Clinical Effects of Strict Control versus Conventional Control of Blood Glucose on Perioperative Cardiac Surgery: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

SONG Baohua ¹ , JIANG Pingjun ² ,  WANG Zhihong ³

1. Anesthesiology Department, Xinjiang Cardiovascular and Cerebrovascular Hospital, Urumqi 830054, China;2. Anesthesiology Department, Fangcaohu Hospital of the Sixth Xinjiang Construction Corps, Fangcaohu 831100, China3. People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830054, China;

Corresponding author：

WANG Zhihong, Email: sbh510@163.com

Keywords：

Cardiac surgery; Perioperative; Blood glucose control; Systematic review; Meta-analysis; Randomized controlled tria

DOI：

10.7507/1672-2531.20120191

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Objective 　To evaluate clinical effects of strict control vs. conventional control of blood glucose in perioperative cardiac surgery.
Methods 　Databases including PubMed, EMbase, HighWire, The Cochrane Library, CBM and VIP were searched to collect the randomized controlled trials (RCTs) on strict control vs. conventional control of blood glucose in perioperative cardiac surgery, published from 2000 to 2011. Two reviewers independently screened articles according to the inclusion and exclusion criteria, extracted data, and assessed quality of the included studies. Then meta-analysis was performed using RevMan 5.1.
Results 　A total of 8 RCTs involving 2 250 patients were included. The results of meta-analysis showed that compared with the conventional group, the strict control of blood glucose could reduce postoperative short-term mortality (OR=0.52, 95% CI 0.30 to 0.91, P=0.02) and postoperative incidence rate of both atrial fibrillation (OR=0.64, 95%CI 0.43 to 0.96, P=0.03) and incision infection (OR=0.30, 95%CI 0.15 to 0.57, P=0.000 2), and shorten hospital stay (MD=1.75, 95%CI –3.18 to –0.32, P lt;0.02) and time of mechanical ventilation (MD=–0.9, 95%CI –1.43 to –0.38, P lt;0.000 8).
Conclusion 　Current evidence shows that the strict control of blood glucose in perioperative cardiac surgery can reduce postoperative short-term mortality and postoperative incidence rate of both atrial fibrillation and incision infection, shorten hospital stay and time of mechanical ventilation, and have important clinical values and social and economic significance. However, this conclusion has to be proved by more high-quality and large-scale RCTs for the limitation of quantity and quality of the included studies.

Citation： SONG Baohua,JIANG Pingjun,WANG Zhihong. Clinical Effects of Strict Control versus Conventional Control of Blood Glucose on Perioperative Cardiac Surgery: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2012, 12(10): 1229-1234. doi: 10.7507/1672-2531.20120191 Copy

