糖尿病患者体外循环或非体外循环冠状动脉旁路移植术后血糖控制水平对临床结局的影响  

Effect of Post-operative Glycemic Control Level on Clinical Outcomes in Diabetic Patients Undergoing Coronary Artery Bypass Grafting With and Without Cardiopulmonary Bypass

作　　者：张东蕊 尤宏钊 张恒[2] 侯晓沛 李肖珏 冯新星[1] 钱鑫[1] 时娜[1] 孙寒松[2] 凤玮[2] 郑哲[2] 陈燕燕[1] ZHANG Dongrui;YOU Hongzhao;ZHANG Heng;HOU Xiaopei;LI Xiaojue;FENG Xinxing;QIAN Xin;SHI Na;SUN Hansong;FENG Wei;ZHENG Zhe;CHEN Yanyan(Endocrinology Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院内分泌中心,北京市100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院成人外科中心,北京市100037 [3]首都医科大学附属北京友谊医院老年医学科

出　　处：《中国循环杂志》2022年第6期621-626,共6页Chinese Circulation Journal

基　　金：国家心血管疾病临床医学研究中心自主课题(NCRC2020004);中国医学科学院学科发展重点项目(2011-YIRI)。

摘　　要：目的:探讨糖尿病患者在应用或不应用体外循环下行冠状动脉旁路移植术(CABG),术后不同血糖控制水平对临床结局的影响。方法:入选3387例行CABG的糖尿病患者,其中1638例术中应用体外循环。对于应用或不应用体外循环下行CABG的两类患者,分别根据术后血糖控制水平分为严格控制组(平均血糖水平<7.8 mmol/L)、中度控制组(平均血糖水平7.8~9.9 mmol/L)和宽松控制组(平均血糖水平≥10.0 mmol/L)。主要终点为院内全因死亡,次要终点为主要心血管并发症(包括急性心肌梗死、脑卒中和急性肾功能不全)。结果:体外循环CABG患者中,与中度控制组(n=1050)相比,严格控制组(n=100)院内死亡的发生率明显升高(1.4%vs.9.0%,P<0.001),宽松控制组(n=488)与中度控制组之间差异无统计学意义(P>0.05)。多因素回归分析显示,与中度控制组相比,严格控制组院内死亡风险(OR=9.98,95%CI:2.97~33.56,P<0.001)和主要心血管并发症风险(OR=2.21,95%CI:1.01~4.81,P=0.047)均明显增加。而在非体外循环CABG患者中,严格控制组(n=104)、中等控制组(n=1202)与宽松控制组(n=443)的院内全因死亡和主要心血管并发症发生率差异均无统计学意义(P均>0.05)。结论:对于行体外循环CABG的糖尿病患者,严格控制血糖(<7.8 mmol/L)可能增加院内死亡和心血管并发症发生风险。Objectives:The aim of this study is to determine the association between different glycemic control level and postoperative adverse outcomes in diabetic patients undergoing coronary artery bypass grafting(CABG)with and without cardiopulmonary bypass(CPB).Methods:A total of 3387 diabetic patients undergoing CABG,including 1638 patients with CPB and 1749 patients without CPB,were categorized into strict,moderate,and liberal glucose control groups according to their post-operative mean blood glucose control level<7.8 mmol/L,7.8 to 9.9 mmol/L,and≥10.0 mmoL/L.Primary endpoint was defined as in-hospital all-cause mortality,and secondary endpoint was defined as major cardiovascular complication including acute myocardial infraction,stroke,and acute kidney injury.Results:Among the patients undergoing CABG with CPB,the strict control group(n=100)had a higher rate of both in-hospital death and major complications(9.0%vs.1.4%,P<0.001;12.0%vs.6.8%,P=0.020),comparing with moderate control group(n=1050).By multivariate regression analysis,strict glucose control was significantly associated with inhospital mortality(OR=9.98,95%CI:2.97-33.56,P<0.001)and major cardiovascular complication(OR=2.21,95%CI:1.01-4.81,P=0.047)in the CPB patients,comparing with moderate glucose control.Patients without CPB included 104 patients in the strict control group,1202 patients in the moderate control group and 443 patients in the liberal control group.However,there were no differences among different glucose control groups in patients without CPB(all P>0.05).Conclusions:Comparing with moderate and liberal blood glucose controls,the strict glucose control was related with an increased risk of in-hospital mortality and major cardiovascular complications in the diabetic patients undergoing CABG with cardiopulmonary bypass.

关 键 词：糖尿病 冠状动脉旁路移植术 体外循环 血糖 临床结局 

分 类 号：R541.4[医药卫生—心血管疾病]