Doenst Torsten, Wijeysundera Duminda, Karkouti Keyvan, Zechner Christoph, Maganti Manjula, Rao Vivek, Borger Michael A
Division of Cardiovascular Surgery, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 2005 Oct;130(4):1144. doi: 10.1016/j.jtcvs.2005.05.049.
Hyperglycemia is commonly present in the perioperative period in patients undergoing cardiac surgery, even during administration of insulin. A direct relationship between postoperative hyperglycemia and mortality has been established in diabetic patients undergoing cardiac surgery. However, this relationship might be confounded because patients with poor outcome receive more glucogenic drugs postoperatively. We assessed the influence of hyperglycemia (highest glucose level) during cardiopulmonary bypass on perioperative morbidity and mortality in diabetic and nondiabetic patients.
We performed a multivariate logistic regression analysis on all diabetic (n = 1579) and nondiabetic (n = 4701) patients undergoing cardiac surgery at the Toronto General Hospital between 1999 and 2001. Boluses of insulin were given during cardiopulmonary bypass when the glucose level exceeded 15 mmol/L, when the serum potassium level exceeded 6.0 mmol/L, or both.
Overall mortality was 1.8% (n = 115). A high glucose level during cardiopulmonary bypass was an independent predictor of mortality in both diabetic (odds ratio, 1.20; confidence interval, 1.08-1.32) and nondiabetic (odds ratio, 1.12; confidence interval, 1.06-1.19; per millimole per liter increase in glucose) patients. A high glucose level during cardiopulmonary bypass was also an independent predictor of all major adverse events in both patient groups (odds ratio, 1.06; confidence interval, 1.03-1.09). A high glucose level was not closely related to cardiopulmonary bypass (r = 0.3) or aortic crossclamp times (r = 0.4).
A high peak serum glucose level during cardiopulmonary bypass is an independent risk factor for death and morbidity in diabetic patients and unexpectedly also in nondiabetic patients.
心脏手术患者围手术期普遍存在高血糖，即便在使用胰岛素治疗期间也是如此。心脏手术的糖尿病患者中，术后高血糖与死亡率之间已确立直接关联。然而，这种关系可能存在混淆因素，因为预后较差的患者术后接受更多生糖药物治疗。我们评估了体外循环期间高血糖（最高血糖水平）对糖尿病和非糖尿病患者围手术期发病率及死亡率的影响。
我们对1999年至2001年期间在多伦多综合医院接受心脏手术的所有糖尿病患者（n = 1579）和非糖尿病患者（n = 4701）进行了多因素逻辑回归分析。当血糖水平超过15 mmol/L、血清钾水平超过6.0 mmol/L或两者均超过时，在体外循环期间给予胰岛素推注。
总体死亡率为1.8%（n = 115）。体外循环期间的高血糖水平是糖尿病患者（优势比，1.20；置信区间，1.08 - 1.32）和非糖尿病患者（优势比，1.12；置信区间，1.06 - 1.19；血糖每升高一毫摩尔每升）死亡率的独立预测因素。体外循环期间的高血糖水平也是两组患者所有主要不良事件的独立预测因素（优势比，1.06；置信区间，1.03 - 1.09）。高血糖水平与体外循环时间（r = 0.3）或主动脉阻断时间（r = 0.4）无密切关联。
体外循环期间血清葡萄糖峰值水平高是糖尿病患者以及意外地也是非糖尿病患者死亡和发病的独立危险因素。
