Research On Influence Factors For The Difficulty Of Glycemic Control In Patients Undergoing Valve Replacement Surgery With Cardiopulmonary Bypass

Objective: To observe perioperative changes of blood glucose and the use of insulin, and explore the influence factors for the difficulty of glycemic control in patients undergoing valve replacement surgery with cardiopulmonary bypass, in order to develop more effective blood glucose control scheme, and to control the perioperative hyperglycemia more effectively, and accelerate the rehabilitation of patients.Methods:⑴ Sixty-nine patients undergoing date-selectived valve replacement surgery(Including single valve replacement, combined valve replacement and/or modified maze operation) were enrolled, and all cases were collected from the Central Hospital of Suining City. Recorded the clinical indicators that may be related to the difficulty of glycemic control, including preoperative general situation, preoperative laboratory examination indexes, echocardiography index, operation process related indicators, valve disease types and operation method, postoperative factors, blood gas analysis index.Separately select whether the blood sugar on 72 hours after operation reduces to 8.3 mmol/L or not and perioperative total insulin dosage as the indicators to describe the difficulty of glycemic control, he patients whose blood glucose on 72 hours after operation reduced to below 8.3mmol/L were assigned to easy to control group(group A1); the patients whose blood glucose on 72 hours after operation remains still above 8.3mmol/L were divided into difficult to control group(group A2).Divided patients whose perioperative total insulin dosage was below 60 u into easy to control group(group B1),and divided patients whose perioperative total insulin dosage was above 60 u into difficult to control group(group B2). Use the method of combining single factor analysis and multivariate logistic regression analysis to analysis the risk factors for the difficulty of glycemic control in valve replacement patients.⑵ Use the method of single factor analysis to analysis the clinical indicators that may be related to the difficulty of glycemic control.⑶ Variables considered to be statistical significant and clinical significant in the results of single factor analysis are analysised by multivariate logistic regression analysis.Results:⑴ Blood glucose began to rise since CPB started in all of the patients, and reached peak in postoperative 4 hours and then blood sugar declined gradually, but to the third day morning postoperation blood sugar is still higher than preoperative. Among them, 42 cases had fasting glucose of the third day morning postoperation back to 8.3mmol/L, 27 patients′ blood sugar is still higher than 8.3mmol/L in the third day morning postoperation. 41 patients′ perioperative insulin dosage during ICU ≤60u, 28 patients′ insulin dosage >60 u.⑵ Results of the single factor analysis showed: According to the grouping standard of whether the fasting glucose of the third day morning postoperation declined to 8.3mmol/L, the indexes of operation time、CPB time、the speed of rewarming, red blood cell suspension input postoperation and preoperative complications had statistically significant differences between the two groups(P<0.05).According to the grouping standard of total insulin dosage during ICU, age, preoperative complications, operation time, the mean arterial blood pressure(MAP) during CPB, the lowest arterial blood pressure during CPB, red blood cell suspension infusion postoperation and MAP during 6 hours postoperation was significantly different between the two groups(P<0.05).⑶ Results of Multivariate Logistic regression analysis: variables considered to be statistical significant and clinical significant in the result of the single factor analysis are analysised by multivariate Logistic Regression analysis, the results showed: According to the grouping standard of whether the fasting glucose of the third day morning postoperation declined to 8.3mmol/L, the above indicators has no statistical significance between two groups affect the difficulty of glucose control; According to the grouping standard of total insulin dosage during ICU, preoperative complications and blood pressure on 6 hours postoperative are independent risk factors which affect the difficulty of glycemic control in patients undergoing valve replacement with cardiopulmonary bypass.Conclusions:⑴ Age, combined with preoperative hypertension significantly increased the perioperative difficulty of blood glucose control, to pay attention to the control of complications before operation, will be good for perioperative blood glucose control.⑵ Longer operation time, longer CPB time, more postoperative red blood cell suspension input significantly increased the difficulty of blood glucose control.⑶ Lower speed of rewarming and lower blood pressure during CPB can decrease the difficulty of blood glucose control.⑷ The mean blood pressure during 6 hours postoperation significantly influenced the difficulty of perioperative glycemic control in patients undergoing heart valve replacement, maintaining blood pressure of early postoperative at a higher level, will be good for perioperative blood glucose control.