心臟手術患者圍手術期嚴格控制血糖與常規控制血糖比較療效的Meta分析_《中國循證醫學雜志》

作者：

宋保華 ¹ , 蔣平君 ² ,  王志紅 ³

1. 新疆心腦血管病醫院麻醉科（烏魯木齊 830054）；2. 兵團農六師芳草湖醫院麻醉科（芳草湖 831100）；3. 新疆維吾爾自治區人民醫院（烏魯木齊 830054）;

關鍵詞：

心臟手術圍手術期血糖控制系統評價 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20120191

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　系統評價心臟手術患者圍手術期嚴格控制血糖與常規控制血糖的療效。
方法　計算機檢索PubMed、EMbase、HighWire、Cochrane圖書館、CBM、VIP中關于心臟手術患者圍手術期嚴格控制血糖與常規控制血糖比較的隨機對照試驗，檢索時限從2000年至2011年。由兩名研究者按照納入與排除標準獨立進行文獻篩選、資料提取和質量評價后，采用RevMan5.1軟件進行Meta分析。
結果　納入8個RCT，共2 250例患者。Meta分析結果顯示，心臟手術患者圍手術期嚴格控制血糖較常規控制血糖可降低術后短期病死率［OR=0.52，95%CI（0.30，0.91），P=0.02］、術后房顫發生率［OR=0.64，95%CI（0.43，0.96），P=0.03］、切口感染發生率［OR=0.30，95%CI（0.15，0.57），P=0.000 2］，縮短術后住院時間［MD=–1.75，95%CI（–3.18，–0.32），P=0.02］和機械輔助通氣時間［MD=–0.9，95%CI（–1.43，–0.38），P=0.000 8］。
結論　現有證據顯示，心臟手術患者圍手術期嚴格控制血糖水平可降低術后短期病死率、術后房顫和切口感染發生率，并縮短住院時間及機械輔助通氣時間，具有臨床價值和社會經濟學意義。但由于納入研究的數量和質量有限，上述結論尚需開展更多高質量、大樣本的隨機對照試驗加以驗證。

引用本文： 宋保華,蔣平君,王志紅. 心臟手術患者圍手術期嚴格控制血糖與常規控制血糖比較療效的Meta分析. 中國循證醫學雜志, 2012, 12(10): 1229-1234. doi: 10.7507/1672-2531.20120191 復制

