心肺转流冠状动脉旁路移植术中血糖波动水平与术后高血糖及患者短期预后的关系

摘要

Objective To investigate the effect of intra-operative glucose concentration fluctuation on postoperative hyperglycemia and clinical outcomes in patients after on-pump coronary artery bypass graft (CABG). Methods One hundred sixteen patients undergoing elective on-pump CABG surgery were enrolled in our study. Blood samples (2 ml) were obtained at the following time points:1 day before operation (T0), 5 minutes after induction of anesthesia (T1 ), peak glucose concentration(T2) > valley glucose level (T3), 5 minutes after closure of sternum (T4) and at the arrival of ICU (T5) and 2 hour after arrival of ICU(T6). Glucose level was also detected every 30 min from T1 to T4. Group L was defined as glucose fluctuation less than 2. 2 mmol/L, group H was defined as glucose fluctuation more than 2. 2 mmol/L. The incidence of postoperative hyperglycemia, atrial fibrillation, myocardial ischemia, automatic cardiac recovery, ventilation supporting duration, pre and postoperative left ventricular ejecting fraction(EF) were recorded. Results There were 76 cases in group L and 40 in group H. Compared with group H, The incidence of postoperative hyperglycemia, atrial fibrillation, and myocardial ischemia and ventilation supporting time was significantly less in group L(P<0. 01 or P<0. 05). EF and rates of automatic cardiac recovery were significantly higher in group L(P<0. 01 or P<0. 05). Conclusion Intraoperative glucose fluctuation is highly related to postoperative hyperglycemia and postoperative outcomes. Glucose variation more than 2. 2 mmol/L is a risk factor in the prognosis.%目的 探讨心肺转流冠状动脉旁路移植术(CABG)中血糖波动水平与术后高血糖及患者短期预后的关系.方法 入选116例无糖尿病患者择期心肺转流CABG.我们按照以下固定时间采集2 ml动脉血进行血糖测定:术前1d空腹(T0)、麻醉诱导后5 min (T1)、术中最高血糖时(T2)、术中最低血糖时(T3)、关胸骨后5 min(T4)、入心脏重症监护室(CSICU)即刻(T5)、回CSICU后2 h(T6),在T1和T4之间每隔30分钟进行一次血糖测定.所有标本均由同一血气分析仪进行测定.根据术中血糖波动水平分为两组,L组为血糖波动＜2.2 mmol/L,H组为血糖波动≥2.2mmol/L.观察并记录术后高血糖率、房颤发生率、心肌缺血率、呼吸支持时间、自动复跳和术前、术后射血分数(EF)值.结果 L组为76例,H组为40例,T2、T4～T6时L组患者血糖明显低于H组,且术后高血糖发生率明显低于H组(P＜0.01或P＜0.05).L组患者术后房颤发生率、心肌缺血率明显低于H组,呼吸支持时间明显短于H组,L组自动复跳率和术后EF值明显高于H组(P＜0.01或P＜0.05).结论 在心肺转流CABG患者中,术中血糖波动水平与术后高血糖发生有一定相关性,血糖波动水平可以预测患者的短期预后,而血糖波动水平≥2.2 mmol/L的患者预后可能存在明显恶化趋势.