Puskas Ferenc, Grocott Hilary P, White William D, Mathew Joseph P, Newman Mark F, Bar-Yosef Shahar
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Ann Thorac Surg. 2007 Nov;84(5):1467-73. doi: 10.1016/j.athoracsur.2007.06.023.
Neurocognitive dysfunction (NCD) continues to occur in a significant number of patients after cardiac procedures. The factors influencing its incidence and severity are not completely known. We hypothesized that hyperglycemia, which is known to exacerbate other forms of cerebral injury, may exacerbate NCD after cardiac operations.
A total of 525 patients having on-pump coronary artery bypass graft (CABG) procedures underwent cognitive testing at baseline and 6 weeks postoperatively. Multivariable linear regression was used to determine the relationship between NCD and intraoperative hyperglycemia (glucose > or = 200 mg/dL). Diabetic and nondiabetic patients were analyzed separately to eliminate a possible confounding effects between diabetes and hyperglycemia.
In the nondiabetic patients, even after controlling for age, years of education, and baseline cognitive function, hyperglycemia was associated with a decrease in cognitive function at 6 weeks (p = 0.0351). Hyperglycemia had no effect on cognitive function in diabetic patients, however.
These findings suggest that in nondiabetic patients undergoing CABG operations, intraoperative hyperglycemia is associated with an increased risk of NCD.
心脏手术后，仍有相当数量的患者会出现神经认知功能障碍（NCD）。影响其发生率和严重程度的因素尚不完全清楚。我们推测，已知会加重其他形式脑损伤的高血糖，可能会加重心脏手术后的NCD。
共有525例行体外循环冠状动脉旁路移植术（CABG）的患者在基线和术后6周接受了认知测试。采用多变量线性回归分析来确定NCD与术中高血糖（血糖≥200mg/dL）之间的关系。对糖尿病患者和非糖尿病患者分别进行分析，以消除糖尿病和高血糖之间可能存在的混杂效应。
在非糖尿病患者中，即使在控制了年龄、受教育年限和基线认知功能后，高血糖仍与术后6周的认知功能下降有关（p = 0.0351）。然而，高血糖对糖尿病患者的认知功能没有影响。
这些发现表明，在接受CABG手术的非糖尿病患者中，术中高血糖与NCD风险增加有关。
