非糖尿病患者在非体外循环下行CABG术围手术期血糖和血乳酸水平变化分析
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摘要
目的回顾性分析非糖尿病患者行非体外循环冠状动脉旁路移植术(Off-Pump CABG)术前、术中、术后进入ICU血糖与血乳酸的变化趋势,探讨血糖与血乳酸之间的相关性。方法选取2016年10月～2018年7月承德医学院附属医院心外科50例择期行Off-Pump CABG的非糖尿病患者资料进行研究,观察术前血糖及血乳酸水平,分别为术前、术中1 h、2 h和术后在ICU 1、2、4、6、12、24、48 h各时间点的血乳酸及血糖水平并作趋势分析。结果患者随着手术及进入ICU时间的延长血乳酸水平均有增高趋势,血糖、血乳酸都有先升高到再次恢复正常的过程,并于进入ICU 4 h到达最高值;同时观察到血乳酸值与血糖值的变化趋势大致相同。通过一元线性回归分析血糖与乳酸的相关系数为0.350,单侧P=0.001,证明两个变量间有直线相关关系。结论积极控制Off-Pump CABG围手术期的血糖,能够减少高乳酸血症的发生,对于患者积极恢复及预后有积极意义。
Objective To investigate the relationship between blood glucose and blood lactic acid in non-diabetic patients before and after off-pump coronary artery bypass grafting(Off-Pump CABG).Methods From October 2016 to July 2018, 50 patients with non-diabetic patients who underwent Off-Pump CABG in the Department of Cardiac Surgery, Affiliated Hospital of Chengde Medical College, were selected to observe preoperative blood glucose and blood lactate levels, respectively. Blood lactate and blood glucose levels were measured at 1 h, 2 h, and postoperative ICU at 1, 2, 4, 6,12, 24, and 48 h. Results The blood lactate level increased with the prolongation of surgery and ICU. The blood glucose and blood lactate increased first to normal again, and reached the highest value after entering the ICU for 4 h. At the same time, blood lactate was observed. The value is approximately the same as the change in blood glucose level. The correlation coefficient between blood glucose and lactic acid was 0.350 by one-dimensional linear regression, and one-sided P=0.001, which proved that there was a linear correlation between the two variables. Conclusion Active control of blood glucose during the perioperative period of Off-Pump CABG can reduce the incidence of hyperlactosis, which is positive for the positive recovery and prognosis of patients.
Objective To investigate the relationship between blood glucose and blood lactic acid in non-diabetic patients before and after off-pump coronary artery bypass grafting(Off-Pump CABG).Methods From October 2016 to July 2018, 50 patients with non-diabetic patients who underwent Off-Pump CABG in the Department of Cardiac Surgery, Affiliated Hospital of Chengde Medical College, were selected to observe preoperative blood glucose and blood lactate levels, respectively. Blood lactate and blood glucose levels were measured at 1 h, 2 h, and postoperative ICU at 1, 2, 4, 6,12, 24, and 48 h. Results The blood lactate level increased with the prolongation of surgery and ICU. The blood glucose and blood lactate increased first to normal again, and reached the highest value after entering the ICU for 4 h. At the same time, blood lactate was observed. The value is approximately the same as the change in blood glucose level. The correlation coefficient between blood glucose and lactic acid was 0.350 by one-dimensional linear regression, and one-sided P=0.001, which proved that there was a linear correlation between the two variables. Conclusion Active control of blood glucose during the perioperative period of Off-Pump CABG can reduce the incidence of hyperlactosis, which is positive for the positive recovery and prognosis of patients.
引文
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[2]Piroze M.Davierwala.Current outcomes of off-pump coronary artery bypass grafting:evidence from real world practice[J].J Thorac Dis,2016,8(Suppl 10):S772-S786.
[3]Lazar HL,Chipkin SR,Fitzgerald CA,et al.Tight Glycemic Control in Diabetic Coronary Artery Bypass Graft Patients Improves Perioperative Outcomes and Decreases Recurrent Ischemic Events[J].Circulation,2004,109(12):1497-1502.
[4]Maillet JM,Le Besnerais P,Cantoni M,et al.Frequency, Risk Factors, and Outcome of Hyperlactatemia After Cardiac Surgery[J].Chest,2003,123(5):1361-1366.
[5]Noguchi S,Saito J,Hashiba E,et al.Lactate level during cardiopulmonary bypass as a predictor of postoperative outcomes in adult patients undergoing cardiac surgery[J].JA Clinical Reports,2016,2(1):39.
[6]Khan NE,De Soyza A,Mister R,et al.A Randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery[J].NEJM,2018(350):21-28.
[7]LI S,Zhou P,Hua Q,et al.Effects of blood glucose, blood lipids and blood pressure control on recovery of patients with gastric cancer complicated with metabolic syndrome after radical gastrectomy[J].Experimental and Therapeutic Medicine,2018,15(6):4785-4790.
[8]Floh AA,Manlhiot C,Redington AN,et al.Insulin resistance and infammation are a cause of hyperglycemia after pediatric cardiopulmonary bypass surgery[J].J Thorac Cardiovasc Surg,2015,150(3):498-504.
[9]李大鹤,于俊民,张小波,等.优化心肌能量代谢治疗心力衰竭的研究进展[J].实用临床医药杂志,2013,17(23):197-199.
[10]Matsushima K,Peng M,Velasco C,et al.Glucose variability negatively impacts long-term functional outcome in patients with traumatic brain injury[J].J Crit Care,2012,27(2):125-131.