Gandhi Gunjan Y, Nuttall Gregory A, Abel Martin D, Mullany Charles J, Schaff Hartzell V, Williams Brent A, Schrader Lisa M, Rizza Robert A, McMahon M Molly
Department of Internal Medicine and Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
Mayo Clin Proc. 2005 Jul;80(7):862-6. doi: 10.4065/80.7.862.
To estimate the magnitude of association between intraoperative hyperglycemia and perioperative outcomes in patients who underwent cardiac surgery.
We conducted a retrospective observational study of consecutive adult patients who underwent cardiac surgery between June 10, 2002, and August 30, 2002, at the Mayo Clinic, a tertiary care center in Rochester, Minn. The primary independent variable was the mean intraoperative glucose concentration. The primary end point was a composite of death and infectious (sternal wound, urinary tract, sepsis), neurologic (stroke, coma, delirium), renal (acute renal failure), cardiac (new-onset atrial fibrillation, heart block, cardiac arrest), and pulmonary (prolonged pulmonary ventilation, pneumonia) complications developing within 30 days after cardiac surgery.
Among 409 patients who underwent cardiac surgery, those experiencing a primary end point were more likely to be male and older, have diabetes mellitus, undergo coronary artery bypass grafting, and receive insulin during surgery (P< or =.05 for all comparisons). Atrial fibrillation (n=105), prolonged pulmonary ventilation (n=53), delirium (n=22), and urinary tract infection (n=16) were the most common complications. The initial, mean, and maximal intraoperative glucose concentrations were significantly higher in patients experiencing the primary end point (P<.01 for all comparisons). In multivariable analyses, mean and maximal glucose levels remained significantly associated with outcomes after adjusting for potentially confounding variables, including postoperative glucose concentration. Logistic regression analyses indicated that a 20-mg/dL increase in the mean intraoperative glucose level was associated with an increase of more than 30% in outcomes (adjusted odds ratio, 1.34; 95% confidence Interval, 1.10-1.62).
Intraoperative hyperglycemia is an independent risk factor for complications, including death, after cardiac surgery.
评估接受心脏手术患者术中高血糖与围手术期结局之间的关联程度。
我们对2002年6月10日至2002年8月30日在明尼苏达州罗切斯特市的三级医疗中心梅奥诊所接受心脏手术的连续成年患者进行了一项回顾性观察研究。主要自变量是术中平均血糖浓度。主要终点是心脏手术后30天内发生的死亡和感染（胸骨伤口、尿路感染、败血症）、神经（中风、昏迷、谵妄）、肾脏（急性肾衰竭）、心脏（新发房颤、心脏传导阻滞、心脏骤停）和肺部（延长机械通气时间、肺炎）并发症的综合情况。
在409例接受心脏手术的患者中，发生主要终点事件的患者更可能为男性且年龄较大，患有糖尿病，接受冠状动脉搭桥术，并在手术期间接受胰岛素治疗（所有比较P≤0.05）。房颤（n = 105）、延长机械通气时间（n = 53）、谵妄（n = 22）和尿路感染（n = 16）是最常见的并发症。发生主要终点事件的患者术中初始、平均和最高血糖浓度显著更高（所有比较P<0.01）。在多变量分析中，在校正包括术后血糖浓度在内的潜在混杂变量后，平均和最高血糖水平仍与结局显著相关。逻辑回归分析表明，术中平均血糖水平每增加20 mg/dL，结局增加超过30%（校正比值比，1.34；95%置信区间，1.10 - 1.62）。
术中高血糖是心脏手术后包括死亡在内的并发症的独立危险因素。
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