Effects Of Perioperative Blood Glucose Levels On Surgical Outcomes And The Days Of Hospitalization In Patients After Coronary Artery Bypass Grafting

ObjectiveThis paper aims to study the effects of blood glucose levels in patients after CABG surgery on the postoperative complications and the days of hospitalization, and to explore the importance of perioperative glycemic control after CABG surgery on the postoperative recovery.MethodsMaking information collection form, collecting objects are2,157patients who were operated by CABG in Beijing Fu Wai Hospital on2011. According to the process of admission→surgery→ICU (intensive care unit, ICU)→cardiac surgical ward to gather the information. Information includes:1. admission data of patients:gender, age, height, weight, history of diabetes mellitus.2. data of blood glucose:1) preoperative glucose:admission fasting glucose (FPG), two-hour postprandial blood glucose (PPG), random blood glucose, glycosylated hemoglobin (HbAlc);2) intraoperative blood glucose:intraoperative blood glucose values of arterial blood, measuring intervals depending on the severity of the patient’s condition, generally15-30minutes once measured;3) postoperative blood glucose:3) arterial blood glucose levels after1-2days in ICU, measuring intervals depending on the severity of the patient’s condition, severe patients15-30minutes once measured, the mild patients once measured by hours②blood glucose values of1-7days in general cardia surgery ward includes:FPG and PPG (measured finger peripheral blood of patients).3. postoperative complications during hospitalization:1) cardiac arrhythmias including atrial fibrillation, ventricular fibrillation, atrial premature beats, ventricular premature beats and atrioventricular block and other types of arrhythmia, and the exclusion of a transient arrhythmias;2) infection:wound infection, respiratory tract infection;3) pleural effusion and pericardial effusion;4) death.4. the number of days of hospitalization:1) the days in ICU;2) the days in general cardia surgery ward;3) the total number of days of hospitalization.The patients are grouped according to perioperative different time periods blood glucose levels:2157cases of patients were divided into groups with high blood glucose hypoglycemia group by five different time periods of admission, surgery, the first postoperative day, the next day after surgery, blood glucose postoperative cardiac surgical ward. The criteria are as follows:1. admission:hyperglycemia group (FPG^7.8mmol/L), hypoglycemia group (FPG <7.8mmol/L);2. intraoperative:hyperglycemia group (arterial blood glucose≥10mmol/L), hypoglycemia group (arterial blood glucose<10mmol/L);3. the first day after surgery:hyperglycemia group (arterial blood glucose≥10mmol/L), hypoglycemia group (arterial blood glucose<10mmol/L);4. after the second day:hyperglycemia group (arterial blood glucose≥10mmol/L), hypoglycemia group (arterial blood glucose<10mmol/L);5. postoperative cardiac surgical ward, there are two different grouping criteria:1) by FPG levels, hyperglycemia group (FPG≥7.8mmol/L), hypoglycemia group (FPG<7.8mmol/L)2) after two average meals hour glucose levels, hyperglycemia group (arterial blood glucose≥10mmol/L), hypoglycemia group (arterial blood glucose <10mmol/L).Using spssl7.0statistical software for statistical analysis, count data using the chi-square test, measurement data were expressed as mean±standard deviation between the two groups were compared using t test, ANOVA missing method using near F test, p<0.05for the difference statistically significant.ResultsPerioperative blood glucose levels on postoperative complications:1. The differences between intraoperative arterial blood glucose and cardiac arrhythmias (p=0.003), death (p=0.008) in frequency distribution were statistically significant; 2. The differences between the first day of the average blood glucose and respiratory tract infections (p=0.001), pericardial effusion (p=0.011), death (p=0.033) in frequency distribution were statistically significant;3. The differences between admission FPG, the second day of the average blood glucose, postoperative cardiac surgical ward FPG, two hours postprandial glucose in cardiac surgical ward after surgery and postoperative complications (arrhythmias, wound infections, respiratory infections, pleural effusion, pericardial effusion, death) in frequency distribution were not statistically significant (p>0.05).Peri operative blood glucose levels on the number of days of hospitalization:1. The days in ICU:There are statistically significant differences between the average arterial blood glucose on the first day after the surgery (p=0.000)、the average arterial blood glucose on the second day after the surgery(p=0.012) and the days of ICU;2. The days in cardiac surgical ward after surgery:There are statistically significant differences between admission FPG (p=0.021)、mean intraoperative arterial blood glucose(p=0.040)、the average arterial blood glucose on the first day after the surgery (p=0.010)、postoperative FPG in cardiac surgical ward (p=0.008) and the days in cardiac surgical ward after surgery3. The total days of hospitalization:There are statistically significant differences between the average arterial blood glucose on the first day after the surgery (p=0.000) and the total days of hospitalization;4. There are not statistically significant differences between glucose levels in other time periods and the days of each stage of hospitalization.The correlation between the blood glucose level and the days of hospitalization1. The days in ICU:The relationship between mean intraoperative arterial blood glucose (r=0.105,/?=0.000)、average arterial blood glucose on the first day after the surgery (r=0.131,p=0.000)、the average arterial blood glucose on the second day after the surgery (r=0.100,p=0.000) and the days in ICU is positively related;2. The days in cardiac surgical ward after surgery:The relationship between admission FPG (r=0.058,p=0.016)、average arterial blood glucose on the first day after the surgery (r=0.091,p=0.000) and the days in cardiac surgical ward after surgery is positively related;3. The total days of hospitalization:The relationship between average arterial blood glucose on the first day after the surgery (r=0.091,p=0.000)and the total days of hospitalization is positively related;4. There is no correlation between glucose levels in other time periods and the days of each stage of hospitalization.ConclusionThe Control of blood glucose during peri operation has an important influence on the prognosis of patients with CABG. Especially, the control of blood glucose on the first day after operation has important influence on reducing postoperative complications and reducing the days of hospitalization.