中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2011年
2期
141-143
,共3页
血糖%预后%冠状动脉旁路移植术,非体外循环
血糖%預後%冠狀動脈徬路移植術,非體外循環
혈당%예후%관상동맥방로이식술,비체외순배
Blood glucose%Prognosis%Coronary artery bypass,off-pump
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.
目的 評價非體外循環冠狀動脈徬路移植術患者術中血糖波動水平與短期預後的關繫.方法 擇期行非體外循環冠狀動脈徬路移植術的患者214例,ASA分級Ⅰ～Ⅲ級,NYHA分級Ⅰ～Ⅲ級,穩定性心絞痛分級Ⅰ～Ⅲ級,左室射血分數≥30%.于痳醉誘導後10 min時至關胸骨後10min時,每隔1 h取動脈血樣1 ml,測定血糖,計算術中血糖波動水平,即術中血糖最高值與最低值之差.記錄預後各指標的髮生情況,包括鑑護室內滯留(在鑑護室內停留時間≥24 h)、機械通氣時間延長(機械通氣時間≥12 h)、術後併髮癥(包括新髮的心功能不全、心律失常、心肌梗死、呼吸功能不全、腦卒中、感染、胸腔積液、外科齣血,髮生其中一項即為髮生瞭併髮癥)和術後住院時間延長(術後住院時間≥7 d).以術中血糖波動水平400 mg/L作為分界點,將患者分為2組:<400 mg/L組(L組)和≥400 mg/L組(H組).繪製術中血糖波動水平與預後各指標髮生率之間的受試者工作特徵麯線,計算麯線下麵積及其95%可信區間,以此評估術中血糖波動水平預測患者的短期預後的準確性.結果 術中血糖水平波動預測鑑護室內滯留時間、機械通氣時間延長、術後併髮癥和術後住院時間延長的受試者工作特徵麯線下麵積及其95%可信區間分彆為0.804(0.739～0.869)、0.604(0.415～0.793)、0.801(0.720～0.882)、0.615(0.523～0.707).與L組比較,H組鑑護室內滯留時間延長,術後併髮癥和術後住院時間延長的髮生率升高(P<0.01),機械通氣時間延長髮生率差異無統計學意義(P>0.05).結論 術中血糖波動水平可較好地預測非體外循環冠狀動脈徬路移植術患者的短期預後;血糖波動水平≥400 mg/L的患者預後較差.
목적 평개비체외순배관상동맥방로이식술환자술중혈당파동수평여단기예후적관계.방법 택기행비체외순배관상동맥방로이식술적환자214례,ASA분급Ⅰ～Ⅲ급,NYHA분급Ⅰ～Ⅲ급,은정성심교통분급Ⅰ～Ⅲ급,좌실사혈분수≥30%.우마취유도후10 min시지관흉골후10min시,매격1 h취동맥혈양1 ml,측정혈당,계산술중혈당파동수평,즉술중혈당최고치여최저치지차.기록예후각지표적발생정황,포괄감호실내체류(재감호실내정류시간≥24 h)、궤계통기시간연장(궤계통기시간≥12 h)、술후병발증(포괄신발적심공능불전、심률실상、심기경사、호흡공능불전、뇌졸중、감염、흉강적액、외과출혈,발생기중일항즉위발생료병발증)화술후주원시간연장(술후주원시간≥7 d).이술중혈당파동수평400 mg/L작위분계점,장환자분위2조:<400 mg/L조(L조)화≥400 mg/L조(H조).회제술중혈당파동수평여예후각지표발생솔지간적수시자공작특정곡선,계산곡선하면적급기95%가신구간,이차평고술중혈당파동수평예측환자적단기예후적준학성.결과 술중혈당수평파동예측감호실내체류시간、궤계통기시간연장、술후병발증화술후주원시간연장적수시자공작특정곡선하면적급기95%가신구간분별위0.804(0.739～0.869)、0.604(0.415～0.793)、0.801(0.720～0.882)、0.615(0.523～0.707).여L조비교,H조감호실내체류시간연장,술후병발증화술후주원시간연장적발생솔승고(P<0.01),궤계통기시간연장발생솔차이무통계학의의(P>0.05).결론 술중혈당파동수평가교호지예측비체외순배관상동맥방로이식술환자적단기예후;혈당파동수평≥400 mg/L적환자예후교차.
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 after offpump CABG. The patients with the BGC≥400 mg/L has a poor prognosis.
