Ulate Kalia Patricia, Lima Falcao Germano Correia, Bielefeld Mark Richard, Morales John Mark, Rotta Alexandre Tellechea
Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX 78411, USA.
Pediatrics. 2008 Oct;122(4):e898-904. doi: 10.1542/peds.2008-0871. Epub 2008 Sep 8.
The goal was to determine whether a more permissive glycemic target would be associated with a decreased incidence of hypoglycemia but not increased mortality rates in critically ill pediatric patients.
This retrospective study evaluated clinical and laboratory data for 177 patients who underwent 211 consecutive surgical procedures for repair or palliation of congenital heart defects at Driscoll Children's Hospital. To establish the relationship between postoperative glycemia and subsequent morbidity and mortality rates, patients were stratified into 4 groups according to their median glucose levels, that is, euglycemia (60-125 mg/dL, 3.3-6.9 mmol/L), mild hyperglycemia (126-139 mg/dL, 6.9-7.7 mmol/L), moderate hyperglycemia (140-179 mg/dL, 7.7-9.9 mmol/L), or severe hyperglycemia (>or=180 mg/dL, >or=9.9 mmol/L). Postoperative outcomes for those groups also were compared with outcomes for a more permissive glycemic target group (90-140 mg/dL, 5-7.7 mmol/L).
The peak and mean blood glucose measurements and duration of hyperglycemia were not different for survivors and nonsurvivors in the first 24 hours after surgery. Nonsurvivors had higher peak glucose levels (389.3 +/- 162 mg/dL vs 274.4 +/- 106.3 mg/dL, 21.4 +/- 8.9 mmol/L vs 15.1 +/- 5.9 mmol/L) and longer duration of hyperglycemia (3.06 +/- 1.67 days vs 2.11 +/- 0.92 days) during the first 5 postoperative days, compared with survivors. Mortality rates were significantly higher for the moderate (38.8%) and severe (58.3%) hyperglycemia groups, compared with the euglycemia (6.02%) and permissive target (4.69%) groups. The incidence of hypoglycemia was significantly higher in the euglycemia group (31.8%), compared with the permissive target group (17.18%).
Postoperative hyperglycemia is associated with increased morbidity and mortality rates in children after surgical repair of congenital heart defects. A more permissive glycemic target is associated with a lower incidence of hypoglycemia but not increased mortality rates in these patients.
确定在危重症儿科患者中，更宽松的血糖目标是否会降低低血糖发生率且不增加死亡率。
这项回顾性研究评估了在德里斯科尔儿童医院接受211例连续先天性心脏缺陷修复或姑息手术的177例患者的临床和实验室数据。为了确定术后血糖水平与随后的发病率和死亡率之间的关系，根据患者的血糖中位数水平将其分为4组，即血糖正常（60 - 125 mg/dL，3.3 - 6.9 mmol/L）、轻度高血糖（126 - 139 mg/dL，6.9 - 7.7 mmol/L）、中度高血糖（140 - 179 mg/dL，7.7 - 9.9 mmol/L）或重度高血糖（≥180 mg/dL，≥9.9 mmol/L）。还将这些组的术后结果与更宽松血糖目标组（90 - 140 mg/dL，5 - 7.7 mmol/L）的结果进行了比较。
术后第1个24小时内，存活者与非存活者的血糖峰值、平均血糖测量值及高血糖持续时间无差异。与存活者相比，非存活者在术后第1个5天内的血糖峰值水平更高（389.3±162 mg/dL对274.4±106.3 mg/dL，21.4±8.9 mmol/L对15.1±5.9 mmol/L），高血糖持续时间更长（3.06±1.67天对2.11±0.92天）。与血糖正常组（6.02%）和宽松目标组（4.69%）相比，中度（38.8%）和重度（58.3%）高血糖组的死亡率显著更高。与宽松目标组（17.18%）相比，血糖正常组的低血糖发生率显著更高（31.8%）。
先天性心脏缺陷手术修复术后，儿童术后高血糖与发病率和死亡率增加相关。在这些患者中，更宽松的血糖目标与较低的低血糖发生率相关，但不会增加死亡率。
