术中血糖变异度对心脏瓣膜术后肾功能的影响  

Influence of intraoperative blood glucose variability on renal function and prognosis after cardiac valve surgery

作　　者：林丽珠[1] 檀润先 梁友君[1] 范海鸥[1] LIN Lizhu;TAN Runxian;LIANG Youjun;FAN Haiou(The First People's Hospital of Qinzhou,Qinzhou 535099,Guangxi,China)

机构地区：[1]钦州市第一人民医院,广西钦州535099

出　　处：《西部医学》2023年第3期405-410,共6页Medical Journal of West China

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z20200172)。

摘　　要：目的探讨术中血糖变异度对心脏瓣膜手术术后肾功能的影响。方法选取2018年8月—2021年8月在我院行心脏瓣膜手术患者67例为研究对象,采用回顾性队列研究的方式,根据术中血糖最高值与最低值的差值水平以2.8和5.0 mmol/L为分界值将患者分为3组,血糖差值<2.8 mmol/L者为低血糖变异组(G1组),血糖差值在2.8~5.0 mmol/L之间者为中血糖变异组(G2组),血糖差值≥5.0 mmol/L者为高血糖变异组(G3组),分析术中血糖变异度与术后肾功能及院内预后的关系。结果3组患者在年龄、女性、脑梗塞病史等一般资料比较,差异无统计学意义(P>0.05);3组住院总费用总体均数存在着统计差异(F=3.227,P=0.046),G3组明显高于G1组(P<0.05);3组CysC在术后第二天和第三天总体上存在着统计学差异(P<0.05),G1组明显低于G3组(P<0.05),G2组在术后第三天(t4)明显低于G3组(P<0.05);3组SCr值比较,G1组G2组在术后第二天和第三天明显低于G3组(P<0.05);3组eGFR在术后第二天和第三天总体上存在着统计学差异(P<0.05),G1组明显高于G3组(P<0.05)。结论血糖变异与心脏瓣膜手术围手术期肾功能损伤和住院总费用存在相关性。低血糖变异可能有助于减少心脏瓣膜手术围手术期肾功能损伤,降低总住院费用。Objective To evaluate the influence of intraoperative blood glucose variability on renal function and in-hospital prognosis after cardiac valve surgery.Methods A total of 67 eligible patients undergoing heart valve surgery in our hospital from August 2018 to August 2021 were selected.A retrospective cohort study was adopted based on the difference between the highest and lowest intraoperative blood glucose values.The patients were divided into three groups,the blood glucose difference is less than 2.8mmol/L as the hypoglycemia variant group(G1 group),and the blood glucose difference between 2.8mmol/L~5.0mmol/L is the middle blood glucose variant group(G2 group).Patients with a blood glucose difference greater than or equal to 5.0mmol/L belonged to the hyperglycemia variant group(G3 group).The relationship between intraoperative blood glucose variability and postoperative renal function and hospital prognosis was analyzed.Results There were no significant differences between these three groups in age,female,history of cerebral infarction,and so on,all P>0.05.There had a statistical difference in the overall average of the total hospitalization expenses in the three groups(F=3.227,P=0.046).The G3 group was significantly higher than the G1 group,P<0.05.The CysC had a statistical difference on the second and third postoperative days among the three groups(P<0.05).The G1 group was significantly lower than the G3 group on the second and third days(P<0.05),and the G2 group was significantly lower than the G3 group on the third postoperative day(P<0.05).The Cr had a statistical difference on the second and third postoperative days among the three groups(P<0.05).The G1 and G2 groups were significantly lower than the G3 group(P<0.05).The eGFR had a statistical difference on the second and third postoperative days among the three groups(P<0.05).The G1 group is significantly higher than the G3 group(P<0.05).Conclusion Blood glucose variability is associated with perioperative renal impairment and total hospitalization costs

关 键 词：血糖变异度 心脏瓣膜手术 肾功能 住院费用 

分 类 号：R654.2[医药卫生—外科学]