摘要
目的探讨体外循环(CPB)下心脏手术患者入院血糖(BG)水平与术后心肌损伤指标血肌钙蛋白(cTnI)水平的关系。方法将择期拟行CPB下心脏瓣膜或冠状动脉搭桥手术(CABG)的患者56例,按照入院BG水平分为BG正常组(BG<7.0mmol/L)30例和高BG组(BG≥7.0mmol/L)26例,术后入ICU立即检测静脉血c TnI值。采用Pearson相关分析入院BG与cTnI的相关性,比较两组c TnI水平的差异,并采用多元线性回归分析预测术后心肌损伤的风险因素。结果患者入院时BG水平与术后c TnI水平呈正相关(r=0.62,P<0.01)。BG正常组c TnI水平明显低于高BG组(P<0.05)。高BG水平(β=0.565,P<0.01)和长CPB时间(β=0.384,P<0.01)均为cTnI水平升高的相关危险因素,但是BG对c TnI水平的影响大于CPB时间。结论 CPB下心脏手术患者的入院BG水平与术后c TnI水平呈正相关,高BG水平是导致心肌损伤的相关影响因素,可能与CABG有一定的关系。
Objective To investigate the relationship between blood glucose （BG） at admission and troponin （cTnI） levelin patients undergoing cardiac surgery under cardiopulmonary bypass （CPB）. Methods Fifty six patients undergoing cardiacvalve surgery or coronary artery bypass surgery under cardiopulmonary bypass were enrolled in the study including 30cases with normal blood glucose （BG〈7.0mmol/L） and 26 cases with high glucose （BG≥7.0mmol/L） at admission. Thetroponin cTnI levels were measured immediately after the surgery. The cTnI values were compared between the two groupsand the correlation between BG and cTnI was analyzed by multiple linear regression analysis. Results Pearson correlationanalysis showed that BG was positively correlated with cTnI （r = 0.62, P〈0.01）. Multiple linear regression analysis showed thatBG （ 茁=0.565, P〈0.01） and CPB （ 茁=0.384, P〈0.01） were independent risk factors （P〈0.01） for increased cTnI level, and theeffect of BG was greater than CPB time. Intergroup-analysis also showed significantly less influence of the normal blood glucosegroup than that of the hyperglycemic group on cTnI （P〈0.05）. Conclusion Blood glucose at admission is positively correlatedwith cTnI in patients undergoing cardiac surgery with cardiopulmonary bypass, indicating that BG is a related factor leading tomyocardial injury.
作者
周红梅
孟雨
张宏利
朱志鹏
ZHOU Hongmei;MENG Yu;ZHANG Hongli(Department of Anesthesiology,the Second Affiliated Hospital of Jiaxing University,Jiaxing 314000,China)
出处
《浙江医学》
CAS
2018年第20期2223-2226,共4页
Zhejiang Medical Journal
基金
浙江省医药卫生项目(2015KYB388)
关键词
心脏手术
体外循环
血糖
肌钙蛋白
Cardiac surgery；Cardiopulmonary bypass；Blood Glucose；Troponin
