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在CABG患者中优化术后葡萄糖管理:探索早期过渡到皮下胰岛素
Hamza Alzghoul1, Joel Weimer2, Abigail Antigua2
1Graduate Medical Education, University of Central Florida College of Medicine, Orlando, FL 32816, USA.
Journal of cardiovascular development and disease
|November 26, 2024
概括
在冠状动脉旁路移植手术后,在术后的第一天早期过渡到皮下胰岛素可以缩短住院时间. 这种胰岛素管理方法可以改善结果,但不会增加返回静脉注射胰岛素的风险.
科学领域:
- 心脏病学 心脏病学
- 内分泌学 在内分泌学.
- 外科手术的结果
背景情况:
- 在接受冠状动脉旁路移植 (CABG) 手术的患者中,最佳的血糖控制至关重要.
- 在CABG后从静脉注射 (IV) 转换为皮下注射 (SC) 胰岛素的最佳时间仍未确定.
- 这项研究调查了早期与延迟的胰岛素过渡策略.
研究的目的:
- 为了比较早期 (术后第1天,POD1) 与延迟从IV过渡到SC胰岛素的效果.
- 为了评估对血糖控制和CABG手术后患者结果的影响.
主要方法:
- 在CABG住院期间接受胰岛素的394名患者的回顾性分析.
- 患者被分为早期 (POD1过渡) 和延迟 (POD1过渡后) 组.
- 主要结局:POD1上的euglycemia;次要结局:LOS,ICU LOS,葡萄糖水平,高血糖/低血糖率.
主要成果:
- 早期过渡组 (n=326) 与延迟过渡组 (n=68) 相比,显示了较短的ICU和住院时间 (LOS).
- 在早期过渡组中,没有观察到重新启动IV胰岛素率的显著增加.
- 血糖控制和其他次要结果是可比的,根据BMI和糖尿病诊断进行调整.
结论:
- 在CABG手术后在POD1上切换到SC胰岛素是安全有效的.
- 早期胰岛素过渡减少了在ICU和医院停留的时间.
- 这种策略优化了资源利用,而不会影响患者的安全或血糖控制.
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