持续术后胰岛素输注可降低使用双侧乳内动脉移植物进行冠状动脉旁路移植术的糖尿病患者的深部胸骨伤口感染：一项倾向匹配分析。
Continuous postoperative insulin infusion reduces deep sternal wound infection in patients with diabetes undergoing coronary artery bypass grafting using bilateral internal mammary artery grafts: a propensity-matched analysis.
作者信息
Ogawa Shinji, Okawa Yasuhide, Sawada Koshi, Goto Yoshihiro, Yamamoto Masanori, Koyama Yutaka, Baba Hiroshi, Suzuki Takahiko
机构信息
Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan.
出版信息
Eur J Cardiothorac Surg. 2016 Feb;49(2):420-6. doi: 10.1093/ejcts/ezv106. Epub 2015 Mar 29.
OBJECTIVES
Deep sternal wound infection (DSWI), especially in patients with diabetes mellitus (DM), is a major concern after coronary artery bypass grafting (CABG) with bilateral internal mammary artery (BIMA) grafts. We evaluated the risk of DSWI and other clinical outcomes between continuous insulin infusion therapy (CIT) and insulin sliding scale therapy (IST) in a cohort of DM patients who underwent CABG with BIMA.
METHODS
The clinical records of DM patients who underwent isolated CABG with BIMA were retrospectively reviewed. The study population consisted of 95 patients who received CIT and 126 patients who received IST. Furthermore, a one-to-one matched analysis based on estimated propensity scores for patients who received CIT or IST yielded two groups comprising 58 patients each. The proportion of patients with DSWI, overall survival rates and major adverse cardiac events were compared between the two groups in the overall and the propensity-matching cohort.
RESULTS
The prevalence of DSWI requiring debridement and closure was significantly reduced in the CIT group compared with that in the IST group [1/95 (1.1%) vs 9/126 (7.1%), P = 0.031]; these results were not attenuated even after propensity-matching analysis [0/58 (0%) vs 6/58 (10.3%), P = 0.031]. The mean preoperative glucose levels were similar between the two groups (157.5 ± 54.6 vs 176.1 ± ±70 mg/dl, P = 0.063), whereas the mean glucose values were significantly lower on the first and second operative days in the CIT group than in the IST group (132.9 ± 44.1 vs 197.8 ± 78.6 mg/dl, P < 0.0001; 153.5 ± 58.8 vs 199.6 ± 89.1 mg/dl, P < 0.0001, respectively). The glucose variability levels within 24 h postoperatively were significantly higher in the IST group (46.1 ± 19.4 vs 66.4 ± 26.8 mg/dl, P < 0.0001). The 30-day and 1-year survival rates were similar between the two groups (100 vs 99.2%, P = 0.384; 96.6 vs 94.4%, P = 0.454). No results were changed in the propensity-matching models.
CONCLUSIONS
The CIT approach reduced the variability in glucose concentration and resulted in fewer instances of DSWI after CABG with BIMA grafts.
目的
深部胸骨伤口感染（DSWI），尤其是糖尿病（DM）患者，是双侧乳内动脉（BIMA）搭桥的冠状动脉旁路移植术（CABG）后的一个主要问题。我们评估了接受BIMA搭桥CABG的DM患者队列中持续胰岛素输注治疗（CIT）和胰岛素滑动剂量治疗（IST）之间DSWI的风险及其他临床结局。
方法
回顾性分析接受单纯BIMA搭桥CABG的DM患者的临床记录。研究人群包括95例接受CIT的患者和126例接受IST的患者。此外，基于接受CIT或IST患者的估计倾向评分进行一对一匹配分析，得到两组，每组58例患者。比较两组在总体队列和倾向匹配队列中DSWI患者的比例、总生存率和主要不良心脏事件。
结果
与IST组相比，CIT组需要清创和缝合的DSWI患病率显著降低[1/95（1.1%）对9/126（7.1%），P = 0.031]；即使在倾向匹配分析后，这些结果也没有减弱[0/58（0%）对6/58（10.3%），P = 0.031]。两组术前平均血糖水平相似（157.5±54.6对176.1±70mg/dl，P = 0.063），而CIT组在手术第一天和第二天的平均血糖值显著低于IST组（132.9±44.1对197.8±78.6mg/dl，P < 0.0001；153.5±58.8对199.6±89.1mg/dl，P < 0.0001）。IST组术后24小时内的血糖变异性水平显著更高（46.1±19.4对66.4±26.8mg/dl，P < 0.0001）。两组的30天和1年生存率相似（100对99.2%，P = 0.384；96.6对94.4%，P = 0.454）。倾向匹配模型中的结果没有变化。
结论
CIT方法降低了血糖浓度的变异性，并减少了BIMA搭桥CABG术后DSWI的发生例数。
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