CAJ | 학술논문

目的回顾性分析总结术前非终末期器官功能受损的糖尿病对心脏移植受者移植后早期及中期存活的影响.方法 2004年6月至2012年7月间单中心完成315例心脏移植,回顾分析住院和随访资料,根据患者移植前是否患有糖尿病将患者分为糖尿病组(47例)和非糖尿病组(268例).比较分析两组术后早期恢复情况,包括机械通气时间,因并发症需持续肾脏替代治疗(CRRT)、体外膜肺氧合(ECMO)或主动脉内球囊反搏(IABP)支持治疗的应用率,重症监护病房(ICU)住院时间及住院总时间.绘制Kaplan-Meier生存曲线,比较两组患者术后早期和中期存活率.结果患者年龄为(44.6±13.8)岁,术前糖尿病占15.0％.糖尿病组与非糖尿病组术后机械通气时间,需CRRT、ECMO和IABP支持治疗的应用率,ICU住院时间及住院总时间的差异均无统计学意义(P＞0.05).平均随访33个月(17～60个月),糖尿病组和非糖尿病组受者术后1个月存活率为97.9％和97.0％；1年存活率分别为93.5％和95.4％；3年存活率分别为86.6％和91.1％;5年存活率分别为72.8％和88.9％；各个时间段存活率的差异均无统计学意义(P＞0.05)结论术前糖尿病占15.0％的心脏移植单中心经验显示,经严格筛选的非终末期器官功能受损的糖尿病患者心脏移植术后早期及中期存活率未受明显影响.
목적 회고성분석총결술전비종말기기관공능수손적당뇨병대심장이식수자이식후조기급중기존활적영향.방법 2004년6월지2012년7월간단중심완성315례심장이식,회고분석주원화수방자료,근거환자이식전시부환유당뇨병장환자분위당뇨병조(47례)화비당뇨병조(268례).비교분석량조술후조기회복정황,포괄궤계통기시간,인병발증수지속신장체대치료(CRRT)、체외막폐양합(ECMO)혹주동맥내구낭반박(IABP)지지치료적응용솔,중증감호병방(ICU)주원시간급주원총시간.회제Kaplan-Meier생존곡선,비교량조환자술후조기화중기존활솔.결과 환자년령위(44.6±13.8)세,술전당뇨병점15.0％.당뇨병조여비당뇨병조술후궤계통기시간,수CRRT、ECMO화IABP지지치료적응용솔,ICU주원시간급주원총시간적차이균무통계학의의(P＞0.05).평균수방33개월(17～60개월),당뇨병조화비당뇨병조수자술후1개월존활솔위97.9％화97.0％；1년존활솔분별위93.5％화95.4％；3년존활솔분별위86.6％화91.1％;5년존활솔분별위72.8％화88.9％；각개시간단존활솔적차이균무통계학의의(P＞0.05)결론 술전당뇨병점15.0％적심장이식단중심경험현시,경엄격사선적비종말기기관공능수손적당뇨병환자심장이식술후조기급중기존활솔미수명현영향.
Objective In this retrospectively study,we compared perioperative and mediumterm survival rate of heart transplant (HT) between non-diabetic and diabetic patients,in order to clarify the effect of preoperative diabetes with non-end-organ damage to patients undergoing HT.Methods From June 2004 to July 2012,the HT Center of Fuwai Hospital had completed a total of 315 cases,and the clinical data of all patients and follow-up information were analyzed.315 patients were divided into diabetic (47 cases) and non-diabetic (268 cases) groups.Clinical characteristic data and perioperative recovery data of two groups were compared.The perioperative recovery data included perioperative duration of mechanical ventilation,perioperative complications required CRRT/ECMO/IABP support,ICU length of stay and total hospital stay.The perioperative and mediumterm survivals between two groups were also compared by Kaplan-Meier method.Results Among 315HT patients,with mean age of (44.6 ± 13.8) years,diabetic patients accounted for 15.0％.Between diabetic and non-diabetic groups,perioperative duration of mechanical ventilation,incidence of perioperative complications required CRRT/ECMO /IABP support,ICU length of stay and total hospital stay had no statistically significant difference (P＞0.05).The median follow-up period was 33 months (17-60 months).Postoperatively,the one-month,one-year,3-year and 5-year survival rats in diabetic and non-diabetic groups 97.9％ vs.97.0％,93.5％ vs.95.4％,86.6％ vs.91.1％,and 72.8％ vs.88.9％,respectively.There was no statistically significant difference in the survival between two groups at each time (P＞ 0.05).Conclusion Among 315 HT patients,preoperative diabetic patients accounted for 15.0％.The perioperative and medium-term survivals were not affected in HT diabetes patients with non-end-organ damage and restrictive glycemic control.