血糖干预对先天性心脏病手术患儿围手术期恢复的影响:单中心、回顾性研究

The effects of postoperative tight glycemic control on the perioperative recovery of children undergo complex congenital heart surgeries:a retrospective,single center study

目的探讨对复杂先天性心脏病术后患儿进行严格血糖干预后,对其围手术期恢复的影响。方法回顾性分析阜外医院一组复杂先天性心脏病的连续性病例,对患儿围手术期中采取的血糖严格和传统控制两种方式的比较,记录并分析两组患儿各项早期恢复的指标。结果血糖严格控制组183例患儿,血糖传统控制组258例患儿,年龄分别是12.0(7.0,25.5)个月和13.0(6.0,35.5)个月,无明显统计学差异(P=0.936)。两组各有2例患儿于住院期间死亡,血糖严格控制组2例患儿死于严重低心排,传统组1例死于低心排,另1例死于严重的肺部感染,两组在住院死亡率上无明显差别(P=0.729)。严格组在住院总天数、小儿重症监护室住院天数、呼吸机辅助通气时间上明显低于传统组(P=0.001,<0.001,<0.001)。其主要并发症发生率在血糖严格控制组中,明显低于血糖传统控制组,发生率分别为32.6%和39.9%(P<0.001)。血糖严格控制组患儿血浆使用量高于血糖传统组(P=0.006),但在红细胞使用上,两组无统计学意义(P=0.308)。结论血糖严格控制组患儿在围手术期整体恢复优于血糖传统控制组,其并发症发生率较低。但进一步验证血糖严格控制对于复杂先天性心脏病患儿围手术期恢复还需要更进一步的前瞻性、大样本的研究及随访。

Objective To analyze the effects of the perioperative recovery for the children undergo the complex congenital heart surgeries using the tight glycemic control in the pediatric intensive care unit （PICU）. Methods Retrospectively studied the consecutive cases and medical materials of complex congenital heart surgeries during from 2010 to 2011, Compared the indexes of the patients in tight glycemic control group （ CGC ） and conventional group（CG） ,and analyzed the information of perioperative recovery. Results There were 183 children in CGC and 258 children in CG ,the median age（month） of two groups were 12.0（7.0,25.5 ） and 13.0（6.0,35.5 ）, respectively, which had no significant difference（ P = 0. 936）. There were 2 children died during hospital stay in both groups ,in the CGC the two children died of severe low cardiac output syndrome while the severe pulmonary infection and low cardiac output syndrome caused the other two deaths in CG, which the mortality of two groups was not statistical different（P =0. 729）. The total hospital stays, PICU stays and mechanical ventilation hours in CGC were lower than those of CG（ P = 0. 001, P 〈 0. 001, P 〈 0. 001 ）. The incidence of complication in CGC and CG were 32. 6% and 39. 9% ,which was statistically different（P 〈0. 001 ）. The use of blood plasma in CGC were lower than that of CG（ P = 0. 006 ）, while the use of erythrocytes in two groups had no significant difference （ P = 0. 308 ）. Conclusion The perioperative outcome in CGC was better than that of CG,the incidence of complication and chest effusion were less in CGC. The further prospective and a larger sample clinical trial and follow-up have to be carried out to prove the advantages in the using of tight glycemic control during perioperative recovery for the children with complex congenital heart surgeries.