冠狀動脈旁路移植術后高血糖臨床分析_《中國呼吸與危重監護雜志》

作者：

張黎瑛 , 劉莉 , 胡莉娟 ,  朱蕾

復旦大學附屬中山醫院呼吸科(上海 200032);

關鍵詞：

冠狀動脈旁路移植術高血糖癥

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目的探討冠狀動脈旁路移植術（CABG）后患者高血糖的特點。方法連續選擇中山醫院2005年1月~2005年12月行CABG的患者，收集患者有無糖尿病史、術前術后血糖水平、術后高血糖和血糖峰值的出現時間等資料。按術前有無糖尿病分為糖尿病組和非糖尿病組，比較分析兩組的差異。結果共納入200例患者，術后高血糖發生率77%，且99.4%出現在入住重癥加強醫療病房（ICU）24 h以內，其發生與是否患有糖尿病無關系(χ2=2.58，P=0.108)，與術前血糖≥6.1 mmol/L有關（χ2=12.31，P=0.000)。全組出現血糖峰值的中位時間為10 h，80%出現在入ICU 24 h之內；非糖尿病患者術后血糖峰值的出現時間較糖尿病組早（中位數8.5 h比18.5 h，P=0.02）；術后高血糖患者的血糖峰值出現的中位時間為10.5 h，75.3%出現在入ICU 24 h內。結論 CABG后高血糖的發生率很高，且絕大多數出現在術后24 h以內，術前血糖較高的患者術后高血糖的發生率明顯升高。

引用本文： 張黎瑛 ,劉莉,胡莉娟,朱蕾. 冠狀動脈旁路移植術后高血糖臨床分析. 中國呼吸與危重監護雜志, 2008, 08(2): 116-119. doi: 復制

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1. 邢曉燕,陳惠德,王小文,等.高血糖與外科危重病人預后的相關分析.腸外與腸內營養,2004,11:341-343.
2. Expert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults.Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection,Evaluation,And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III).JAMA,2001,285:2486-2497.
3. Bartnik M,Rydén L,Ferrari R,et al.The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe. The Euro Heart Survey on diabetes and the heart.Eur Heart J,2004,25:1880-1890.
4. 中國心臟調查組.中國住院冠心病患者糖代謝異常研究——中國心臟調查.中華內分泌代謝雜志,2006,22:7-10.
5. Capes SE,Hunt D,Malmberg K,et al.Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes:a systematic overview.Lancet,2000,355:773-778.
6. McCowen KC,Malhotra A,Bistrian BR. Stress-induced hyperglycemia.Crit Care Clin,2001,17:107-124.
7. Montori VM,Bistrian BR,McMahon MM.Hyperglycemia in acutely ill patients.JAMA,2002,288:2167-2169.
8. Cerra FB.Hypermetabolism,organ failure,and metabolic support.Surgery,1987,101:1-14.
9. 王克安,李天麟,向紅丁,等.中國糖尿病流行特點研究糖尿病和糖耐量低減患病率調查.中華流行病學雜志,1998,19:282-285.
10. Thorell A,Nygren J,Ljungqvist O.Insulin resistance: a marker of surgical stress.Curr Opin Clin Nutr Metab Care,1999,2:69-78.
11. Srinivasan V,Spinella PC,Drott HR,et al.Association of timing, duration, and intensity of hyperglycemia with intensive care unit mortality in critically ill children.Pediatr Crit Care Med,2004,5:329-336.
12. Doenst T,Wijeysundera D,Karkouti K,et al.Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery.J Thorac Cardiovasc Surg,2005,130:1144.
13. van den Berghe G,Wouters P,Weekers F,et al.Intensive insulin therapy in the critically ill patients.N Engl J Med,2001,345:1359-1367.

《中國呼吸與危重監護雜志》

冠狀動脈旁路移植術后高血糖臨床分析

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《中國呼吸與危重監護雜志》

冠狀動脈旁路移植術后高血糖臨床分析

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