1.	Rassias AJ. Intraoperative management of hyperglycemia in the cardiac surgical patient. Semin Thorac Cardiovasc Surg, 2006, 18(4): 330- 338 .
2.	Ingels C, Debaveye Y, Milants I, et al. Strict blood glucose control with Insulin during intensive care after cardiac surgery: impaction 4-years survival, dependency on medical care, and quality of life. Eur Heart J, 2006, 27(22):2716-2724.
3.	Ghandi GY, Nuttall GA, Abel MD, et al. Intensive intraoperative insulin Therapy versus conventional glucose management during cardiac surgery. AnnIntern Med, 2007, 146(3): 233-243.
4.	Hoedemaekers CW, Pickkers P, Netea MG, et al. Intensive insulin therapy Does notalter the inflammatory response in patients undergoing Coronaryartery bypass grafting: a randomized controlled trial. Crit Care, 2005, 9(6): R790-797.
5.	Koskenkari JK, Kaukoranta PK, Kiviluoma KT, et al. Metabolic and emodynamic effects of high-dose insulin treatment inaorticvalve and oronary surgery. Ann Thorac Surg, 2005, 80(2): 511-517.
6.	Lazar L, Chipkin R, Fitzgerald A, et al. Tight glycemic control in Diabetic coronaryartery bypass graft patients improves perioperative Outcomes and decreases recurrent ischaemic events. Circulation, 2004, 109(9): 1497-1502.
7.	Groban L, Butterworth J, Legault C, et al. Intraoperative insulin therapy Does not reduce the need for inotropic or antiarrhythmic therapy after Cardiopulmonary bypass. Cardiothorac Vasc Anesth, 2002, 16(4): 405-412.
8.	胡小平, 王志維, 區家樂. 嚴格控制血糖對心臟瓣膜置換術患者近期預后的影響. 中國胸心血管外科臨床雜志, 2010, 2(17): 18-21.
9.	高洪鋒, 浦怡, 陶涼. 冠狀動脈旁路移植手術后血糖控制對預后的影響. 實用醫學雜志, 2011, 27(3): 444-445.
10.	Boord JB, Graber AL, Christman JW, et al. Practical management of diabetes in critically ill patients. Am JR espirCrit Care Med, 2001, 164(10): 1763-1767.
11.	Gale SC, Sicoutris C, Reilly PM, et al. Poor glycemic control is associated with increased mortality in critically ill trauma patients. Am Surg, 2007, 73(5): 454-460.
12.	Hirshberg E, Larsen G, Van Duker H. Alterations in glucose homeostas is in the pediatric intensive care unit : Hyperglycemia and glucose variability are associated with Increased mortality and morbidity. Pediatr Crit Care Med, 2008, 9(4): 361-366.
13.	Doenst T, Wijeysundera D, Karkouti K, et al. Hyperglycemia during cardiopulmonary bypass is an independ ent risk factor for mortality in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg, 2005, 130(4): 1144.
14.	Morariu AM, Loef BG, Aarts LP, et al. Dexamethasone: benefit and prejudice for patients Undergoing on-pump coronaryartery bypass grafting: astudyon myocardial, pulmonary, renal, intestinal, and hepatic injury. Chest, 2005, 128(7): 2677-2687.
15.	Angelini P, Feldman MI, Lufschanowski R, et al. Cardiacarrhythmias duringAnd after heart surgery: diagnosis and management. Prog Cardiovasc Dis, 1974, 16(2): 469-495.
16.	Chen X, Newman M, Rosenfeldt FL. Internal cardiac cooling improves Atrial preservation: electrophysiological and biochemical assessment. Ann Thorac Surg, 1988, 46(10): 406-410.
17.	White HD, Antman EM, Glynn MA, et al. Efficacy and safety of timolol for prevention of supraventric ulartachyarrhythmias after coronary artery Bypass surgery. Circulation, 1984, 70(5): 479-484.
18.	Kalman JM, Munawar M, Howes LG, et al. Atrial fibrillation after coronaryArtery bypass surgery is associated with sympathetic activation. Ann Thorac Surg, 1985, 60(8): 1709-1715.
19.	Hewitt RL, Lolley DM, Adrouney GA, et al. Protective effect of glycog And glucose on the anoxicresting heart. Surgery, 1974, 75(1): 1-10.
20.	Gandhi GY, Nuttall GA, Abel MD, et al. Intensive intraoperatvie insulin therapy versus conventional glucosem anagement during cardiac surgery: a randomized trial. Ann Int ern Med, 2007, 146(4): 233-243.

