Congenital Heart Institute, Arnold Palmer Hospital for Children, Orlando, Florida 32806, USA.
Ann Thorac Surg. 2010 Jan;89(1):181-5. doi: 10.1016/j.athoracsur.2009.08.062.
Studies demonstrate that cardiopulmonary bypass (CPB) causes intraoperative and postoperative hyperglycemia. Hyperglycemia has been associated with morbidity and mortality after infant cardiac surgery. We studied the effects on early postoperative outcomes of glucose (GLU) changes during and after pediatric cardiac surgery.
The records of 144 infants less than 10 kg who underwent CPB for a variety of congenital cardiac procedures were reviewed. The GLU values (at multiple intervals during and after surgery), age, weight, CPB time, ultrafiltration volume, and risk adjustment for congenital heart surgery (RACHS-1) score were recorded. Univariate and multivariate linear and binary logistic regression were used to examine the dependence of the composite outcome mortality or postoperative infection, the mechanical ventilation time (VENT time), and the length of stay (LOS), on these variables.
The RACHS-1 score was the only significant predictor of the composite variable "mortality or infection" (p = 0.008). Glucose at any time was not a significant factor predicting this outcome. Lower pre-CPB GLU, younger age, and higher RACHS-1 score were significant predictors of greater LOS and VENT time.
In this study, post-CPB and postoperative hyperglycemia were not risk factors for postoperative morbidity and mortality after infant cardiac surgery.
研究表明心肺转流（CPB）会导致术中及术后高血糖。高血糖与婴儿心脏手术后的发病率和死亡率有关。我们研究了小儿心脏手术后 CPB 期间和之后的血糖（GLU）变化对术后早期结果的影响。
回顾了 144 名体重小于 10 公斤的婴儿的记录，他们因各种先天性心脏病手术接受 CPB。记录了 GLU 值（手术期间和手术后的多个时间点）、年龄、体重、CPB 时间、超滤量和先天性心脏病手术风险调整（RACHS-1）评分。使用单变量和多变量线性和二项逻辑回归来检查这些变量对复合结果（死亡率或术后感染）、机械通气时间（VENT 时间）和住院时间（LOS）的依赖性。
RACHS-1 评分是复合变量“死亡率或感染”的唯一显著预测因子（p = 0.008）。任何时候的血糖都不是预测这一结果的重要因素。较低的术前 CPB GLU、较小的年龄和较高的 RACHS-1 评分是 LOS 和 VENT 时间延长的显著预测因子。
在这项研究中，CPB 后和术后高血糖并不是婴儿心脏手术后发病率和死亡率的危险因素。
