Cardiac Surgery Intensive Care Unit, Evangelismos General Hospital of Athens, Greece.
Eur J Cardiovasc Nurs. 2012 Mar;11(1):105-13. doi: 10.1177/1474515111430887. Epub 2012 Jan 11.
Hyperglycemia occurs frequently in patients undergoing cardiac surgery. It has been identified as a risk factor for increased peri-operative morbidity and mortality.
To review the evidence of the correlation of peri-operative hyperglycemia with mortality in cardiac surgery patients and to discuss the main results in order to provide evidence-based knowledge for the appropriate glycemic control.
We searched the electronic databases MEDLINE, CINAHL and EMBASE in June 2010. The material of our study was articles published between 1 January 1990 and 31 May 2010, which investigated the correlation between peri-operative hyperglycemia and in-hospital and/or 30-day cardiac surgery mortality.
Out of the 16 reviewed articles in our study, 12 (75%) significantly associated hyperglycemia and inadequate blood glucose control with increased mortality. In addition, four of the reviewed articles were controlled randomized trials and among them only one demonstrated strong correlation between poor glycemic control and mortality. No study was multi-centre and the reviewed articles were characterized by different definitions of peri-operative hyperglycemia, different intensity and duration of the applied therapy and heterogeneity of the population.
It is clear that peri-operative hyperglycemia is harmful for cardiac surgery patients. The significant shortage of randomized controlled trials, the absence of multicentre studies, the different definitions of peri-operative hyperglycemia, the different intensity and duration of the applied insulin therapy protocol and the heterogeneity of the studied population (diabetics and non-diabetics) are significant limitations, which could explain the inconsistent findings of the literature. These limitations indicate the need for further research.
心脏手术患者常发生高血糖症。高血糖症已被确定为增加围手术期发病率和死亡率的危险因素。
回顾围手术期高血糖与心脏手术患者死亡率之间相关性的证据，并讨论主要结果，为适当的血糖控制提供循证知识。
我们于 2010 年 6 月检索了 MEDLINE、CINAHL 和 EMBASE 电子数据库。我们研究的材料是 1990 年 1 月 1 日至 2010 年 5 月 31 日期间发表的研究高血糖症与住院和/或 30 天心脏手术死亡率之间相关性的文章。
在我们研究的 16 篇综述文章中，有 12 篇（75%）明确将高血糖症和血糖控制不充分与死亡率增加联系起来。此外，综述文章中有 4 篇为对照随机试验，其中只有 1 篇显示血糖控制不佳与死亡率之间存在很强的相关性。没有多中心研究，综述文章的特点是围手术期高血糖症的定义不同，应用治疗的强度和持续时间不同，以及人群异质性。
很明显，围手术期高血糖症对心脏手术患者有害。随机对照试验显著不足，缺乏多中心研究，围手术期高血糖症的定义不同，应用胰岛素治疗方案的强度和持续时间不同，以及研究人群（糖尿病患者和非糖尿病患者）的异质性，这些都是导致文献结果不一致的重要限制因素。这些局限性表明需要进一步研究。
