Ghafoori A Fawad, Twite Mark D, Friesen Robert H
Department of Anesthesiology, The Children's Hospital, University of Colorado School of Medicine, Denver, CO 80045, USA.
Paediatr Anaesth. 2008 Dec;18(12):1202-7. doi: 10.1111/j.1460-9592.2008.02808.x.
Mediastinitis is an infrequent, but significant complication of median sternotomy. Perioperative hyperglycemia is associated with increased morbidity, including infection in pediatric and adult cardiac surgical patients. We hypothesized that perioperative blood glucose levels would be higher in patients who later developed mediastinitis.
We examined the medical records of all infants and children diagnosed with poststernotomy mediastinitis (n = 24) from July 2001 to December 2005. Data recorded included postoperative blood glucose levels, age, diagnosis, operation, surgical complexity score, duration of operation and cardiopulmonary bypass, delayed sternal closure, perioperative use of steroids and total parenteral nutrition, and duration of postoperative inotropic and ventilatory support. Records of patients without mediastinitis matched for age, complexity score, and month of operation (control group, n = 32) were also reviewed. Data were analyzed with t-tests and chi-square tests. Variables with P < 0.21 on univariate tests were entered into a multivariate logistic regression model.
Initially, postoperative blood glucose levels were elevated, but similar in both mediastinitis and control groups. The number of subjects having peak blood glucose levels >7.2 mm (>130 mg.dl(-1)) during the first 24 h was greater in the mediastinitis group (P = 0.07). The significant multivariate predictor of mediastinitis was 24 h peak blood glucose >7.2 mM (>130 mg.dl(-1)) (P = 0.039).
Our data support the hypothesis that postoperative hyperglycemia is a risk factor for the development of mediastinitis in infants and children following cardiac surgery.
纵隔炎是正中开胸手术罕见但严重的并发症。围手术期高血糖与发病率增加相关，包括小儿和成人心脏手术患者的感染。我们推测，随后发生纵隔炎的患者围手术期血糖水平会更高。
我们检查了2001年7月至2005年12月期间所有诊断为胸骨切开术后纵隔炎的婴幼儿和儿童的病历（n = 24）。记录的数据包括术后血糖水平、年龄、诊断、手术、手术复杂程度评分、手术和体外循环持续时间、胸骨延迟闭合、围手术期类固醇和全胃肠外营养的使用情况，以及术后强心和通气支持的持续时间。还查阅了年龄、复杂程度评分和手术月份相匹配的无纵隔炎患者的记录（对照组，n = 32）。数据采用t检验和卡方检验进行分析。单因素检验中P < 0.21的变量被纳入多因素逻辑回归模型。
最初，术后血糖水平升高，但纵隔炎组和对照组相似。纵隔炎组在术后最初24小时内血糖峰值>7.2 mmol/L（>130 mg·dl⁻¹）的受试者数量更多（P = 0.07）。纵隔炎的显著多因素预测指标是术后24小时血糖峰值>7.2 mmol/L（>130 mg·dl⁻¹）（P = 0.039）。
我们的数据支持这一假设，即术后高血糖是小儿心脏手术后发生纵隔炎的危险因素。
