冠状动脉旁路移植术后应激性高血糖患者血糖波动评估参数研究

doi:10.3761/j.issn.0254-1769.2019.09.003

摘要/Abstract

摘要：

目的建立冠状动脉旁路移植术（coronary artery bypass grafting,CABG）后应激性高血糖患者的血糖波动评估参数。方法收集某三级甲等医院心脏外科2017年1月—2018年10月行CABG术后发生应激性高血糖的200例患者的临床资料,对患者术后72 h内进行每4 h 1次的末梢血糖监测;比较不同基线特征下并发症发生率的差异,评价不同血糖波动评估参数与术后并发症的相关性,同时运用受试者操作特征（receiver operating characteristic,ROC）曲线,判断不同血糖不稳定指数（glycemic lability index,GLI）对CABG术后并发症发生风险的预测价值。结果 CABG术后应激性高血糖患者术后第1天的GLI（GLI₁）、术后第2天的GLI（GLI₂）、术后3 d总的GLI（GLI_3d）与术后单一并发症及合并并发症发生风险均显著关联（P<0.05）,GLI₁、GLI₂、GLI_3d均可对术后并发症发生风险进行预测,其中GLI₁的ROC曲线下面积为0.665。结论 GLI₁、GLI₂、GLI_3d是CABG术后应激性高血糖患者血糖波动评估参数,可在一定程度上预测患者术后并发症的发生风险,特别是GLI₁预测效果最佳,可以提示医护人员尽早对患者的血糖波动进行干预,以减少并发症的发生。

关键词: 冠状动脉旁路移植术, 非体外循环, 高血糖症, 血糖指数, 手术后并发症, 护理评估

Abstract:

Objective To select better glucose fluctuation parameters to evaluate the fluctuation of blood glucose in patients with stress hyperglycemia after coronary artery bypass graft（CABG）,in order to detect and intervene early and improve nursing quality.Methods The clinical data of 200 patients with stress hyperglycemia who underwent CABG in a tertiary hospital from January 2017 to October 2018 were collected. Peripheral blood glucose was measured within 72 hours after surgery,once every 4 hours. Differences in complication rates under different baseline characteristics were compared,the correlation between different blood glucose fluctuation parameters and postoperative complications was compared,and glycemic instability index（GLI） for predictive value of the risk of complications after coronary artery bypass grafting was determined using the receiver operating characteristic curve.Results GLI₁,GLI₂ and GLI_3d in patients with stress hyperglycemia after CABG were significantly associated with postoperative single complications and risk of complications（P<0.05）. GLI₁,GLI₂ and GLI_3d all predicted postoperative complications,and GLI₁ had the best predictive effect.Conclusion GLI₁,GLI₂ and GLI_3d are better evaluation parameters of blood glucose fluctuation in patients with stress hyperglycemia after CABG,which can predict the risk of postoperative complications to some extent. In particular,GLI₁ can prompt early intervention in blood glucose fluctuation,to reduce the occurrence of complications.

Key words: Coronary Artery Bypass, Off-Pump, Hyperglycemia, Glycemic Index, Postoperative Complications, Nursing Assessment

凌青, 陈玉红. 冠状动脉旁路移植术后应激性高血糖患者血糖波动评估参数研究[J]. 中华护理杂志, 2019, 54(9): 1297-1301.

LING Qing, CHEN Yuhong. Correlation between blood glucose instability index and postoperative complications in patients with stress hyperglycemia after coronary artery bypass grafting[J]. Chinese Journal of Nursing, 2019, 54(9): 1297-1301.

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