首页> 外文期刊>European journal of cardio-thoracic surgery: Official journal of the European Association for Cardio-thoracic Surgery >Prevalence and clinical significance of elevated preoperative glycosylated hemoglobin in diabetic patients scheduled for coronary artery surgery.
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Prevalence and clinical significance of elevated preoperative glycosylated hemoglobin in diabetic patients scheduled for coronary artery surgery.

机译:计划进行冠状动脉手术的糖尿病患者术前糖基化血红蛋白升高的患病率及其临床意义。

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摘要

We read with great interest the recently published retrospective study by Knapik et al. [1]. The authors postponed coronary artery surgery (CAS) in majority of patients with glycosylated hemoglobin (HbAIC) exceeding 8%. However, 15 % of patients underwent CAS despite high HbAIC. It would be interesting if authors separately presented outcome evaluation in that subgroup of patients. A major drawback of this study is the lack of early postoperative platelet-function (PF) assessment. A greater proportion of patients with elevated HbAIC were scheduled to on-pump surgery. Cardiopulmonary bypass results with postoperative platelet-count turnover with platelet count exceeding preopera-tive values [2], which inevitably results with higher thromboxane level, thereby may contribute to aspirin resistance onset [2]. In addition, Zimmermann et al. [2] summarized in a review article the facts indicating that aspirin is more effective after off-pump revascularization comparing to on-pump and described diabetes-associated permanent aspirin resistance. Diabetes-related aspirin resistance, together with procedurally acquired resistance, can lead to a hyperaggregability state, thus influencing perioperative myocardial-infarction (Ml) onset. Knapik et al.
机译:我们非常感兴趣地阅读了Knapik等人最近发表的回顾性研究。 [1]。作者对大多数糖化血红蛋白(HbAIC)超过8%的患者推迟了冠状动脉手术(CAS)。然而,尽管HbAIC较高,仍有15%的患者接受CAS。如果作者在该患者亚组中单独进行结果评估,那将很有趣。该研究的主要缺点是缺乏早期的术后血小板功能(PF)评估。 HbAIC升高的患者中有更大比例的患者计划进行泵上手术。体外循环导致术后血小板计数更新,血小板计数超过术前值[2],这不可避免地导致血栓烷水平升高,从而可能导致阿司匹林耐药性发作[2]。另外,Zimmermann等。 [2]在一篇综述文章中总结了以下事实,这些事实表明,在进行非血运重建后,阿司匹林比在血运重建时更有效,并描述了与糖尿病相关的永久性阿司匹林耐药性。糖尿病相关的阿司匹林抵抗力以及程序性获得的抵抗力可能导致过度凝集状态,从而影响围手术期心肌梗塞(M1)的发作。 Knapik等。

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