围术期急性血糖波动对患者冠状动脉旁路移植术后心房颤动发生率及重症监护病房住院时间的影响

目的 探讨围术期急性血糖波动幅度对患者冠状动脉旁路移植(coronary artery bypass grafting,CABG)术后心房颤动(postoperative atrial fibrillation,POAF)发生率及重症监护病房(intensive care unit,ICU)住院时间的影响.方法 前瞻性...

Effect of perioperative glycemic fluctuations on incidence of postoperative atrial fibrillation and duration of intensive care unit in patients underwent coronary artery bypass grafting

Objectives To investigate the effect of perioperative glycemic fluctuations on incidence of postoperative atrial fibrillation(POAF)and duration of intensive care unit(ICU)in patients underwent coronary artery bypass grafting(CABG).Methods Clinical data of patients underwent CABG in Affiliated Hospital of Guangdong Medical University from 2016 to 2019 were prospectively and continuously collected.The magnitude of the difference between the highest and the lowest perioperative glucose concentrations up till the first 48 postoperative hours was employed as a measure of glycemic fluctuation.Patients were divided into 4 groups for analysis based on the magnitude of glycemic fluctuation:A group 0-2 mmol/L(n=9);B group>2-4 mmol/L(n=23);C group>4-6 mmol/L(n=31);D group>6 mmol/L(n=36).The primary outcome was the incidence of POAF and the secondary outcome included ICU mortality,30-day mortality and duration of ICU.Results The overall incidence of POAF was 15.2%and it increased as the magnitude of glycemic fluctuation increased.Incidence of POAF was the highest and duration of ICU were the longest in group D as compared with the other 3 groups with statistically significance(P<0.05).However,ICU mortality and 30-day mortality did not differ significantly among the 4 groups(P>0.05).Multifactor Logistics regression analysis found that the magnitude of perioperative glycemic fluctuation was an independent risk factor for POAF(P<0.05).Conclusions Incidence of POAF and duration of ICU increase as acute perioperative glycemic fluctuation increases in patients underwent CABG.Therefore,perioperative blood glucose stability should be maintained to reduce the incidence of POAF and improve the prognosis of patients.