非体外循环冠状动脉旁路移植术患者术中血糖波动水平与短期预后的关系  

Intraoperative blood glucose concentration fluctuation is closely related to short-term clinical outcomes in patients after off-pump coronary artery bypass graft

作　　者：穆东亮[1] 敖虎山[2] 

机构地区：[1]北京大学第一医院麻醉科 [2]中国医学科学院,北京协和医学院,阜外心血管病医院麻醉科,100037

出　　处：《中华麻醉学杂志》2011年第2期141-143,共3页Chinese Journal of Anesthesiology

摘　　要：目的 评价非体外循环冠状动脉旁路移植术患者术中血糖波动水平与短期预后的关系.方法 择期行非体外循环冠状动脉旁路移植术的患者214例,ASA分级Ⅰ～Ⅲ级,NYHA分级Ⅰ～Ⅲ级,稳定性心绞痛分级Ⅰ～Ⅲ级,左室射血分数≥30%.于麻醉诱导后10 min时至关胸骨后10min时,每隔1 h取动脉血样1 ml,测定血糖,计算术中血糖波动水平,即术中血糖最高值与最低值之差.记录预后各指标的发生情况,包括监护室内滞留（在监护室内停留时间≥24 h）、机械通气时间延长（机械通气时间≥12 h）、术后并发症（包括新发的心功能不全、心律失常、心肌梗死、呼吸功能不全、脑卒中、感染、胸腔积液、外科出血,发生其中一项即为发生了并发症）和术后住院时间延长（术后住院时间≥7 d）.以术中血糖波动水平400 mg/L作为分界点,将患者分为2组：〈400 mg/L组（L组）和≥400 mg/L组（H组）.绘制术中血糖波动水平与预后各指标发生率之间的受试者工作特征曲线,计算曲线下面积及其95%可信区间,以此评估术中血糖波动水平预测患者的短期预后的准确性.结果 术中血糖水平波动预测监护室内滞留时间、机械通气时间延长、术后并发症和术后住院时间延长的受试者工作特征曲线下面积及其95%可信区间分别为0.804（0.739～0.869）、0.604（0.415～0.793）、0.801（0.720～0.882）、0.615（0.523～0.707）.与L组比较,H组监护室内滞留时间延长,术后并发症和术后住院时间延长的发生率升高（P〈0.01）,机械通气时间延长发生率差异无统计学意义（P〉0.05）.结论 术中血糖波动水平可较好地预测非体外循环冠状动脉旁路移植术患者的短期预后;血糖波动水平≥400 mg/L的患者预后较差.Objective To investigate the effect of intraoperative fluctuation in blood glucose concentration （BGCF） on short-term clinical outcomes in patients after off-pump coronary artery bypass graft （CABG） .Methods Two hundred and fourteen ASA Ⅰ -Ⅲ patients （ NYHA grade Ⅰ -Ⅲ ） of both sexes aged 18-64 yr with body mass index 23-29 kg/m2 underwent elective off-pump CABG. Their left ventricular ejection fraction was ≥30% .Blood samples were obtained once an hour for determination of blood glucose concentration （BGC） between 10 min after induction of anesthesia and 10 min after closure of sternum. The maximum and minimum BGCs were record-ed . Intraoperative BGCF was defined as the difference between the maximum and minimum BGCs. Other factors which may influence clinical outcome were also recorded, including prolonged ICU stay （ ≥24 h）, prolonged me-chanical ventilation （ ≥12 h） , postoperative complications （cardiac insufficiency secondary to operation, arrhyth-mia, myocardial infarction, respiratory insufficiency, stroke, infection, pleural effusion and surgical bleeding） and prolonged postoperative hospital stay （ ≥ 7 d） . The patients were divided into 2 groups using intraoperative BGCF 400 mg/L as cutoff point： group L 〈 400 mg/L and group H ≥400 mg/L. Receiver operating characteristic （ROC）curve was used to evaluate if intraoperative BGCF was a good index of postoperative outcomes. Results The area under the ROC curve of intraoperative BGC against prolonged ICU stay was 0. 804 （0.739-0. 869）, against prolonged mechanical ventilation 0. 604 （ 0.415-0.793 ）, against postoperative complications 0.801 （ 0.720-0. 882 ）and against postoperative hospital stay 0.615 （0.523-0.707）. The duration of ICU stay was significantly longer and the incidences of complications and prolonged postoperative hospital stay were higher in group H than in group L （P 〈 0.01）. Conclusion Intraoperative BGCF is closely related to postoperative outcomes in patients aft

关 键 词：血糖 预后 冠状动脉旁路移植术 非体外循环 

分 类 号：R654.2[医药卫生—外科学]