1.	Rassias AJ. Intraoperative management of hyperglycemia in the cardiac surgical patient. Semin Thorac Cardiovasc Surg, 2006, 18(4): 330- 338 .
2.	Ingels C, Debaveye Y, Milants I, et al. Strict blood glucose control with Insulin during intensive care after cardiac surgery: impaction 4-years survival, dependency on medical care, and quality of life. Eur Heart J, 2006, 27(22):2716-2724.
3.	Ghandi GY, Nuttall GA, Abel MD, et al. Intensive intraoperative insulin Therapy versus conventional glucose management during cardiac surgery. AnnIntern Med, 2007, 146(3): 233-243.
4.	Hoedemaekers CW, Pickkers P, Netea MG, et al. Intensive insulin therapy Does notalter the inflammatory response in patients undergoing Coronaryartery bypass grafting: a randomized controlled trial. Crit Care, 2005, 9(6): R790-797.
5.	Koskenkari JK, Kaukoranta PK, Kiviluoma KT, et al. Metabolic and emodynamic effects of high-dose insulin treatment inaorticvalve and oronary surgery. Ann Thorac Surg, 2005, 80(2): 511-517.
6.	Lazar L, Chipkin R, Fitzgerald A, et al. Tight glycemic control in Diabetic coronaryartery bypass graft patients improves perioperative Outcomes and decreases recurrent ischaemic events. Circulation, 2004, 109(9): 1497-1502.
7.	Groban L, Butterworth J, Legault C, et al. Intraoperative insulin therapy Does not reduce the need for inotropic or antiarrhythmic therapy after Cardiopulmonary bypass. Cardiothorac Vasc Anesth, 2002, 16(4): 405-412.
8.	胡小平, 王志维, 区家乐. 严格控制血糖对心脏瓣膜置换术患者近期预后的影响. 中国胸心血管外科临床杂志, 2010, 2(17): 18-21.
9.	高洪锋, 浦怡, 陶凉. 冠状动脉旁路移植手术后血糖控制对预后的影响. 实用医学杂志, 2011, 27(3): 444-445.
10.	Boord JB, Graber AL, Christman JW, et al. Practical management of diabetes in critically ill patients. Am JR espirCrit Care Med, 2001, 164(10): 1763-1767.
11.	Gale SC, Sicoutris C, Reilly PM, et al. Poor glycemic control is associated with increased mortality in critically ill trauma patients. Am Surg, 2007, 73(5): 454-460.
12.	Hirshberg E, Larsen G, Van Duker H. Alterations in glucose homeostas is in the pediatric intensive care unit : Hyperglycemia and glucose variability are associated with Increased mortality and morbidity. Pediatr Crit Care Med, 2008, 9(4): 361-366.
13.	Doenst T, Wijeysundera D, Karkouti K, et al. Hyperglycemia during cardiopulmonary bypass is an independ ent risk factor for mortality in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg, 2005, 130(4): 1144.
14.	Morariu AM, Loef BG, Aarts LP, et al. Dexamethasone: benefit and prejudice for patients Undergoing on-pump coronaryartery bypass grafting: astudyon myocardial, pulmonary, renal, intestinal, and hepatic injury. Chest, 2005, 128(7): 2677-2687.
15.	Angelini P, Feldman MI, Lufschanowski R, et al. Cardiacarrhythmias duringAnd after heart surgery: diagnosis and management. Prog Cardiovasc Dis, 1974, 16(2): 469-495.
16.	Chen X, Newman M, Rosenfeldt FL. Internal cardiac cooling improves Atrial preservation: electrophysiological and biochemical assessment. Ann Thorac Surg, 1988, 46(10): 406-410.
17.	White HD, Antman EM, Glynn MA, et al. Efficacy and safety of timolol for prevention of supraventric ulartachyarrhythmias after coronary artery Bypass surgery. Circulation, 1984, 70(5): 479-484.
18.	Kalman JM, Munawar M, Howes LG, et al. Atrial fibrillation after coronaryArtery bypass surgery is associated with sympathetic activation. Ann Thorac Surg, 1985, 60(8): 1709-1715.
19.	Hewitt RL, Lolley DM, Adrouney GA, et al. Protective effect of glycog And glucose on the anoxicresting heart. Surgery, 1974, 75(1): 1-10.
20.	Gandhi GY, Nuttall GA, Abel MD, et al. Intensive intraoperatvie insulin therapy versus conventional glucosem anagement during cardiac surgery: a randomized trial. Ann Int ern Med, 2007, 146(4): 233-243.

