血糖水平与开胸手术及心肺转流术患儿术后并发症的相关性分析

doi:10.3969/j.issn.1006-6233.2020.06.032

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1246 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的:分析血糖水平与开胸手术及心肺转流术(CPB)患儿术后并发症的相关性,并分析术后并发症发生的影响因素。方法:采用回顾性研究,收集2016年5月至2018年5月本院100例均行开胸手术和CPB患儿的临床资料,按照术后是否出现并发症进行分组,分为并发症组与无并发症组。收集患儿基线资料、手术资料、围手术期血糖水平等信息,采用单因素分析和多因素Logistic回归分析诱发术后并发症的影响因素。结果:38例患儿住院期间出现并发症,发生率为38.00%。相比无并发症组,并发症组年龄较小,体重较轻,CPB时间、主动脉阻断时间、手术时间和住院天数均显著增加,术中输血量明显增多,先天性心脏病手术风险矫正评分(RACHS-1)显著提高(P<0.05)。两组患儿CPB开始时、CPB结束时及CPB后20min均明显高于术前(P<0.05),其中CPB后20min达到峰值;入住重症监护室(ICU)后血糖水平有所降低,但入住ICU时、入住ICU后24h的平均血糖值仍明显高于术前(P<0.05);两组患儿围手术期血糖水平的组间比较,均无明显差异(P>0.05)。经多因素Logistic回归分析显示,手术时间、住院天数及RACHS-1评分均是术后并发症发生的影响因素(P<0.05)。结论:开胸手术和CPB患儿术后并发症的发生可能与手术时间、住院天数、RACHS-1评分情况密切相关,而与围手术期血糖水平可能并无密切关系。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	刘超
	刘锴
	罗纲
	黄维勤

关键词 ：心肺转流术, 开胸手术, 血糖水平, 术后并发症, 影响因素

Abstract：Objective: To analyze the correlation between blood glucose level and postoperative complications of thoracotomy and cardiopulmonary bypass (CPB), and to analyze the influencing factors of postoperative complications. Methods: A retrospective study was carried out to collect the clinical data of 100 children who underwent thoracotomy and CPB from May 2016 to may 2018 in our hospital. The patients were divided into complication group and complication-free group according to whether there were complications after operation. The baseline data, operation data and perioperative blood glucose level were collected, and then monofactor analysis and multivariate logistic regressive analysis were conducted to findout the influencing factors of postoperative complications . Results: There were 38 cases of complications during hospitalization, with the incidence of 38.00%. Compared with the complication-free group, the complication group were found younger and underweight, whose CPB time, aortic occlusion time, operation duration and hospital stays were significantly longer, and whose amount of blood transfusion during operation was significantly increased, so the Risk Adjustment for Congenital Heart Surgery (RACHS-1) of congenital heart disease was much higher (P < 0.05). The blood glucose level of the two groups was significantly higher, compared to pre-operation, at the beginning and the end of CPB, and 20 minutes after CPB, (P < 0.05), with the peak value being observed 20 minutes after CPB. The blood glucose level decreased after patients had been admitted to intensive care unit (ICU), but still higher then pre-operation when, and 24 hours after, being admitted to ICU (P < 0.05).No significant difference of blood glucose level was found between the two groups perioperatively (P > 0.05). Multivariate logistic regressive analysis showed that surgery duration, hospital stay and RACHS-1 score were all the influencing factors of postoperative complications (P < 0.05). Conclusion: The postoperative complications of thoracotomy and CPB may be closely related to the surgery duration, hospital stay and the score of RACHS-1, but may not be closely related to the perioperative blood glucose level.

Key words： Cardiopulmonary bypass Thoracotomy Blood glucose level Postoperative complication Influencing factor

基金资助:湖北省卫生厅科研项目,(编号:JX3F-54)

通讯作者: 黄维勤

引用本文:

刘超, 刘锴, 罗纲, 黄维勤. 血糖水平与开胸手术及心肺转流术患儿术后并发症的相关性分析[J]. 河北医学, 2020, 26(6): 1024-1028.
LIU Chao, LIU Kai, LUO Gang, et al. An Analysis of the Relationship Between Blood Glucose Level and Postoperative Complications in Children Undergoing Thoracotomy and Cardiopulmonary Bypass. HeBei Med, 2020, 26(6): 1024-1028.

链接本文:

http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2020.06.032 或 http://www.hbyxzzs.cn/CN/Y2020/V26/I6/1024

[1] 王玉茹,梁俊永,张剑峰,等.先天性心脏病儿童生长发育状况[J].中国临床研究,2018,31(5):673~675.
[2] Yamamoto N, Irie T, Takaki S, et al. Predictors of severe postoperative hyperglycemia after cardiac surgery in infants: a single-center, retrospective, observational study[J].Anesth,2018, 32(2):160~166.
[3] Tamura T, Yatabe T, Namikawa T, et al. Glucose control using a closed-loop device decreases inflammation after cardiovascular surgery without increasing hypoglycemia risk[J].Artif Organs,2019,22(2):154~159.
[4] Jacobs JP, O'Brien SM, Hill KD, et al. Refining the society of thoracic surgeons congenital heart surgery database mortality risk model with enhanced risk adjustment for chromosomal abnormalities, syndromes, and noncardiac congenital anatomic abnormalities[J]. Ann Thorac Surg,2019,108(2):558~566.
[5] Chaki T, Nawa Y, Tamashiro K, et al. Remifentanil prevents increases of blood glucose and lactate levels during cardiopulmonary bypass in pediatric cardiac surgery[J]. Ann Card Anaesth,2017,20(1):33~37.
[6] Hirata Y. Cardiopulmonary bypass for pediatric cardiac surgery[J]. Gen Thorac Cardiovasc Surg,2018,66(2):65~70.
[7] Wang YY, Hu SF, Ying HM, et al. Postoperative tight glycemic control significantly reduces postoperative infection rates in patients undergoing surgery: a meta-analysis[J]. BMC Endocr Disord,2018,18(1):42.
[8] Preiser JC, Lheureux O, Thooft A, et al. Near-continuous glucose monitoring makes glycemic control safer in ICU patients[J]. Crit Care Med,2018,46(8): 1224~1229.
[9] Blinder JJ, Asaro LA, Wypij D, et al. Acute kidney injury after pediatric cardiac surgery: A secondary analysis of the safe pediatric euglycemia after cardiac surgery trial[J]. Pediatr Crit Care Med,2017,18(7):638~646.
[10] 刘智娜,白延平,胡彬,等.氨甲环酸与体外循环下心脏手术患者出血的相关性[J].实用临床医药杂志,2017,21(11):69~72.
[11] Santos FCGB, Croti UA, Marchi CH, et al. Surgical treatment for congenital heart defects in down syndrome patients[J]. Braz Cardiovasc Surg,2019,34(1):1~7.