Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures
Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures
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DOI：
10.1016/s0003-4975(99)00014-4
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发表时间：
1999-02-01
影响因子：
4.6
通讯作者：
Starr, A
中科院分区：
文献类型：
--
作者：
Furnary, AP;Zerr, KJ;Starr, A
背景糖尿病是心脏直视手术后深部胸骨伤口感染的危险因素。我们以前的研究表明，术后血糖水平升高是糖尿病患者胸骨深部伤口感染的预测因子。因此，我们假设积极的静脉药物控制术后血糖水平将降低深部胸骨伤口感染的发生率。在一项前瞻性研究中，2,167例糖尿病患者在1987年至1997年期间接受了心脏直视手术，每隔1至2小时记录一次围手术期血糖水平。将患者分为两个连续组：对照组包括968例接受滑动标尺引导的间歇皮下胰岛素注射（SQI）治疗的患者;研究组包括1，499例接受持续静脉胰岛素输注以维持血糖水平低于200 mg/dL的患者。在年龄、性别、手术方式、转流时间、抗生素预防或皮肤准备方法方面，这些组之间没有差异。与皮下注射胰岛素相比，持续静脉胰岛素输注诱导围手术期血糖水平显著降低，从而导致持续静脉胰岛素输注组胸骨深部伤口感染的发生率显著降低（0.8% [12/1，499]）与间歇性皮下胰岛素注射组（2.0% [19/968]，卡方检验p = 0.01）。多因素logistic回归分析显示，持续静脉输注胰岛素可显著降低深部胸骨伤口感染的风险（p = 0.005;相对危险度，0.34），而肥胖p < 0.03;相对危险度，1.06）和使用胸廓内动脉蒂（p = 0.1;相对危险度，2.0）增加深部胸骨伤口感染的风险。在接受心脏直视手术的糖尿病患者中使用围手术期持续静脉胰岛素输注可显著降低主要感染发病率及其相关的社会经济成本。(C)1999年，美国胸外科医师协会（Society of Thoracic Surgeons）
Background. Diabetes mellitus is a risk factor for deep sternal wound infection after open heart surgical procedures. We previously showed that elevated postoperative blood glucose levels are a predictor of deep sternal wound infection in diabetic patients. Therefore, we hypothesized that aggressive intravenous pharmacologic control of postoperative blood glucose levels would reduce the incidence of deep sternal wound infection.Methods. In a prospective study of 2,167consecutive diabetic patients who underwent open heart surgical procedures between 1987 and 1997, perioperative blood glucose levels were recorded every I to 2 hours. patients were classified into two sequential groups: the control group included 968 patients treated with sliding-scaleguided intermittent subcutaneous insulin injections (SQI); the study group included 1,499 patients treated with a continuous intravenous insulin infusion in an attempt to maintain a blood glucose level of less than 200 mg/dL. There were no differences between these groups with respect to age, sex, procedure, bypass time, antibiotic prophylaxis, or skin preparation methods.Results. Compared with subcutaneous insulin injections, continuous intravenous insulin infusion induced a significant reduction in perioperative blood glucose levels, which led to a significant reduction in the incidence of deep sternal wound infection in the continuous intravenous insulin infusion group (0.8% [12 of 1,499]) versus the intermittent subcutaneous insulin injection group (2.0% [19 of 968], p = 0.01 by the chi(2) test). Multivariate logistic regression revealed that continuous intravenous insulin infusion induced a significant decrease in the risk of deep sternal wound infection (p = 0.005; relative risk, 0.34), whereas obesity p < 0.03; relative risk, 1.06) and use of an internal thoracic artery pedicle (p = 0.1; relative risk, 2.0) increased the risk of deep sternal wound infection.Conclusions. Use of perioperative continuous intravenous insulin infusion in diabetic patients undergoing open heart surgical procedures significantly reduces major infectious morbidity and its associated socioeconomic costs. (C) 1999 by The Society of Thoracic Surgeons.