤、心肌梗死、心律失常、急性肺损伤、肝功能不全、暂时性神经功能障碍、二次开胸止血）、ICU带管时间、ICU停留时间、术后住院时间。采用多元线性回归分析围术期血糖波动与术后ICU带管时间、ICU停留时间和术后住院时间的相关性。
结果 与L组比较，H组术后急性肾损伤发生率明显升高，ICU带管时间、ICU停留时间和术后住院时间明显延长（P＜0.001）。多元线性回归分析显示，MGD与ICU带管时间、ICU停留时间和术后住院时间均呈线性正相关（P＜0.001）。
结论 非糖尿病患者非心肺转流冠状动脉旁路移植术围术期血糖波动幅度超过7.7 mmol/L时，术后早期转归质量下降。 |
| 英文摘要: |
Objective To investigate the correlation between perioperative glycemic variability and postoperative short-term prognosis in non-diabetic patients after off-pump coronary artery bypass grafting (OPCABG).
Methods A retrospective analysis was performed on 844 non-diabetic patients selected for OPCABG, 627 males and 217 females, aged 28-80 years, BMI 16-43 kg/m2, ASA physical status Ⅱ-Ⅳ. Maximal glycemic difference (MGD) was used to reflect perioperative glycemic variability in this study. Patients were divided into two groups according to their perioperative MGD: group L (MGD <7.7 mmol/L, n = 511) and group H (MGD ≥7.7 mmol/L, n = 333). All patients' preoperative general information, biochemical examinations, and intraoperative information were collected. Postoperative short-term prognostic indicators included postoperative complications (acute kidney injury, myocardial infarction, arrhythmia, acute lung injury, liver insufficiency, temporary neurological dysfunction, and secondary thoracotomy hemostasis), postoperative ICU intubation time, time of postoperative ICU stay, time of postoperative hospitalization, and in-hospital death. Glycemic was measured before and during surgery, and before extubation in ICU. Multiple linear regression was used to analyze the correlation between perioperative glycemic variability and time of postoperative ICU intubation, time of ICU stay and postoperative hospitalization.
Results Compared with group L, the incidence of postoperative acute kidney injury in group H was significantly higher (P < 0.001), the time of ICU intubation time, time of ICU stay, and postoperative hospitalization were longer in group H (P < 0.001). Multiple linear regression analysis showed that the MGD was positively correlated with time of ICU intubation, time of ICU stay, and postoperative hospitalization after OPCABG (P < 0.001).
Conclusion The short-term prognosis after OPCABG of non-diabetic patients is bad when the perioperative maximal glycemic variability is greater than 7.7 mmol/L. |
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