Nurozler Feza, Kutlu Tolga, Küçük Güngör
Division of Cardiovascular Surgery, Central Hospital, Izmir, Turkey.
Scand Cardiovasc J. 2007 Jan;41(1):39-43. doi: 10.1080/14017430601050330.
We aimed to analyze influence of insulin dependency on short-term outcomes after OPCAB in patients with diabetes.
Retrospective cohort study was planned based on chart review. Study population consisted of 148 diabetic cases (63 insulin-dependent diabetics in group I and 85 non-insulin-dependent diabetics in group II). Patients' preoperative data and risk factors for adverse outcomes are analysed. The primary endpoint was all causes of mortality during the in-hospital course. Preestablished secondary endpoints included all major postoperative complications, including non-fatal acute myocardial infarction, non-fatal stroke, sepsis, shock, mediastinitis, respiratory insufficiency, and renal insufficiency, and minor postoperative complications, including mechanical ventilation for more than 24 hours, inotropic support, reoperation for bleeding, and necessity of blood transfusion. Additional analysis was performed on the duration of stay in the intensive care unit and overall hospital stay.
Group I patients were significantly more likely to have hypertension (87.3% versus 82.5%, p=0.023), they also had a trend toward higher prevalence of hypercholesterolemia (71.4% versus 68.6%, p=0.092) and body mass index (28.1+/-4.2 versus 26.9+/-3.7, p=0.085). Angiographic characteristics and number of distal anastomosis were similar in the two groups. There was no significant difference in mortality during the in-hospital course as the primary endpoint. However, analysis in secondary endpoints revealed that group I patients were significantly more likely to have stroke (3.1% versus 2.3%, p=0.027), sternal wound infection (4.7% versus 3.4%, p=0.036) and atrial arrhythmia (28.3% versus 20.9%, p=0.021). Moreover, group I patients were significantly more likely to stay longer than 2 days in ICU (14.2% versus 11.6%, p=0.038). Higher prevalence of renal dysfunction was also observed in group I patients (7.9% versus 6.9%, p=0.069).
Similar to insulin dependent diabetes who had on-pump CABG, insulin dependent diabetes develop higher rate of major postoperative complications and stay longer in ICU after off-pump CABG.
我们旨在分析胰岛素依赖对糖尿病患者非体外循环冠状动脉搭桥术（OPCAB）后短期预后的影响。
基于病历回顾计划进行一项回顾性队列研究。研究人群包括148例糖尿病患者（I组63例胰岛素依赖型糖尿病患者和II组85例非胰岛素依赖型糖尿病患者）。分析患者的术前数据及不良预后的危险因素。主要终点是住院期间的全因死亡率。预先设定的次要终点包括所有主要术后并发症，如非致命性急性心肌梗死、非致命性中风、败血症、休克、纵隔炎、呼吸功能不全和肾功能不全，以及次要术后并发症，如机械通气超过24小时、使用血管活性药物支持、因出血再次手术和输血需求。对重症监护病房（ICU）住院时间和总住院时间进行了额外分析。
I组患者患高血压的可能性显著更高（87.3%对82.5%，p = 0.023），他们在高胆固醇血症患病率（71.4%对68.6%，p = 0.092）和体重指数（28.1±4.2对26.9±3.7，p = 0.085）方面也有升高趋势。两组患者的血管造影特征和远端吻合数量相似。作为主要终点，住院期间的死亡率无显著差异。然而，次要终点分析显示，I组患者发生中风（3.1%对2.3%，p = 0.027）、胸骨伤口感染（4.7%对3.4%，p = 0.036）和房性心律失常（28.3%对20.9%，p = 0.021）的可能性显著更高。此外，I组患者在ICU停留超过2天的可能性显著更高（14.2%对11.6%，p = 0.038）。I组患者肾功能不全的患病率也更高（7.9%对6.9%，p = 0.069）。
与接受体外循环冠状动脉搭桥术的胰岛素依赖型糖尿病患者相似，胰岛素依赖型糖尿病患者在非体外循环冠状动脉搭桥术后发生主要术后并发症的几率更高，在ICU停留时间更长。
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