目的：应用动态血糖监测评估2型糖尿病患者冠状动脉搭桥手术（CABG）围手术期血糖波动特点。方法选取2012年5月至2013年5月于泰达国际心血管病医院行CABG的住院患者，共42例，根据是否合并糖代谢异常分为2型糖尿病组（DM组，24例）和正常糖耐量组（NGT组，18例），所有入选患者手术前1 d至术后第2天进行动态血糖检测仪（CGMS）检测，均进行相同的手术术式、相同的围手术期胰岛素治疗方案、相同的饮食方案。记录所有入选患者的一般资料、血糖波动相关指标以及手术相关参数。结果（1）与NGT组比较，DM组手术当天、术后第1天的血糖水平的标准差（SD）和日间血糖平均绝对差（MODD）均升高，差异有统计学意义（P＜0.05）。两组间手术当天（用0表示）及术后第1天（用1表示）的平均血糖波动幅度（MAGE）、平均血糖（MBG）、最大血糖波动幅度（LAGE）、血糖时间百分率（PT）差异均无统计学意义（P＞0.05）。（2）在DM组，MODD与LDL呈独立负相关， MAGE0与HDL、手术时间和年龄呈正相关，年龄是其独立危险因素。在NGT组，MODD与LDL呈独立负相关，与体外循环时间呈独立正相关；手术当天的MAGE0、LAGE0水平与体外循环时间呈正相关；术后第1天的MBG1、SD1与体外循环时间、机械通气时间也呈正相关关系；而体外循环时间、阻断时间越长，术后第1天的LAGE和PT越大。结论在采用严格胰岛素控制围手术期血糖的情况下，由CGMS显示的糖尿病患者围手术期血糖波动消失，血糖离散度增加；CABG 中阻断及体外循环时间可能是血糖波动的独立危险因素。%Objective Perioperative glucose fluctuation was assessed in patients with type 2 diabetics undergoing on-pump coronary artery bypass surgery (CABG) by continuous glucose monitor system(CGMS). Methods 42 patients undergoing isolated CABG from May 2012 to May 2013 in TEDA International Cardiovascular Disease Hospital were involved. According to 1999 WHO diagnostic criteria of diabetes, they were devided into two groups:24 cases of inpatients were type 2 diabetes(DM group) and 18 cases of inpatients were normal glucose tolerance(NGT group). All patients were measured by CGMS from the day before surgery to postoperative second day.Surgical procedures were performed in the same type, the same perioperative insulin regimen and the same diet program. Record all enrolled patients general information indicators related with blood fluctuations and parameters related with surgery. Results Compared with the NGT group, DM group had significantly higher Standard deviation(SD) of the blood sugar level and absolute mean of daily difference (MODD) during intraoperative(with 0) and postoperative day 1(with 1), and the difference was statistically significant(P<0.05). Mean amplitude of glycemic excursions(MAGE), mean blood glucose(MBG), large amplitude of glycemic excursions(LAGE) and percentage of time glucose(PT) did not differ significantly between two groups. In the DM group, MODD were independently negatively correlated with LDL. HDL, operation time and age was positively correlated with MAGE0.Age was an independent risk factor. In the NGT group, MODD were independently negatively correlated with LDL and positively related with cardiopulmonary bypass time(CPB time).There were high MAGE and LAGE during intraoperative in patients of CPB time. There were positive relationship between MBG, SD during postoperative day 1 with CPB time and mechanical ventilation time. The CPB time or blocking time were longer, the LAGE and PT was higher during postoperative day 1. Conclusion When perioperative glucose of DM patients were strictly controlled using insulin, the perioperative glucose fluctuation disappeared and glucose dispersion degree increased showing by CGMS; the CPB time and blocking time during CABG were an independent risk factor with perioperative blood glucose fluctuations.
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