| Objective In recent years,the application of off-pump coronary artery bypass grafting(OPCABG)has benefited more and more patients with coronary heart disease.However,there is no consistent conclusion as to whether diabetes can increase the perioperative risk of coronary artery bypass grafting.The purpose of this study was to compare the general preoperative data,surgicity-related indicators,postoperative mortality,complications and other conditions of patients with coronary heart disease complicated with diabetes and non-diabetic patients,and to evaluate whether diabetes will increase the perioperative risk of off-pump coronary artery bypass grafting.Methods Retrospective analysis of the clinical data of 171 patients undergoing OPCABG from December 2017 to December 2018.According to the diagnostic criteria for diabetes of WHO(1999),the patients were divided into the diabetic group and the non-diabetic group.Two groups of patients with preoperative blood glucose screening,and on the basis of hypoglycemic program prior to admission control blood sugar,poor blood sugar control,we will use a short-acting insulin subcutaneous injection,as far as possible control postprandial blood sugar is no more than 2h tendency for 11.1 mmol/ l,two groups of postoperative patients with tracheal intubation before pull out all routine every 2h monitoring the blood sugar,poor blood sugar control,plus use short-acting insulin or insulin pump,blood glucose control within the tendency for 11.1mmol/l.Chest radiographs were dynamically reexamined every 24 hours or with the changes of the patient's condition one week before the operation.For patients with pulmonary infection or postoperative temperature exceeding 38.5 ?,blood culture or sputum culture and drug sensitivity test were performed,and antibiotics were used according to the drug sensitivity results.To compare the age,gender,BMI,heart function grade,coronary artery disease,operation time,number of bypass joints,ventilator assisted time,postoperative hospital stay,postoperative drainage 24 hours,postoperative mortality 30 days,the incidence of various complications and other indicators.Results There was no significant difference in preoperative data,left ventricular ejection fraction(LVEF),operation time,balloon repulsation rate and ventilator use time between the two groups,P >0.05;the total number of deaths in 30 days after operation was 8,the total mortality rate was 4.68%,among them,the mortality rate in the diabetic group was higher than that in the non-diabetic group(7.79% vs 2.13%),the incidence of postoperative renal impairment was higher than that in the non-diabetic group(6.49% vs 1.06%),and the incidence of special infection in the lung increased significantly(7.79% vs 2.13%),but the difference was not statistically significant,P >0.05;There was no significant difference in the incidence of stroke,malignant arrhythmia,poor sternum and incision healing after operation,P>0.05;The postoperative hospitalization time of the diabetic group was prolonged compared with that of the non-diabetic group,[(14.67±8.64)d vs(11.94±2.04)d],the difference was statistically significant,P <0.05;the patients in the two groups had smaller left ventricular end diastolic diameter(LVEDD)than after operation,and the diabetic group,[(56.65±6.63)mm vs(52.87±5.57)mm] and the non-diabetic group [(56.41±6.68)mm vs(54.20±8.20)mm],P<0.05.Conclusion Patients with coronary heart disease and diabetes mellitus may have longer hospitalization time,but the risk associated with OPCABG is not increased during the perioperative period.OPCABG is still a relatively safe and reliable surgical method for patients with diabetes mellitus. |
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