Lauruschkat A H, Albert A, Arnrich B, Bauer S, Dalladaku F, Ennker I C, Rosendahl U, Ennker J
Herz-, Thorax- und Gefässchirurgie, Herzzentrum Lahr/Baden, 77933 Lahr.
Clin Res Cardiol. 2006 Jan;95 Suppl 1:i7-13. doi: 10.1007/s00392-006-1110-3.
The objective of this paper was to analyze demographic and clinical characteristics of diabetic patients undergoing coronary artery bypass grafting on the basis of a significant number of cases.
The data of 8,195 patients who have undergone coronary bypass operations between 1996 and 2003 were analyzed. Non-diabetic patients (no DM), oral treated diabetics (DM oral) and insulin-treated diabetics (DM insulin) were compared in terms of their pre-operative, intra-operative and post-operative characteristics. The statistical analyses were performed with the support of SPSS 11.5 under application of chi-square and student-t tests.
In cardiosurgery, diabetics differ in various ways from non-diabetic patients. They show a significantly higher prevalence of the known cardiovascular risk factors such as raised body mass index, age and hypertension. Furthermore they present a higher prevalence of vascular comorbidity such as peripheral vascular disease and carotid disease. At the postoperative stage, cerebral dysfunction occurred more often among the diabetic patients (no DM 5.2% vs. DM oral 7.3% vs. DM insulin 10.5%; p < 0.05), they suffered from apoplexies more frequently (no DM 1.9% vs. DM oral 2.1% vs. DM insulin 3.2%; p < 0.05), and they required re-intubation more frequently (no DM 2.6% vs. DM oral 3.1% vs. DM insulin 5.6%; p < 0.05). Peri-operative mortality was highest in the group of insulin-treated diabetics (no DM 1.1% vs. DM oral 1.6% vs. DM insulin 1.8%; p < 0.05).
In coronary surgery, diabetic patients represent an especially challenging patient group with an independent risk profile, who require specific consideration as far as the selection of the operative approach, on, one hand, and the post-operative follow-up, on the other hand, are concerned.
本文旨在基于大量病例分析接受冠状动脉旁路移植术的糖尿病患者的人口统计学和临床特征。
分析了1996年至2003年间接受冠状动脉搭桥手术的8195例患者的数据。比较了非糖尿病患者（无糖尿病）、口服降糖药治疗的糖尿病患者（糖尿病口服药组）和胰岛素治疗的糖尿病患者（糖尿病胰岛素组）的术前、术中和术后特征。在SPSS 11.5软件支持下，应用卡方检验和学生t检验进行统计分析。
在心脏外科手术中，糖尿病患者在多方面与非糖尿病患者不同。他们已知的心血管危险因素如体重指数升高、年龄和高血压的患病率显著更高。此外，他们血管合并症如外周血管疾病和颈动脉疾病的患病率也更高。在术后阶段，糖尿病患者发生脑功能障碍的频率更高（无糖尿病组5.2%，糖尿病口服药组7.3%，糖尿病胰岛素组10.5%；p<0.05），中风更频繁（无糖尿病组1.9%，糖尿病口服药组2.1%，糖尿病胰岛素组3.2%；p<0.05），并且需要再次插管的频率更高（无糖尿病组2.6%，糖尿病口服药组3.1%，糖尿病胰岛素组5.6%；p<0.05）。围手术期死亡率在胰岛素治疗的糖尿病患者组中最高（无糖尿病组1.1%，糖尿病口服药组1.6%，糖尿病胰岛素组1.8%；p<0.05）。
在冠状动脉手术中，糖尿病患者是一个具有独立风险特征的特别具有挑战性的患者群体，在手术方式选择和术后随访方面都需要特别考虑。
