| Background and objectiveIn recent years,coronary heart disease(coronary heart diseases,CHD)with diabetes mellitus(diabetes mellitus,DM)has been high incidence,caused serious influence on people’s health.Coronary Artery Bypass Grafting(CABG)is a kind of traumatic treatment,the prognosis of CABG is related to many factors,and various factors coexist and interact,which seriously affects the postoperative recovery of patients.Therefore,it is of positive significance to evaluate the prognostic risk factors of patients and give targeted intervention measures to improve the prognosis of patients.It has been reported that the prognosis of coronary heart disease patients with diabetes is related to preoperative blood glucose control.Glycosylated hemoglbin Alc(HbAlc)is an important indicator of glucose control in diabetes mellitus and can predict the severity of coronary artery disease.The purpose of this study was to investigate the relationship between preoperative HbAlc level and prognosis in patients with coronary artery bypass grafting.MethodsOne hundred and twenty-two CHD patients with DM who underwent coronary artery bypass grafting in the department of cardiovascular surgery of the second affiliated hospital of zhengzhou university from September 2015 to October 2018 were selected as the study subjects.According to the preoperative blood glucose control,the patients were divided into the group with good blood glucose control(HbA1c<6.5%)and the group with poor blood glucose control(HbA1c ≥6.5%).Patients were divided into normal cardiac function group(EF≥50%)and decreased cardiac function group(EF<50%)according to postoperative ejection fraction(EF).General data of patients were collected,such as gender,age,height,weight and blood pressure.Past medical history such as cerebrovascular accident,myocardial infarction,dyslipidemia,hypertension,smoking,drinking,etc.Preoperative biochemical indexes of the patients included total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-c),low-density lipoprotein cholesterol(LDL-c),fasting blood glucose(FPG),glycosylated hemoglobin(HbA1c),c-reactive protein(CRP),and uric acid.Cardiac ultrasound: such as ejection fraction(EF).Operative data: postoperative hospitalization time,postoperative ICU stay time,postoperative auxiliary ventilation time,aortic occlusion time,extracorporeal circulation time,etc.Postoperative complications include wound infection,reoperation,acute kidney injury,respiratory failure,cerebrovascular events,myocardial infarction,and low cardiac output syndrome.SPSS 22.0 was used to analyze the data,and the risk factors with statistical significance for patients’ heart function were screened.Multivariate regression analysis was performed to verify the correlation between them and the prognosis of patients,and the postoperative complications of patients with different HbA1 c levels were compared.ResultsBasic clinical data of patients in the group with good blood glucose control(HbA1c<6.5%)and the group with poor blood glucose control(HbA1c≥6.5%)were compared,and the results showed that there was no statistically significant difference among the indicators(P > 0.05).Patients were divided into two groups with EF<50% and EF≥50%.The results showed that there were statistically significant differences in TG,FPG and HbA1 c levels between the two groups(P<0.05),and TG and FPG levels in patients with decreased cardiac function(EF<50%)were significantly higher than those in patients with normal cardiac function(EF≥50%).The number of patients with HbA1c≥6.5% in the decreased heart function group(EF<50%)was significantly higher than that in the normal heart function group(EF≥50%)(P<0.05).Taking the reduction of left ventricular systolic function as the dependent variable,HbA1 c,TG,history of hypertension,and overweight and obesity were used as independent variables to introduce multivariate logistic regression equations by forward stepping method.Adjustments were made and the results showed that the level of HbA1 c entered the equation.In this study,The results showed that HbA1c≥6.5% was associated with decreased cardiac systolic function,OR=4.167,95%CI:1.635-10.618.In this study,there were no deaths.There was no statistically significant difference in the incidence of reoperation,respiratory failure,perioperative infection and acute kidney injury between the group with good blood glucose control(HbA1c<6.5%)and the group with poor blood glucose control(HbA1c≥6.5%)(P>0.05).The incidences of myocardial infarction and hypocardia syndrome in the group with good blood glucose control(HbA1c < 6.5%)were lower than those in the group with poor blood glucose control(HbA1c≥6.5%),but the differences were not statistically significant(P>0.05).The incidence of cerebrovascular events in the group with good blood glucose control(HbA1c < 6.5%)was lower than that in the group with poor blood glucose control(HbA1c≥6.5%),and the difference was statistically significant(P<0.05).Conclusions1.High preoperative levels of FPG,HbA1 c and TG in patients with coronary heart disease and diabetes can affect the recovery of cardiac systolic function after coronary artery bypass grafting.2.Poor blood glucose control(HbA1≥6.5%)is an independent risk factor for postoperative cardiac function recovery,so CHD patients with DM should be controlled to 6.5% below the patient before coronary artery bypass grafting to improve Patient heart function.3.The preoperative blood glucose control level in CHD patients with DM can affect the complications after coronary artery bypass grafting.Poor blood glucose control(HbA1c≥6.5%)can increase the incidence of postoperative cerebrovascular events in patients.Poor blood glucose control(HbA1c≥6.5%)is an important risk factor for the prognosis of coronary artery bypass grafting in CHD patients with DM.Therefore,for CHD patients with DM who have this risk factor,interventions should be actively provided to improve the prognosis of patients. |
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