1. Rassias AJ. Intraoperative management of hyperglycemia in the cardiac surgical patient. Semin Thorac Cardiovasc Surg, 2006, 18(4): 330- 338 .
2. Ingels C, Debaveye Y, Milants I, et al. Strict blood glucose control with Insulin during intensive care after cardiac surgery: impaction 4-years survival, dependency on medical care, and quality of life. Eur Heart J, 2006, 27(22):2716-2724.
3. Ghandi GY, Nuttall GA, Abel MD, et al. Intensive intraoperative insulin Therapy versus conventional glucose management during cardiac surgery. AnnIntern Med, 2007, 146(3): 233-243.
4. Hoedemaekers CW, Pickkers P, Netea MG, et al. Intensive insulin therapy Does notalter the inflammatory response in patients undergoing Coronaryartery bypass grafting: a randomized controlled trial. Crit Care, 2005, 9(6): R790-797.
5. Koskenkari JK, Kaukoranta PK, Kiviluoma KT, et al. Metabolic and emodynamic effects of high-dose insulin treatment inaorticvalve and oronary surgery. Ann Thorac Surg, 2005, 80(2): 511-517.
6. Lazar L, Chipkin R, Fitzgerald A, et al. Tight glycemic control in Diabetic coronaryartery bypass graft patients improves perioperative Outcomes and decreases recurrent ischaemic events. Circulation, 2004, 109(9): 1497-1502.
7. Groban L, Butterworth J, Legault C, et al. Intraoperative insulin therapy Does not reduce the need for inotropic or antiarrhythmic therapy after Cardiopulmonary bypass. Cardiothorac Vasc Anesth, 2002, 16(4): 405-412.
8. 胡小平, 王志維, 區家樂. 嚴格控制血糖對心臟瓣膜置換術患者近期預后的影響. 中國胸心血管外科臨床雜志, 2010, 2(17): 18-21.
9. 高洪鋒, 浦怡, 陶涼. 冠狀動脈旁路移植手術后血糖控制對預后的影響. 實用醫學雜志, 2011, 27(3): 444-445.
10. Boord JB, Graber AL, Christman JW, et al. Practical management of diabetes in critically ill patients. Am JR espirCrit Care Med, 2001, 164(10): 1763-1767.
11. Gale SC, Sicoutris C, Reilly PM, et al. Poor glycemic control is associated with increased mortality in critically ill trauma patients. Am Surg, 2007, 73(5): 454-460.
12. Hirshberg E, Larsen G, Van Duker H. Alterations in glucose homeostas is in the pediatric intensive care unit : Hyperglycemia and glucose variability are associated with Increased mortality and morbidity. Pediatr Crit Care Med, 2008, 9(4): 361-366.
13. Doenst T, Wijeysundera D, Karkouti K, et al. Hyperglycemia during cardiopulmonary bypass is an independ ent risk factor for mortality in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg, 2005, 130(4): 1144.
14. Morariu AM, Loef BG, Aarts LP, et al. Dexamethasone: benefit and prejudice for patients Undergoing on-pump coronaryartery bypass grafting: astudyon myocardial, pulmonary, renal, intestinal, and hepatic injury. Chest, 2005, 128(7): 2677-2687.
15. Angelini P, Feldman MI, Lufschanowski R, et al. Cardiacarrhythmias duringAnd after heart surgery: diagnosis and management. Prog Cardiovasc Dis, 1974, 16(2): 469-495.
16. Chen X, Newman M, Rosenfeldt FL. Internal cardiac cooling improves Atrial preservation: electrophysiological and biochemical assessment. Ann Thorac Surg, 1988, 46(10): 406-410.
17. White HD, Antman EM, Glynn MA, et al. Efficacy and safety of timolol for prevention of supraventric ulartachyarrhythmias after coronary artery Bypass surgery. Circulation, 1984, 70(5): 479-484.
18. Kalman JM, Munawar M, Howes LG, et al. Atrial fibrillation after coronaryArtery bypass surgery is associated with sympathetic activation. Ann Thorac Surg, 1985, 60(8): 1709-1715.
19. Hewitt RL, Lolley DM, Adrouney GA, et al. Protective effect of glycog And glucose on the anoxicresting heart. Surgery, 1974, 75(1): 1-10.
20. Gandhi GY, Nuttall GA, Abel MD, et al. Intensive intraoperatvie insulin therapy versus conventional glucosem anagement during cardiac surgery: a randomized trial. Ann Int ern Med, 2007, 146(4): 233-243.

《中國循證醫學雜志》

心臟手術患者圍手術期嚴格控制血糖與常規控制血糖比較療效的Meta分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

《中國循證醫學雜志》

心臟手術患者圍手術期嚴格控制血糖與常規控制血糖比較療效的Meta分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料