【摘要】：目的：回顧性分析嬰兒心臟直視手術(shù)圍術(shù)期血糖水平變化及其與術(shù)后并發(fā)癥的關(guān)系。 方法：233例接受開胸手術(shù)及體外循環(huán)術(shù)的嬰兒，其中男137例，女96例，年齡5.0月(3.0月-7.0月）。根據(jù)術(shù)后有無并發(fā)癥或死亡將患兒分組，并分別收集患兒圍術(shù)期血糖值、一般資料及手術(shù)資料。采用方差分析、秩和檢驗(yàn)及卡方檢驗(yàn)等對(duì)患兒各資料進(jìn)行分析，并行l(wèi)ogistic回歸方程分析并發(fā)癥及死亡的獨(dú)立危險(xiǎn)因素。以機(jī)械通氣時(shí)間及ICU停留時(shí)間為因變量，行多元逐步回歸分析其危險(xiǎn)因素。 結(jié)果：CPB開始后患兒血糖較CPB前明顯升高（P0.05），，并于CPB結(jié)束時(shí)達(dá)到峰值128.0mg/dl（109.5mg/dl~156.5mg/dl），入ICU1d后血糖緩慢下降。122例（52.6%）患兒住院期間出現(xiàn)并發(fā)癥，20例（8.6%）因心血管系統(tǒng)衰竭死亡。與術(shù)后無并發(fā)癥組比較，并發(fā)癥組及死亡組患兒的圍術(shù)期血糖水平差異無統(tǒng)計(jì)學(xué)意義。圍術(shù)期出現(xiàn)高血糖及低血糖情況在無并發(fā)癥組及并發(fā)癥-死亡組間無統(tǒng)計(jì)學(xué)差異。Logistic回歸分析提示術(shù)后死亡的獨(dú)立危險(xiǎn)因素為手術(shù)時(shí)間及術(shù)中血制品入量，而術(shù)后并發(fā)癥的獨(dú)立危險(xiǎn)因素為體重、RACHS-1評(píng)分、手術(shù)時(shí)間及住院時(shí)間。機(jī)械通氣及ICU時(shí)間與手術(shù)時(shí)間、住院時(shí)間、主動(dòng)脈阻斷時(shí)間及CPB前血糖水平相關(guān)。 結(jié)論：嬰兒心臟直視手術(shù)圍術(shù)期血糖水平并非是其術(shù)后并發(fā)癥及死亡發(fā)生的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: to retrospectively analyze the perioperative blood glucose level and its relationship with postoperative complications in infants undergoing open heart surgery. Methods: 233 infants underwent thoracotomy and cardiopulmonary bypass, including 137 males and 96 females, aged 5.0 months (3.0-7.0 months). According to the postoperative complications or death, the children were divided into groups, and the perioperative blood glucose values, general data and surgical data were collected. Variance analysis, rank sum test and chi-square test were used to analyze the data, and logistic regression equation was used to analyze the independent risk factors of complications and death. Multiple stepwise regression analysis was performed with mechanical ventilation time and ICU residence time as dependent variables. Results: after the onset of CPB, the blood glucose of the children was significantly higher than that before CPB (P0.05), and reached the peak value of 128.0mg/dl (109.5mg/dl~156.5mg/dl) at the end of CPB. Complications occurred during hospitalization in 122 cases (52.6%) and cardiovascular failure in 20 cases (8.6%). There was no significant difference in perioperative blood glucose levels between the complications group and the death group. Perioperative hyperglycemia and hypoglycemia were not significantly different between the non-complication group and the complication death group. Logistic regression analysis showed that the independent risk factors of postoperative death were the operation time and the volume of blood products. The independent risk factors for postoperative complications were body weight, RACHS-1 score, operative time and hospital stay. The time of mechanical ventilation and ICU were correlated with time of operation, duration of hospitalization, time of aortic occlusion and blood glucose level before CPB. Conclusion: perioperative blood glucose level is not an independent risk factor for postoperative complications and death in infants undergoing open heart surgery.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R726.5

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相關(guān)期刊論文 前2條

1 樓松;李景文;龍村;;心臟外科患者圍手術(shù)期高血糖的研究進(jìn)展[J];中國體外循環(huán)雜志;2009年04期

2 劉亞光;歐陽川;卿恩明;劉曉明;李書聞;李秀蘭;;非發(fā)紺型嬰兒心臟手術(shù)糖代謝變化的觀察[J];心肺血管病雜志;2009年04期

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