心脏手术围术期的血糖波动与术后急性肾损伤

心脏手术围术期高血糖与术后并发症的关系已经得到大量研究,高血糖与术后肾功能损伤的关系存在着不同的观点,但是对于围术期血糖水平的波动与术后肾损伤的研究甚少。本文概述了心脏手术围术期血糖水平波动对术后肾功能损伤的影响,简要分析其损伤机制。研究表明,多种因素可以增加围术期血糖水平的波动,对多项围术期高血糖是否增加术后肾功能损伤的研究争议分析发现,围术期血糖水平的波动对术后肾损伤的发生起到潜在作用,其损伤机制主要在于引起氧化应激和血流动力学的波动。相信围术期血糖水平的波动对术后肾功能损伤的影响的进一步的研究,将有助于降低心脏手术后急性肾损伤患者术后并发症的发生率。

Perioperative Glycemic Variability in Cardiac Surgery and Postoperative Acute Kidney Injury

Sufficient studies had investigated perioperative hyperglycemia and its effects on postoperative complications in cardiac surgery but no consensus was obtained. There was few study reported perioperative glycemic oscillation contributing to acute kidney injury. This review systematically introduced effects of glycemic oscillation on acute kidney injury during cardiac surgery and generally analysed its mechanism. Several studies proved multi-risk factors possessed potential in glycemic oscillation perioperatively. Propensity of perioperative glycemic oscillation risking postsurgical acute kidney injury was obsessed after we compared several controversial researches main in hyperglycemia and renal function. Some detriment of glycemic oscillation lied in its trend of provoking hyperoxide stress and hemodynamic unstability. Whether pre- and post-operative glycemic oscillation strongly correlated to postsurgical acute kidney injury in cardiac surgery was still indeterminacy and needed further investigation and this would help decrease morbidity and mortality of patients experiencing AKI after cardiac surgeries.