Järvelä K M, Khan N K, Loisa E L, Sutinen J A, Laurikka J O, Khan J A
1 Department of Cardiothoracic Surgery, TAYS Heart Hospital, Tampere University Hospital, Tampere, Finland.
2 Department of Vascular Surgery, Tampere University Hospital, Tampere, Finland.
Scand J Surg. 2018 Jun;107(2):138-144. doi: 10.1177/1457496917731190. Epub 2017 Sep 22.
To describe the incidence of and risk factors for postoperative infections and the correlation between postoperative hyperglycemia despite tight blood glucose control with infectious and other complications after contemporary cardiac surgery.
The study comprised 1356 consecutive adult patients who underwent cardiac surgery between January 2013 and December 2014 and were followed up for 6 months. Patients surviving the first 2 days were included in the analysis. Preoperative demographic information, medical history, procedural details, and the postoperative course were recorded. The target range for blood glucose levels was 4-7 mmol/L and repeated arterial blood samples were obtained during the intensive care unit stay. The associations of blood glucose levels during the first postoperative day and the occurrence of postoperative infections and other significant complications were analyzed.
Of the study cohort, 9.8% developed infectious complications which were classified as major surgical site infections in 2.2%, minor surgical site infections in 1.1%, lung infections in 2.0%, unclear fever or bacteremia in 0.3%, cannula or catheter related in 2.6%, multiple in 1.5%, and other in 0.2%. The incidence of deep sternal wound infection was 2.0%. Repeated hyperglycemia occurred in 39.7% of patients and was associated with increased rates of postoperative infections, 12.1% versus 8.2%, p = 0.019; stroke, 4.9% versus 1.5%, p < 0.001; and mortality, 6.1% versus 2.1%, p < 0.001, when compared to patients with single or no hyperglycemia.
Every 10th patient develops infectious complications after cardiac surgery. Repeated hyperglycemia is associated with increased rates of infectious complications, stroke, and mortality.
描述当代心脏手术后感染的发生率及危险因素，以及尽管严格控制血糖但术后高血糖与感染及其他并发症之间的相关性。
本研究纳入了2013年1月至2014年12月期间连续接受心脏手术的1356例成年患者，并进行了6个月的随访。分析纳入存活前2天的患者。记录术前人口统计学信息、病史、手术细节及术后病程。血糖目标范围为4 - 7 mmol/L，在重症监护病房住院期间重复采集动脉血样本。分析术后第1天血糖水平与术后感染及其他严重并发症发生情况的相关性。
在研究队列中，9.8%的患者发生感染并发症，其中2.2%为主要手术部位感染，1.1%为次要手术部位感染，2.0%为肺部感染，0.3%为不明原因发热或菌血症，2.6%为插管或导管相关感染，1.5%为多种感染，0.2%为其他感染。深部胸骨伤口感染发生率为2.0%。39.7%的患者出现反复高血糖，与单次或无高血糖患者相比，术后感染发生率增加（12.1%对8.2%，p = 0.019）；中风发生率增加（4.9%对1.5%，p < 0.001）；死亡率增加（6.1%对2.1%，p < 0.001）。
每10例心脏手术后患者中有1例发生感染并发症。反复高血糖与感染并发症、中风及死亡率增加相关。
