Guvener Murat, Pasaoglu Ilhan, Demircin Metin, Oc Mehmet
Department of Thoracic and Cardiovascular Surgery, Hacettepe University, Faculty of Medicine 06100, Sihhiye, Ankara, Turkey.
Endocr J. 2002 Oct;49(5):531-7. doi: 10.1507/endocrj.49.531.
This study was planned to assess the relationship of perioperative glycemic control to the subsequent risk of infectious complications and to compare early clinical outcomes of coronary artery bypass surgery in diabetics with nondiabetics in a single center. A total of 1090 adults who underwent coronary artery surgery in a five year period were included in a retrospective cohort study based on available chart review. Of 1090 patients, 400 had type II diabetes mellitus. Intraoperative and postoperative blood glucose levels in diabetic group were manipulated by means of a continuous insulin infusion. Data of pre- and postoperative blood glucose levels were evaluated with respect to postoperative infection risk for diabetics. Risks of early mortality, cerebrovascular accident, and postoperative infection in diabetic patients were compared with the nondiabetic group. High preoperative mean glucose levels were the main risk factor for the development of postoperative infection (p = 0.012 and p = 0.028 for the mean glucose levels 1 and 2 days before operation, respectively). For diabetic group, of 400 patients 20 (5%) were diagnosed to have postoperative infection (superficial sternal wound in 3 (0.75%), donor site infection in 4 (1%), mediastinitis in 5 (1.25%), urinary tract infection in 6 (1.5%), and lung infection in 2 (0.5%) patients). The diabetic group had significantly higher prevalence of mediastinitis, donor site infection, urinary tract infection and total infection (p values were 0.048, 0.013, 0.009, and 0.044, respectively). Early mortality was higher among diabetics than in nondiabetics (1.73% vs 3%, p = 0.048) but the risk of cerebrovascular accident in diabetics was not greater than in nondiabetics in early period. In patients with diabetes who undergo coronary artery bypass surgery, preoperative hyperglycemia is an independent predictor of short-term infectious complications and total length of stay in hospital.
本研究旨在评估围手术期血糖控制与后续感染并发症风险之间的关系，并比较单中心糖尿病患者与非糖尿病患者冠状动脉搭桥手术的早期临床结局。基于现有病历回顾，一项回顾性队列研究纳入了在五年期间接受冠状动脉手术的1090名成年人。在这1090名患者中，400名患有II型糖尿病。糖尿病组术中及术后血糖水平通过持续胰岛素输注进行控制。针对糖尿病患者，评估术前和术后血糖水平数据与术后感染风险的关系。比较糖尿病患者与非糖尿病组早期死亡、脑血管意外和术后感染的风险。术前平均血糖水平高是术后感染发生的主要危险因素（术前第1天和第2天平均血糖水平的p值分别为0.012和0.028）。在糖尿病组的400名患者中，20名（5%）被诊断为术后感染（3名患者发生胸骨浅表伤口感染（0.75%），4名患者发生供体部位感染（1%），5名患者发生纵隔炎（1.25%），6名患者发生尿路感染（1.5%），2名患者发生肺部感染（0.5%））。糖尿病组纵隔炎、供体部位感染、尿路感染和总体感染的患病率显著更高（p值分别为0.048、0.013、0.009和0.044）。糖尿病患者的早期死亡率高于非糖尿病患者（1.73%对3%，p = 0.048），但糖尿病患者早期脑血管意外的风险并不高于非糖尿病患者。在接受冠状动脉搭桥手术的糖尿病患者中，术前高血糖是短期感染并发症和住院总时长的独立预测因素。
