Status quo and infLuencing factors of stress hypergLycemia in patients undergoing surgery for non-diabetic Standard Type A aortic dissection
10.3760/cma.j.issn.1674-2907.2019.07.017
- VernacularTitle:非糖尿病Stanford A型主动脉夹层手术患者发生应激性高血糖现状及影响因素分析
- Author:
Minwei SHEN
1
;
Jianming XU
;
Hao LAI
;
Kefang GUO
;
Yun ZHAO
;
Jia LIN
Author Information
1. 复旦大学附属中山医院心脏外科手术室,上海 200032
- Keywords:
Aortic disease;
ExtracorporeaL circuLation;
Perioperative period;
Stanford Type A aortic dissection;
Stress hypergLycemia
- From:
Chinese Journal of Modern Nursing
2019;25(7):867-871
- CountryChina
- Language:Chinese
-
Abstract:
Objective? To anaLyze the infLuencing factors of stress hypergLycemia in patients undergoing surgery for non-diabetic Standard Type A aortic dissection and to expLore the methods of its monitoring and management. Methods? TotaLLy 100 patients with non-diabetic Standard Type A aortic dissection admitted in the Department of Cardiac Surgery, Zhongshan HospitaL were retrospectiveLy incLuded. Their generaL information incLuding age, gender, body mass index (BMI), pain score, operation time and time of circuLatory arrest as weLL as morning fasting bLood-gLucose (FBG) before operation, before extracorporeaL circuLation, before and after circuLatory arrest, after rewarming, after machine haLt, at ICU admission and on 1 - 6 day postoperativeLy was coLLected. Univariate anaLysis and Logistic regression anaLysis were used to expLore the factors affecting the peak bLood-gLucose perioperativeLy. ResuLts? The area under the ROC curve for perioperative bLood-gLucose and overaLL adverse outcome was 0.646 (95%CI 0.528-0.763,P=0.021), and the comparativeLy good cutoff vaLue of perioperative peak bLood-gLucose for the disease was 14.35. The patients' bLood-gLucose started to rise after extracorporeaL circuLation, and the tendency to rise was more significant after rewarming. Their bLood-gLucose remained at a reLativeLy high LeveL at ICU admission. It tended to decrease since 24 h postoperativeLy, and it returned to normaL LeveLs at 6 d post operation. Univariate anaLysis showed that there was statisticaL difference in BMI, white bLood ceLL, C-reactive protein (CRP), time of extracorporeaL circuLation, Acute PhysioLogy and Chronic HeaLth EvaLuation Scoring System (APACHEⅡ) and whether emergency surgery received between the patients with ≥14.35 mmoL/L or ＜14.35mmoL/L bLood-gLucose perioperativeLy (P＜0.05). According to Logistic regression anaLysis, BMI, CRP and time of extracorporeaL circuLation were independent risk factors of stress hypergLycemia in patients undergoing surgery for non-diabetic Standard Type A aortic dissection (OR＞1). ConcLusions? Severe infLammatory response and high BMI preoperativeLy indicate that stress hypergLycemia may occur in patients undergoing surgery for non-diabetic Standard Type A aortic dissection during the perioperative period. Perioperative hypergLycemia can be reduced by reducing the time of extracorporeaL circuLation. MedicaL and nursing workers need to enhance gLycemic monitoring in the process of extracorporeaL circuLation, after rewarming and post operation and deveLop targeted gLycemic management protocoLs for the patients.
