| Background:Coronary artery bypass grafting is the main treatment for coronary artery atherosclerotic heart disease,and patients are prone to induce hyperglycemia and lead to high glycemic variability after surgery.Especially in patients with coronary artery disease complicated with diabetes mellitus,they need to rely on drugs to maintain blood glucose because of their physiological characteristics of impaired glycemic self-regulation.Improper perioperative glucose management increases the risk of hyperglycemia or hypoglycemia in patients,with large glycemic variability and more difficulty in maintaining blood glucose homeostasis.At present,there are few standardized perioperative blood glucose nursing management programs for patients with coronary artery disease complicated with diabetes,and the content lacks detail.Moreover,the blood glucose management in clinical nursing practice varies greatly,mostly from the perspective of maintaining blood glucose level,and preventing abnormal blood glucose,with less attention paid to postoperative glycemic variability,and lacking a comprehensive nursing management program of preoperative and postoperative blood glucose.Objective:1.Describe the level of glycemic variability after coronary artery bypass grafting in patients with coronary artery disease complicated with diabetes and analyze its related factors;2.to Construct a preoperative and postoperative blood glucose nursing management program for coronary artery bypass grafting in patients with coronary artery disease complicated with diabetes.Methods:The research consists of two parts.In part one,a cross-sectional survey study of 327 patients with coronary artery disease complicated with diabetes mellitus who underwent elective coronary artery bypass grafting in the adult surgery ward of Fu Wai Hospital,Chinese Academy of Medical Sciences from September 2022 to February 2023.Describing the level and trend of glycemic variability after coronary artery bypass grafting in patients with coronary heart disease complicated with diabetes by collecting general and clinical data during the patients’ hospitalization,and analyzing the factors related to postoperative glycemic variability by univariate analysis and multiple linear regression.In part two,the preoperative and postoperative blood glucose nursing management program for patients with coronary artery disease complicated with diabetes mellitus undergo coronary artery bypass grafting was constructed,through literature review,group discussion,and expert meeting method and combining factors related to postoperative glycemic variability.Results:1.The results of part one:(1)The standard deviation of blood glucose after coronary artery bypass grafting in patients with coronary artery disease complicated with diabetes was 2.85±0.85 mmol/L.The standard deviation of blood glucose on a single day after surgery tended to rise gradually and leveled off on postoperative day 4;the mean of daily differences was 2.58±0.94 mmol/L,the mean of daily differences between postoperative day 2 and day 1 was the highest and leveled off afterwards;The largest amplitude of glycemic excursion was 11.89±3.94 mmol/L,and the largest amplitude of glycemic excursion on a single day after surgery tended to rise gradually and leveled off on the fourth postoperative day.(2)The independent factors associated with the standard deviation of blood glucose were the duration of diabetes(t=2.040;P=0.042),conventional insulin therapy(t=2.080;P=0.038),conventional oral combined insulin therapy(t=2.500;P=0.013),glycated hemoglobin(t=2.062;P=0.040),intravenous insulin pump(t=-2.670;P=0.008).(3)The independent factors associated with the mean of daily differences were gender(t=2.574;P=0.011),duration of diabetes(t=2.100;P=0.037),glycosylated hemoglobin(t=2.366;P=0.019),serum creatinine(t=2.377;P=0.018),intravenous insulin pump(t=-2.815;P=0.005),and parenteral nutrition(t=-2.137;P=0.033).(4)The independent factors associated with the largest amplitude of glycemic excursion were conventional oral hypoglycemic therapy(t=1.997;P=0.047),conventional insulin therapy(t=2.395;P=0.017),conventional oral combined insulin therapy(t=2.464;P=0.014),duration of surgery(t=1.986;P=0.048),glycated hemoglobin(t=1.409;P=0.160),use of intravenous insulin pump(t=-2.140;P=0.033),and parenteral nutrition(t=-3.211;P=0.001).2.The results of part two:(1)The judgment coefficient of 13 clinical medicine and nursing experts was 0.95,the familiarity of experts was 0.92,and the authority of experts was 0.93.(2)the preoperative and postoperative blood glucose nursing management program after coronary artery bypass grafting in patients with coronary heart disease complicated with diabetes mellitus included the preoperative and postoperative two nursing phase blood glucose nursing management.This blood glucose nursing management program includes seven themes:glucose characteristics and key populations,blood glucose monitoring,medication management,nutrition support therapy management,exercise management,psychological nursing,and health education.Conclusions:1.The glycemic variability after were high in patients with coronary artery disease complicated with diabetes mellitus.The postoperative single-day standard deviation of blood glucose tended to rise gradually and leveled off on postoperative day 4;the largest mean of daily difference between postoperative day 2 and day 1 was the highest and then leveled off;the postoperative single-day largest amplitude of glycemic excursion tended to rise gradually and leveled off on postoperative day 4.2.The higher the glycosylated hemoglobin,the longer the duration of diabetes,and the higher the postoperative serum creatinine,the higher the postoperative glycemic variability.Glycemic variability was higher in women than in men,and postoperative glycemic variability was higher in patients with postoperative intravenous insulin pumps than in patients without postoperative intravenous insulin pumps,and postoperative glycemic variability was higher in patients with postoperative parenteral nutrition support than in patients without postoperative parenteral nutrition support.Among the different conventional postoperative glucose-lowering regimens,the postoperative glycemic variability was higher in patients treated with oral combined insulin therapy and insulin alone than in patients treated with oral therapy alone and without drug therapy.3.The preoperative and postoperative blood glucose nursing management program after coronary artery bypass grafting in patients with coronary artery disease complicated with diabetes mellitus,constructed through the expert meeting method,is reliable,scientific,and clinically practical. |
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