St. Luke's Episcopal Hospital Baylor College of Medicine.
Endocr Pract. 2013 Nov-Dec;19(6):928-36. doi: 10.4158/EP12378.OR.
We investigated the relationship between postoperative glucose levels (days 1 through 3) and immediate outcomes in patients who underwent isolated coronary artery bypass grafting (CABG).
We conducted a retrospective study of 2,558 consecutive patients who had isolated CABG. Patients were stratified into 3 groups based on their pre-operative mortality risk (MR), using Society of Thoracic Surgeons' criteria. Average glucose levels for the first 3 days following surgery were determined. Glucose levels for each group were divided into quartiles and related to relevant outcomes. Odds ratios assessing changes in outcomes as functions of increased glucose exposure were determined for postoperative days 1, 2, and 3 and for postoperative days 1 and 2 and 1 through 3.
The number of patients in each MR group (1 through 3; low, medium, and high) was 1,233, 852, and 473, respectively. Mean ± SD quartile glucose levels for days 1 and 2 were 133 ± 8.2, 150.4 ± 4.7, 167.2 ± 6.89, and 205.9 ± 24.9 mg/dL. The proportion of patients with a glucose level <70 mg/dL was 6.4%, <60 mg/dL was 2.7%, and <50 mg/dL was 1.1%. The most consistent and significant correlations between glucose quartiles and outcomes were observed for MR group 1, and they were most significant for the first 2 days following surgery. Glycemic control was not correlated with mortality, but it was correlated with total complications.
Hyperglycemia during the first two days after CABG adversely affected total complications in patients who were in the low and medium MR groups, but it did not significantly affect hospital mortality.
我们研究了行单纯冠状动脉旁路移植术（CABG）患者术后血糖水平（第 1 至 3 天）与即刻转归的关系。
我们对 2558 例行单纯 CABG 的连续患者进行了回顾性研究。根据胸外科医师学会（STS）标准的术前死亡率风险（MR），患者分为 3 组。确定术后第 1 至 3 天的平均血糖水平。将每组的血糖水平分为四分位组，并与相关结局相关联。确定术后第 1、2 和 3 天以及第 1 和 2 天和第 1 至 3 天血糖暴露量增加与结局变化的比值比。
每组（1 至 3 组；低、中、高）的患者数量分别为 1233、852 和 473 例。第 1 天和第 2 天的平均 ± SD 四分位血糖水平分别为 133 ± 8.2、150.4 ± 4.7、167.2 ± 6.89 和 205.9 ± 24.9 mg/dL。血糖水平＜70 mg/dL 的患者比例为 6.4%，＜60 mg/dL 的患者比例为 2.7%，＜50 mg/dL 的患者比例为 1.1%。血糖四分位与结局之间最一致且显著的相关性见于 MR 组 1，且在术后前 2 天最为显著。血糖控制与死亡率无关，但与总并发症相关。
CABG 后前 2 天的高血糖对低和中 MR 组患者的总并发症产生不利影响，但对住院死亡率无显著影响。
