冠状动脉粥样硬化性心脏病合并糖尿病患者CABG 疗效的影响因素及对策

Influence factors and strategies in the prognosis of coronary artery bypass grafting in patients of coronary artery disease combined with diabetes

摘要:

目的 研究影响冠状动脉粥样硬化性心脏病（冠心病）合并糖尿病患者冠状动脉旁路移植术 （CABG）预后的因素及改善预后的相关策略。方法 选取于该院行CABG 的糖尿病患者78 例。根据手术预 后将患者分为疗效不佳组和疗效良好组，详细记录每组患者的一般临床资料。术前检测患者的糖化血红蛋白 水平，评估患者术前中期血糖控制效果。同时，术中、术后3 d 监测患者的血糖水平，分别计算术中、术后患 者平均血糖水平以及血糖变异率。手术后对患者进行密切观察，评估手术效果，并采用多因素Logistic 回归分 析此类患者CABG 术后的影响因素，在此基础上利用ROC 曲线研究糖尿病相关因素在预测CABG 术后的效能。 结果 78 例患者中有17 人CABG 术效果不佳，其中死亡2 人（2.56%）。Logistic 回归结果显示患者的糖化血 红蛋白水平以及术中血糖水平变异率是影响CABG 术的危险因素，并且预测CABG 术后的ROC 曲线显示2 者的AUC 分别为0.866、0.752，2 者联用时AUC 为0.905，显示出了较好的诊断效能。结论 糖化血红蛋白 水平以及血糖水平变异率是糖尿病患者行CABG 术的危险因素，并且有潜力作为一种指标来预测手术疗效。

Abstract:

Objective To study the influence factors and strategies in the prognosis of coronary artery bypass grafting (CABG) in the patients of coronary artery disease combined with diabetes. Methods Diabetic patients undergoing CABG in our hospital were studied (n = 78). According to the prognosis result, the patients were divided into poor prognosis group and good prognosis group. The clinical data were carefully recorded. Preoperative HbA1c level was detected to evaluate the effect of medium-term preoperative diabetes control. Mean glucose level (mmol/L) and blood glucose coefficient of variation (mean/standard deviation) on the day of surgery, and on the day up till three days postoperatively were retrospectively obtained and calculated. The patients were observed after operation in order to evaluate the prognosis. Logistic regression analysis was used to analyze the independent risk factors of CABG outcomes. Furthermore, the ROC curve was used to evaluate the diagnosis value of the related factors. Results Of the 78 patients 17 had poor effect after CABG and 2 died (2.56%). Logistic regression showed that the independent risk factors of CABG outcomes were preoperative HbA1c level and glucose coefficient of variation on the day of surgery. Moreover, the area under the ROC curve was 0.866 for preoperative HbA1c level, 0.752 for glucose coefficient of variation on the day of surgery and 0.905 for their combination. Conclusions Preoperative HbA1c level and glucose coefficient of variation on the day of surgery are the independent risk factors of CABG. Both of them can be used to forecast the outcomes of CABG.