Fujii Takeshiro, Watanabe Yoshinori, Shiono Noritsugu, Kawasaki Muneyasu, Yokomuro Hiroki, Ozawa Tsukasa, Hamada Satoshi, Masuhara Hiroshi, Koyama Nobuya
Toho University School of Medicine, Department of Surgery, Division of Cardiovascular Surgery, 6-11-1 Omorinishi, Ota-ku, Tokyo 143-8541, Japan.
Gen Thorac Cardiovasc Surg. 2007 Oct;55(10):409-15. doi: 10.1007/s11748-007-0153-3.
We investigated the usefulness of perioperative blood glucose control in patients undergoing coronary artery bypass grafting (CABG).
DM patients were aggressively treated with intensive insulin therapy to achieve a preoperative fasting blood glucose level of 140 mg/dl and a postoperative level of 200 mg/dl. For comparison, patients were divided as follows: (1) DM group vs. non-DM group, and (2) for mean blood glucose level in the intensive care unit (ICU), lower than 200 mg/dl (IL) vs. 200 mg/dl or higher (IH).
(1) In the DM group, the amount of insulin (U) used during surgery was greater (P<0.05), and the duration of ICU stay was longer (P<0.05). The incidence of all complications was higher in the DM group (P<0.05). (2) Between the IH group (54) and the IL group (82), the proportion of DM patients was higher in the IH group (75% vs. 38%, P<0.05). In the IH, the duration of ICU stay (P<0.01) was longer, and the incidence of all complications was higher (P<0.05). (3) In the DM group, the incidence of complications tended to be higher in the IH group. The incidence of complications was extremely low in the non-DM group.
Strict perioperative blood glucose control may help to improve the outcomes of CABG.
我们研究了冠状动脉旁路移植术（CABG）患者围手术期血糖控制的有效性。
糖尿病患者采用强化胰岛素治疗积极控制，使术前空腹血糖水平达到140mg/dl，术后达到200mg/dl。为作比较，患者分为以下几组：（1）糖尿病组与非糖尿病组；（2）根据重症监护病房（ICU）的平均血糖水平，低于200mg/dl（IL）组与200mg/dl或更高（IH）组。
（1）糖尿病组手术期间使用的胰岛素量（U）更多（P<0.05），ICU住院时间更长（P<0.05）。糖尿病组所有并发症的发生率更高（P<0.05）。（2）在IH组（54例）和IL组（82例）中，IH组糖尿病患者的比例更高（75%对38%，P<0.05）。在IH组，ICU住院时间更长（P<0.01），所有并发症的发生率更高（P<0.05）。（3）在糖尿病组中，IH组并发症的发生率往往更高。非糖尿病组并发症的发生率极低。
严格的围手术期血糖控制可能有助于改善冠状动脉旁路移植术的预后。
