Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial.
Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial.
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DOI：
10.2337/dc15-0303
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发表时间：
2015-09
期刊：
影响因子：
16.2
通讯作者：
Thourani VH
中科院分区：
文献类型：
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作者：
Umpierrez G;Cardona S;Pasquel F;Jacobs S;Peng L;Unigwe M;Newton CA;Smiley-Byrd D;Vellanki P;Halkos M;Puskas JD;Guyton RA;Thourani VH
改善心脏手术患者预后所需的最佳血糖控制水平仍然存在争议。我们在冠状动脉旁路手术(CABG)后，将152名糖尿病患者和150名非糖尿病患者随机分为高血糖组(100-140 mg/dL，n=151)或保守血糖组(141-180 mg/dL，n=151)。在重症监护病房(ICU)后，患者在医院和出院后90天接受单一治疗方案。主要结果是各种并发症的差异，包括死亡率、伤口感染、肺炎、菌血症、呼吸衰竭、急性肾损伤和主要心血管事件。重症监护室平均血糖为132±14 mg/dL(四分位数范围124~139)，保守组为154±17 mg/dL(IQR142~164)(P<；0.001)。强化组和保守组并发症发生率分别为42%和52%，差异无统计学意义(P=0.08)。糖尿病患者强化治疗与保守治疗的并发症发生率差异无统计学意义(49vs.48%，P=0.87)，但非糖尿病患者强化治疗的并发症发生率明显低于保守治疗(34vs.55%，P=0.008)。ICU胰岛素强化治疗的目标血糖为100 mg/dL和140 mg/dL，与CABG术后目标血糖为141 mg/dL和180 mg/dL相比，并不能显著减少围手术期并发症。亚组分析显示，非糖尿病患者的并发症数量较少，但接受强化治疗的糖尿病患者的并发症数量并不少。需要大型前瞻性随机研究来证实这些发现。
The optimal level of glycemic control needed to improve outcomes in cardiac surgery patients remains controversial. We randomized patients with diabetes (n = 152) and without diabetes (n = 150) with hyperglycemia to an intensive glucose target of 100–140 mg/dL (n = 151) or to a conservative target of 141–180 mg/dL (n = 151) after coronary artery bypass surgery (CABG) surgery. After the intensive care unit (ICU), patients received a single treatment regimen in the hospital and 90 days postdischarge. Primary outcome was differences in a composite of complications, including mortality, wound infection, pneumonia, bacteremia, respiratory failure, acute kidney injury, and major cardiovascular events. Mean glucose in the ICU was 132 ± 14 mg/dL (interquartile range [IQR] 124–139) in the intensive and 154 ± 17 mg/dL (IQR 142–164) in the conservative group (P < 0.001). There were no significant differences in the composite of complications between intensive and conservative groups (42 vs. 52%, P = 0.08). We observed heterogeneity in treatment effect according to diabetes status, with no differences in complications among patients with diabetes treated with intensive or conservative regimens (49 vs. 48%, P = 0.87), but a significant lower rate of complications in patients without diabetes treated with intensive compared with conservative treatment regimen (34 vs. 55%, P = 0.008). Intensive insulin therapy to target glucose of 100 and 140 mg/dL in the ICU did not significantly reduce perioperative complications compared with target glucose of 141 and 180 mg/dL after CABG surgery. Subgroup analysis showed a lower number of complications in patients without diabetes, but not in patients with diabetes treated with the intensive regimen. Large prospective randomized studies are needed to confirm these findings.