目的 探討冠狀動(dòng)脈旁路移植術(shù)（CABG）后患者高血糖的特點(diǎn)。方法 連續(xù)選擇中山醫(yī)院2005年1月~2005年12月行CABG的患者，收集患者有無(wú)糖尿病史、術(shù)前術(shù)后血糖水平、術(shù)后高血糖和血糖峰值的出現(xiàn)時(shí)間等資料。按術(shù)前有無(wú)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(jié)果 共納入200例患者，術(shù)后高血糖發(fā)生率77%，且99.4%出現(xiàn)在入住重癥加強(qiáng)醫(yī)療病房（ICU）24 h以?xún)?nèi)，其發(fā)生與是否患有糖尿病無(wú)關(guān)系(χ2=2.58，P=0.108)，與術(shù)前血糖≥6.1 mmol/L有關(guān)（χ2=12.31，P=0.000)。全組出現(xiàn)血糖峰值的中位時(shí)間為10 h，80%出現(xiàn)在入ICU 24 h之內(nèi)；非糖尿病患者術(shù)后血糖峰值的出現(xiàn)時(shí)間較糖尿病組早（中位數(shù)8.5 h比18.5 h，P=0.02）；術(shù)后高血糖患者的血糖峰值出現(xiàn)的中位時(shí)間為10.5 h，75.3%出現(xiàn)在入ICU 24 h內(nèi)。結(jié)論 CABG后高血糖的發(fā)生率很高，且絕大多數(shù)出現(xiàn)在術(shù)后24 h以?xún)?nèi)，術(shù)前血糖較高的患者術(shù)后高血糖的發(fā)生率明顯升高。
引用本文： 張黎瑛 ,劉莉,胡莉娟,朱蕾. 冠狀動(dòng)脈旁路移植術(shù)后高血糖臨床分析. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2008, 08(2): 116-119. doi: 復(fù)制
| 1. | 邢曉燕,陳惠德,王小文,等.高血糖與外科危重病人預(yù)后的相關(guān)分析.腸外與腸內(nèi)營(yíng)養(yǎng),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(guó)心臟調(diào)查組.中國(guó)住院冠心病患者糖代謝異常研究——中國(guó)心臟調(diào)查.中華內(nèi)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(guó)糖尿病流行特點(diǎn)研究 糖尿病和糖耐量低減患病率調(diào)查.中華流行病學(xué)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. |
- 1. 邢曉燕,陳惠德,王小文,等.高血糖與外科危重病人預(yù)后的相關(guān)分析.腸外與腸內(nèi)營(yíng)養(yǎng),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(guó)心臟調(diào)查組.中國(guó)住院冠心病患者糖代謝異常研究——中國(guó)心臟調(diào)查.中華內(nèi)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(guó)糖尿病流行特點(diǎn)研究 糖尿病和糖耐量低減患病率調(diào)查.中華流行病學(xué)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.