糖尿病患者冠状动脉旁路移植术前两周血糖水平对术后急性肾损伤及康复的影响

The mean blood glucose level in 2 weeks before coronary artery bypass grafting surgery affects postoperative recovery and acute kidney injury in patients with diabetes

目的研究糖尿病患者冠状动脉旁路移植术(CABG)前糖化血清白蛋白(GA)水平对术后急性肾损伤(AKI)及康复的影响。方法回顾性分析2015年3~10月于北京安贞医院心外科行CABG的糖尿病患者病历资料。Logistic回归分析CABG后AKI的危险因素,比较不同GA水平患者住院时间及出院时的生活能力评分。结果646例患者中135例(20.9%)发生CABG后AKI。GA≥21%、年龄≥65岁、高血压、NYHA心功能分级≥Ⅲ级、体外循环、联合手术≥3项为CABG后AKI的独立危险因素。GA<21%及GA<17%组住院时间较GA≥21%及GA≥17%组缩短(P<0.01),出院时的生活能力评分提高(P<0.05)。结论糖尿病患者CABG后AKI发生率20.9%。GA<21%可减少CABG后AKI风险,有利于早期康复。

ObjectiveTo investigate the effect of glycated albumin(GA)level before coronary artery bypass grafting(CABG)surgery on postoperative recovery and acute kidney injury(AKI)in patients with diabetes.Beijing Anzhen Hospital from March to October 2015 were analyzed retrospectively. Logistic regression analysis was used to evaluate the risk factors for AKI after surgery. The duration of hospital stay and the life ability score in discharge were compared among patients with various GA levels.occurred in 135 patients(20. 9% of the whole 646 patients). The logistic regression analysis showed that GA≥21%,the age ≥65 years,hypertension,the NYHA grade ≥Ⅲ,the CPB and the combination of 3 or more surgeries were the independent risk factors for the postoperative AKI. The duration of hospital stay decreased(P<0. 01)and the life ability score in discharge increased(P<0. 05)significantly in patients with GA<21% or GA<17% than in patients with GA≥21% or GA≥17%,respectively.ConclusionThe incidence of AKI after CABG surgery was 20. 9% in patients with diabetes. Preoperative GA<21% was beneficial for reducing the risk of postoperative AKI and improving the recovery.