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Asociación entre los niveles de glucosa intraoperatorios y posoperatorios tempranos y los resultados adversos después
Angelo Polito1, Ravi R Thiagarajan, Peter C Laussen
1Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
Circulation
|November 13, 2008
Resumen
El control perioperatorio de la glucosa es crucial en la cirugía cardíaca congénita compleja. Mantener la glucosa entre 110-126 mg/dL después de la cirugía puede reducir las complicaciones y la estancia hospitalaria.
Área de la Ciencia:
- Cardiología Pediátrica Cardiología pediátrica.
- Medicina de cuidados críticos Medicina de cuidados críticos.
- Trastornos metabólicos Los trastornos metabólicos son trastornos metabólicos que se producen en el cuerpo.
Sus antecedentes:
- La cirugía cardíaca congénita compleja plantea riesgos significativos para los pacientes.
- El control glucémico perioperatorio es un factor crítico que influye en los resultados en estos pacientes de alto riesgo.
Objetivo del estudio:
- Investigar la asociación entre la exposición perioperatoria a la glucosa y los resultados.
- Para determinar la relación entre las métricas de control de la glucosa y la hospitalización prolongada o eventos mórbidos.
Principales métodos:
- Análisis de las métricas de control de la glucosa (promedio, pico, mínimo, SD, duración de la hiperglucemia) en 378 pacientes quirúrgicos cardíacos de alto riesgo.
- Recopilación de datos intraoperatorios y postoperatorios de 72 horas.
- Análisis de regresión multivariable para evaluar las relaciones con la duración de la estancia hospitalaria y el criterio de valoración compuesto de morbilidad-mortalidad.
Principales resultados:
- La glucosa baja intraoperatoria (< o = 75 mg / dl) se relacionó con un aumento de las probabilidades de morbilidad / mortalidad (OR, 3.10).
- La duración de la hiperglucemia postoperatoria se correlacionó con estadías hospitalarias más largas (P<0,001).
- Los niveles extremos de glucosa postoperatorios (avg <110 o >143, min
Conclusiones:
- Se sugiere un rango óptimo de glucosa postoperatoria de 110-126 mg/dL para los niños sometidos a cirugía cardíaca congénita compleja.
- Se necesitan más ensayos aleatorizados para evaluar el estricto control glucémico utilizando infusiones de insulina en esta población.
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