Department of Intensive Care Unit, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
Department of Anesthesiology, Yokohama City University Hospital, Yokohama, Japan.
J Anesth. 2018 Apr;32(2):160-166. doi: 10.1007/s00540-017-2444-x. Epub 2018 Jan 12.
Hyperglycemia is a common issue in infants after cardiac surgery for congenital heart disease. Poor glycemic control is suspected to be associated with adverse postoperative outcomes. This study was performed to investigate clinical factors contributing to hyperglycemia in the perioperative period in infats.
A total of 69 infants (aged 1-12 months) who were admitted to Yokohama City University Hospital Intensive Care Unit (ICU) after surgical repair of congenital heart diseases with cardiopulmonary bypass (CPB) were retrospectively analysed. Hyperglycemia was defined as blood glucose ≥ 250 mg/dL on ICU admission. Clinical background, operative factors, and postoperative factors were compared between the hyperglycemic and non-hyperglycemic groups. Additionally, multivariate analysis was performed to identify factors contributing to hyperglycemia.
Nineteen (27.5%) and 50 (72.5%) infants were classified into the hyperglycemic and non-hyperglycemic groups, respectively. Hyperglycemic infants were significantly younger, shorter, and weighed less, with a higher rate of chromosomal abnormalities. Intraoperatively, they also experienced longer CPB and surgery times and had higher peak lactate levels and higher inotropic requirements. Hyperglycemia was related to longer mechanical ventilation and longer ICU stays. Multivariate analysis detected intraoperative hyperglycemia, longer CPB time, younger age and chromosomal abnormality as significant factors.
Adding to hyperglycemia during the operation, longer CPB time younger age and chromosomal abnormality were identified as predictors of high blood glucose levels at ICU admission.
先天性心脏病心脏手术后婴儿常出现高血糖症。血糖控制不佳与术后不良结局有关。本研究旨在探讨围手术期导致婴儿高血糖的临床因素。
回顾性分析了 69 例因心肺转流术（CPB）先天性心脏病手术后入住横滨市立大学医院重症监护病房（ICU）的婴儿。将 ICU 入院时血糖≥250mg/dL 的患儿定义为高血糖组。比较高血糖组和非高血糖组的临床背景、手术因素和术后因素。此外，还进行了多变量分析以确定导致高血糖的因素。
19 例（27.5%）和 50 例（72.5%）患儿分别归入高血糖组和非高血糖组。高血糖组患儿明显更年轻、更矮小、体重更轻，染色体异常发生率更高。术中，CPB 时间和手术时间更长，峰值乳酸水平更高，正性肌力药物需求更高。高血糖与更长的机械通气时间和 ICU 住院时间相关。多变量分析检测到术中高血糖、CPB 时间较长、年龄较小和染色体异常是 ICU 入院时高血糖的显著预测因素。
除术中高血糖外，CPB 时间较长、年龄较小和染色体异常也是 ICU 入院时血糖升高的预测因素。
