| Objective: To analyze the perioperative clinical data of patients with type 2 diabetes mellitus(T2DM)who received simple coronary artery bypass grafting(CABG)for the first time,and to further follow up the long-term survival status of the patients,and to explore the mechanism of the influence of type 2 diabetes and blood glucose control on the clinical effect after coronary artery bypass grafting,in order to provide reference and experience for the management and follow-up of diabetic patients after coronary artery bypass grafting.Methods: This study reviewed the long-term postoperative effects of T2 DM patients undergoing CABG in our hospital.We regularly followed up the patients who received simple CABG for the first time in our hospital from June 2009 to December 2010.The average follow-up survival time was(85.8±36.5)months.A total of 239 patients were included.All the operations were performed by the same primary diagnosis group.The patients were divided into two groups according to whether they had diabetes or not,including non-diabetic group(non-DM group,n=155)and diabetic group(DM group,n=84).According to the different ways of blood glucose intervention,diabetic patients were divided into oral hypoglycemic drug group(NITDM group,n= 49)and insulin group(ITDM group,n=35).The preoperative and postoperative data of the two groups and the difference of 10-year survival rate between the two groups were evaluated retrospectively.Results: A total of 239 patients were included in this study,including 180 males(75.3%)and 59 females(24.7%),with an average age of(63.2 ±6.82)years.The preoperative data of non-diabetic and diabetic patients included sex,age,weight,height,BMI,cholesterol,triglyceride,number of diseased vascular branches,chronic obstructive pulmonary disease,cardiac function(Ⅲ-Ⅳ),history of smoking,hypertension,stroke,renal insufficiency,LVEF < 0.4,left main artery disease,atrial fibrillation and history of myocardial infarction,there was no statistical significance(P>0.05).The postoperative data included the number of bypass grafts,operation time,tracheal intubation time,ICU retention time,hospital stay time,and postoperative complications such as new postoperative atrial fibrillation,renal injury,cerebral infarction,myocardial ischemia,pulmonary infection and poor incision healing,there was no statistical significance(P>0.05).The last pre-hospital venous plasma fasting blood glucose(FPG)was taken as postoperative reference blood glucose,and the difference was statistically significant(P < 0.001).There was no significant difference in preoperative and postoperative data between hypoglycemic drug group and insulin group(P > 0.05).In the intraoperative data,there was a significant difference in operation time between the two groups(P=0.015).There was no significant difference in other intraoperative data(P > 0.05).The long-term mortality rate of diabetic patients was significantly higher than that of non-diabetic patients(38.1% vs 17.4% P < 0.01).The long-term mortality in the insulin group was higher than that in the oral hypoglycemic drug group(48.6 vs.30.6% P=0.031).Conclusion:1.Type 2 diabetes mellitus is an independent predictor of long-term mortality after coronary artery bypass grafting.2.There was no significant difference in hospitalization complications between non-diabetic and diabetic patients,and there was no significant difference in hospitalization complications of coronary artery bypass grafting with different blood glucose intervention.3.The long-term prognosis of patients with type 2 diabetes was poor.When insulin was included in the blood glucose control strategy,the long-term cardiogenic mortality increased significantly in the insulin group.In future clinical follow-up,it is recommended to increase the review and follow-up for this population,and to tailor more reasonable and detailed postoperative cardiovascular care and glucose control strategies according to individual differences between multiple disciplines. |
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