糖化血红蛋白升高对初次单纯冠状动脉旁路移植术患者住院结局及1年生存率的影响。
Impact of elevated glycosylated hemoglobin on hospital outcome and 1 year survival of primary isolated coronary artery bypass grafting patients.
作者信息
Ramadan Mona, Abdelgawad Ahmed, Elshemy Ahmed, Sarawy Emad, Emad Aly, Mazen Mahmoud, Abdel Aziz Ahmed
机构信息
Anesthesia Department, National Heart Institute, Egypt.
Cardiac Surgery Department, National Heart Institute, Egypt.
出版信息
Egypt Heart J. 2018 Jun;70(2):113-118. doi: 10.1016/j.ehj.2017.09.002. Epub 2017 Oct 27.
OBJECTIVE
It is unknown whether adequacy of diabetic control, measured by hemoglobin A1c, is a predictor of adverse outcomes after coronary artery bypass grafting.
METHODS
From December 2013 to November 2015, 80 consecutive patients underwent primary isolated CABG surgery at national heart institute, their data were prospectively collected and they were classified according to their HbA1c level into two groups, Group (A): Forty patients with fair glycemic control (HbA1c below or equal to 7%), Group (B): Forty patients with poor glycemic control (HbA1c above 7%). Hospital morbidity, mortality and one year survival were examined in both groups. Telephone conversation was used to call patients or their relatives to determine the one year survival and it was 100% complete. This study had gained the ethical approval from national heart institute ethical committee.
RESULTS
In-hospital mortality for group A was 2.5% (one patient) and 7.5% (3 patients) for group B with no statistical significance. One year mortality was (5.13%) (2 patients for group A) and (8.11%) (3 patients) for group B with no statistical significance. As regard the morbidity there was no statistical significance between the two groups in the incidence of neurological complications whether stroke or coma, atrial fibrillation, postoperative myocardial infarction, low cardiac output syndrome, heart failure, renal failure, need for dialysis, deep sternal wound infection, and readmission. However, group B had lengthy hospital stay, lengthy ventilation hours, more respiratory complications, and more superficial wound infection with a statistical significance when compared to group A, P values were 0.003, 0.003, 0.038, 0.044 respectively.
CONCLUSIONS
This study showed that HbA1c is a good predictor of in-hospital morbidity. It worth devoting time and effort to decrease HbA1c level below 7% to decrease possible postoperative complications.
目的
通过糖化血红蛋白测量的糖尿病控制是否充分是冠状动脉搭桥术后不良结局的预测指标，目前尚不清楚。
方法
2013年12月至2015年11月，80例连续患者在国家心脏研究所接受初次单纯冠状动脉搭桥手术，前瞻性收集他们的数据，并根据糖化血红蛋白水平将他们分为两组，A组：40例血糖控制良好（糖化血红蛋白低于或等于7%）的患者，B组：40例血糖控制不佳（糖化血红蛋白高于7%）的患者。对两组患者的医院发病率、死亡率和一年生存率进行了检查。通过电话交谈联系患者或其亲属以确定一年生存率，其完成率为100%。本研究已获得国家心脏研究所伦理委员会的伦理批准。
结果
A组住院死亡率为2.5%（1例患者），B组为7.5%（3例患者），无统计学意义。A组一年死亡率为（5.13%）（2例患者），B组为（8.11%）（3例患者），无统计学意义。在神经并发症（无论是中风还是昏迷）、心房颤动、术后心肌梗死、低心排血量综合征、心力衰竭、肾衰竭、透析需求、深部胸骨伤口感染和再入院的发生率方面，两组之间无统计学意义。然而，与A组相比，B组住院时间更长、通气时间更长、呼吸并发症更多、浅表伤口感染更多，具有统计学意义，P值分别为0.003、0.003、0.038、0.044。
结论
本研究表明，糖化血红蛋白是住院发病率的良好预测指标。值得投入时间和精力将糖化血红蛋白水平降至7%以下，以减少可能的术后并发症。
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