1. Rassias AJ. Intraoperative management of hyperglycemia in the cardiac surgical patient. Semin Thorac Cardiovasc Surg, 2006, 18(4): 330- 338 .
2. Ingels C, Debaveye Y, Milants I, et al. Strict blood glucose control with Insulin during intensive care after cardiac surgery: impaction 4-years survival, dependency on medical care, and quality of life. Eur Heart J, 2006, 27(22):2716-2724.
3. Ghandi GY, Nuttall GA, Abel MD, et al. Intensive intraoperative insulin Therapy versus conventional glucose management during cardiac surgery. AnnIntern Med, 2007, 146(3): 233-243.
4. Hoedemaekers CW, Pickkers P, Netea MG, et al. Intensive insulin therapy Does notalter the inflammatory response in patients undergoing Coronaryartery bypass grafting: a randomized controlled trial. Crit Care, 2005, 9(6): R790-797.
5. Koskenkari JK, Kaukoranta PK, Kiviluoma KT, et al. Metabolic and emodynamic effects of high-dose insulin treatment inaorticvalve and oronary surgery. Ann Thorac Surg, 2005, 80(2): 511-517.
6. Lazar L, Chipkin R, Fitzgerald A, et al. Tight glycemic control in Diabetic coronaryartery bypass graft patients improves perioperative Outcomes and decreases recurrent ischaemic events. Circulation, 2004, 109(9): 1497-1502.
7. Groban L, Butterworth J, Legault C, et al. Intraoperative insulin therapy Does not reduce the need for inotropic or antiarrhythmic therapy after Cardiopulmonary bypass. Cardiothorac Vasc Anesth, 2002, 16(4): 405-412.
8. 胡小平, 王志维, 区家乐. 严格控制血糖对心脏瓣膜置换术患者近期预后的影响. 中国胸心血管外科临床杂志, 2010, 2(17): 18-21.
9. 高洪锋, 浦怡, 陶凉. 冠状动脉旁路移植手术后血糖控制对预后的影响. 实用医学杂志, 2011, 27(3): 444-445.
10. Boord JB, Graber AL, Christman JW, et al. Practical management of diabetes in critically ill patients. Am JR espirCrit Care Med, 2001, 164(10): 1763-1767.
11. Gale SC, Sicoutris C, Reilly PM, et al. Poor glycemic control is associated with increased mortality in critically ill trauma patients. Am Surg, 2007, 73(5): 454-460.
12. Hirshberg E, Larsen G, Van Duker H. Alterations in glucose homeostas is in the pediatric intensive care unit : Hyperglycemia and glucose variability are associated with Increased mortality and morbidity. Pediatr Crit Care Med, 2008, 9(4): 361-366.
13. Doenst T, Wijeysundera D, Karkouti K, et al. Hyperglycemia during cardiopulmonary bypass is an independ ent risk factor for mortality in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg, 2005, 130(4): 1144.
14. Morariu AM, Loef BG, Aarts LP, et al. Dexamethasone: benefit and prejudice for patients Undergoing on-pump coronaryartery bypass grafting: astudyon myocardial, pulmonary, renal, intestinal, and hepatic injury. Chest, 2005, 128(7): 2677-2687.
15. Angelini P, Feldman MI, Lufschanowski R, et al. Cardiacarrhythmias duringAnd after heart surgery: diagnosis and management. Prog Cardiovasc Dis, 1974, 16(2): 469-495.
16. Chen X, Newman M, Rosenfeldt FL. Internal cardiac cooling improves Atrial preservation: electrophysiological and biochemical assessment. Ann Thorac Surg, 1988, 46(10): 406-410.
17. White HD, Antman EM, Glynn MA, et al. Efficacy and safety of timolol for prevention of supraventric ulartachyarrhythmias after coronary artery Bypass surgery. Circulation, 1984, 70(5): 479-484.
18. Kalman JM, Munawar M, Howes LG, et al. Atrial fibrillation after coronaryArtery bypass surgery is associated with sympathetic activation. Ann Thorac Surg, 1985, 60(8): 1709-1715.
19. Hewitt RL, Lolley DM, Adrouney GA, et al. Protective effect of glycog And glucose on the anoxicresting heart. Surgery, 1974, 75(1): 1-10.
20. Gandhi GY, Nuttall GA, Abel MD, et al. Intensive intraoperatvie insulin therapy versus conventional glucosem anagement during cardiac surgery: a randomized trial. Ann Int ern Med, 2007, 146(4): 233-243.

Chinese Journal of Evidence-Based Medicine

Clinical Effects of Strict Control versus Conventional Control of Blood Glucose on Perioperative Cardiac Surgery: A Meta-Analysis

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