婴儿心脏直视手术围术期血糖水平与术后预后的关系

发布时间：2018-11-21 07:17

【摘要】：目的：回顾性分析婴儿心脏直视手术围术期血糖水平变化及其与术后并发症的关系。方法：233例接受开胸手术及体外循环术的婴儿，其中男137例，女96例，年龄5.0月(3.0月-7.0月）。根据术后有无并发症或死亡将患儿分组，并分别收集患儿围术期血糖值、一般资料及手术资料。采用方差分析、秩和检验及卡方检验等对患儿各资料进行分析，并行logistic回归方程分析并发症及死亡的独立危险因素。以机械通气时间及ICU停留时间为因变量，行多元逐步回归分析其危险因素。结果：CPB开始后患儿血糖较CPB前明显升高（P0.05），，并于CPB结束时达到峰值128.0mg/dl（109.5mg/dl~156.5mg/dl），入ICU1d后血糖缓慢下降。122例（52.6%）患儿住院期间出现并发症，20例（8.6%）因心血管系统衰竭死亡。与术后无并发症组比较，并发症组及死亡组患儿的围术期血糖水平差异无统计学意义。围术期出现高血糖及低血糖情况在无并发症组及并发症-死亡组间无统计学差异。Logistic回归分析提示术后死亡的独立危险因素为手术时间及术中血制品入量，而术后并发症的独立危险因素为体重、RACHS-1评分、手术时间及住院时间。机械通气及ICU时间与手术时间、住院时间、主动脉阻断时间及CPB前血糖水平相关。结论：婴儿心脏直视手术围术期血糖水平并非是其术后并发症及死亡发生的独立危险因素。
[Abstract]:Objective: to retrospectively analyze the perioperative blood glucose level and its relationship with postoperative complications in infants undergoing open heart surgery. Methods: 233 infants underwent thoracotomy and cardiopulmonary bypass, including 137 males and 96 females, aged 5.0 months (3.0-7.0 months). According to the postoperative complications or death, the children were divided into groups, and the perioperative blood glucose values, general data and surgical data were collected. Variance analysis, rank sum test and chi-square test were used to analyze the data, and logistic regression equation was used to analyze the independent risk factors of complications and death. Multiple stepwise regression analysis was performed with mechanical ventilation time and ICU residence time as dependent variables. Results: after the onset of CPB, the blood glucose of the children was significantly higher than that before CPB (P0.05), and reached the peak value of 128.0mg/dl (109.5mg/dl~156.5mg/dl) at the end of CPB. Complications occurred during hospitalization in 122 cases (52.6%) and cardiovascular failure in 20 cases (8.6%). There was no significant difference in perioperative blood glucose levels between the complications group and the death group. Perioperative hyperglycemia and hypoglycemia were not significantly different between the non-complication group and the complication death group. Logistic regression analysis showed that the independent risk factors of postoperative death were the operation time and the volume of blood products. The independent risk factors for postoperative complications were body weight, RACHS-1 score, operative time and hospital stay. The time of mechanical ventilation and ICU were correlated with time of operation, duration of hospitalization, time of aortic occlusion and blood glucose level before CPB. Conclusion: perioperative blood glucose level is not an independent risk factor for postoperative complications and death in infants undergoing open heart surgery.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R726.5

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