非糖尿病Stanford A型主动脉夹层手术患者发生应激性高血糖现状及影响因素分析  

Status quo and influencing factors of stress hyperglycemia in patients undergoing surgery for nondiabetic Standard Type A aortic dissection

作　　者：沈敏伟[1] 徐建鸣[1] 赖灏 郭克芳[1] 赵赟[1] 林佳[1] Shen Minwei;Xu Jianming;Lai Hao;Guo Kefang;Zhao Yun;Lin Jia(Operation Room,Department of Cardiac Surgery、Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院心脏外科手术室,上海200032

出　　处：《中华现代护理杂志》2019年第7期867-871,共5页Chinese Journal of Modern Nursing

摘　　要：目的分析非糖尿病Stanford A 型主动脉夹层手术患者并发应激性高血糖的影响因素,探讨其血糖监测管理方法。方法回顾性纳入复旦大学附属中山医院心脏外科2016 年1 月—2017 年 12 月收治的非糖尿病Stanford A 型主动脉夹层患者100 例,收集患者的年龄、性别、BMI、疼痛评分、手术时间、停循环时间等一般资料,以及术前、体外循环前、停循环前后、复温后、停机后、入ICU时及术后 1~6 d 晨时空腹血糖值。采用单因素分析和 Logistic 回归分析探讨患者围手术期峰值血糖的影响因素。结果围手术期血糖值与术后不良事件的ROC 曲线下面积为0.646(95%CI:0.528~0.763,P=0.021),围手术期血糖峰值在疾病的较佳诊断截点为14.35。体外循环后患者血糖开始上升,复温后血糖上升趋势明显,患者入ICU 时的血糖值仍然处于较高的状态,在手术后24 h 血糖逐渐降低,手术后6 d 逐渐恢复正常。单因素分析结果显示,围手术期血糖峰值≥14.35 mmol/L与<14.35 mmol/L患者的BMI、白细胞、C-反应蛋白、体外循环时间、急性生理学及慢性健康状况评分系统(APACHE Ⅱ)、是否实施急诊手术6 个指标间的差异有统计学意义(P<0.05)。Logistic 回归分析结果显示,BMI、C-反应蛋白、体外循环时间是非糖尿病Stanford A 型主动脉夹层手术患者并发应激性高血糖的独立危险因素(OR>1)。结论术前较重的炎症反应和高BMI提示非糖尿病Stanford A 型主动脉夹层手术患者围手术期可能并发应激性高血糖,通过减少体外循环时间可降低围手术期高血糖情况。医护人员需要在体外循环过程中、复温后及术后加强血糖监测,为此类患者采取有针对性的血糖管理方案。Objective To analyze the influencing factors of stress hyperglycemia in patients undergoing surgery for non-diabetic Standard Type A aortic dissection and to explore the methods of its monitoring and management. Methods Totally 100 patients with non-diabetic Standard Type A aortic dissection admitted in the Department of Cardiac Surgery, Zhongshan Hospital were retrospectively included. Their general information including age, gender, body mass index( BMI), pain score, operation time and time of circulatory arrest as well as morning fasting blood-glucose( FBG) before operation, before extracorporeal circulation, before and after circulatory arrest, after rewarming, after machine halt, at ICU admission and on 1 - 6 day postoperatively was collected. Univariate analysis and Logistic regression analysis were used to explore the factors affecting the peak blood-glucose perioperatively. Results The area under the ROC curve for perioperative blood-glucose and overall adverse outcome was 0.646( 95%CI 0.528-0.763,P=0.021), and the comparatively good cutoff value of perioperative peak blood-glucose for the disease was 14.35. The patients' blood-glucose started to rise after extracorporeal circulation, and the tendency to rise was more significant after rewarming. Their blood-glucose remained at a relatively high level at ICU admission. It tended to decrease since 24 h postoperatively, and it returned to normal levels at 6 d post operation. Univariate analysis showed that there was statistical difference in BMI, white blood cell, C-reactive protein( CRP), time of extracorporeal circulation, Acute Physiology and Chronic Health Evaluation Scoring System( APACHE Ⅱ) and whether emergency surgery received between the patients with ≥14.35 mmol/L or <14.35mmol/L blood-glucose perioperatively(P<0.05). According to Logistic regression analysis, BMI, CRP and time of extracorporeal circulation were independent risk factors of stress hyperglycemia in patients undergoing surgery for non-diabetic Standard Type A aortic dissection( O

关 键 词：主动脉疾病 体外循环 围手术期 STANFORD A 型主动脉夹层 应激性高血糖 

分 类 号：R473.6[医药卫生—护理学]