心脏手术围术期血糖波动与术后急性肾损伤的相关性分析  

Correlation analysis of perioperative glycemic variability and post-operative acute kidney injury

作　　者：何建斌[1] 孙建中 徐学敏[1] 邢柏春[1] 陶蕾[1] 丁倩[1] 姚立农[1] 

机构地区：[1]第四军医大学唐都医院麻醉科,西安市710038 [2]Department of Anesthesiology,Thomas Jefferson University

出　　处：《临床麻醉学杂志》2014年第2期134-137,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨心脏手术围术期血糖波动与术后急性肾损伤(AKI)的相关性及术前阿司匹林的保护作用。方法回顾性分析2 298例冠状动脉搭桥术和/或瓣膜置换术患者围术期血糖的变化和AKI发生情况。依据血糖波动范围将患者分为四组,G1组≤25mg/dl,G2组26～50mg/dl,G3组51～75mg/dl,G4组>75mg/dl。根据AKIN国际标准确定术后AKI。采用多元逻辑回归分析AKI的危险因素。结果 G1、G2、G3、G4组术后AKI的发生率分别为6.6%、8.3%、14.1%和18.1%,G3、G4组明显高于G1、G2组(P<0.05)。G1、G2、G4组糖尿病患者AKI的发生率明显高于非糖尿病患者(P<0.05)。随血糖波动幅度增大,AKI发生的可能性增加。同组患者中,服用阿司匹林者AKI的发生率明显低于未服用者(P<0.05)。结论心脏手术围术期血糖波动大于50mg/dl显著增加术后AKI的风险,术前服用阿司匹林可降低术后AKI的发生率。Objective To investigate the correlation of perioperative glycemic variability and incidence of AKI in patients undergoing cardiac surgery. The protective effects of preoperative aspirin. Methods An observational retrospective study was performed in patients （n = 2298） underwent CABG, valve or CABG plus valve surgery. All patients were respectively divided into four groups, group G1≤25 mg/dl, group G2 26-50 mg/dl, group G3 51-75 mg/dl, group G4）75 mg/dl. AKI was defined based on the acute kidney injury network （AKIN） criteria. Potential risk factors of AKI were analyzed by multivariate logistic regression.Results 6.6%, 8.3%, 14. 1% and 18. 1% in groups G1, G2, Incidence of AKI respectively performed as G3 and G4. groups G3 and G4 significantly higher than groups G1 and group G2 （P〈0.05）. Incidence of AK1 in diabetics were higher than that in nowdiabetics of groups G1, G2 and G4 （P d0.05）. Larger glycemic oscillation expected higher probability of incidence of AKI. Aspirin reduced AKI occurrence among patients limited in same glycemic oscillation breadth. Conclusion Perioperative glycemic fluctuation over than 50 mg/dl increased risk of postoperative AKI in cardiac surgery and aspirin administration before operation could reduce the incidence of AKI.

关 键 词：急性肾损伤 血糖波动 阿司匹林 

分 类 号：R654.2[医药卫生—外科学]