开放式心脏手术前 5 天停止使用葡萄糖钠转运体 2 抑制剂后优生糖尿病酮症酸中毒率和预后的回顾性病历分析。

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia Pub Date : 2025-02-22 DOI:10.1053/j.jvca.2025.02.030

Jonathan S. Auerbach MD , Ahmed Alnajar MD, MSPH , Samira S. Patel MBA , Hayley B. Gershengorn MD , Joseph Lamelas MD , Daitiara Perez PharmD , Oscar D. Aljure MD , Tanira D. Ferreira MD , Lazaro A. Gonzalez APRN , Jorge L. Cabrera DO

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引用次数: 0

摘要

目的：心内直视手术前5天停用钠-葡萄糖共转运蛋白2抑制剂（SGLT2i）的结果（正糖糖尿病酮症酸中毒[eDKA]发生率、死亡率、感染、住院时间和心血管重症监护病房[CVICU]住院时间[LOS]）。设计：回顾性研究。单位：学术大学附属医院。参与者：成人心内直视手术患者。暴露：在心脏直视手术前5天停用SGLT2i的患者与未使用SGLT2i的患者比较。测量和主要结果：我们评估了入院24小时内（2022年12月14日至2023年10月25日）接受心脏手术前5天因eDKA发展而被告知停用sgltti的患者。使用Wilcoxon秩和和卡方检验比较SGLT2i使用者和非使用者的非edka结果。540例心内直视手术患者中，48例（8.9%）术前处方SGLT2i；其中0（0%）在入院24小时内发生eDKA。使用SGLT2i的患者的医院LOS在统计学上更长(中位数[四分位数间距]:4[4-5]天和4[3-6]天，p = 0.003；平均值[标准差]:4bb1 vs 5bb1， p = 0.03)。我们发现使用SGLT2i和未使用SGLT2i的患者在CVICU LOS（中位数[四分位数间距]:1.67 [0.95-2.09]v 1.17[0.96-1.88]天，p = 0.14）、住院死亡率（2.1% [3]v 0.6% [3], p = 0.3）或胸骨感染（0 [0.0%]v 2 [0.4%], p > 0.9）方面无显著差异。结论：在心脏直视手术前5天停止用药的SGLT2i患者术后无eDKA。两个队列之间的LOS、感染率和死亡率相似。在心脏直视手术前5天停止SGLT2i药物似乎是安全的。

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Retrospective Chart Review of Euglycemic Diabetic Ketoacidosis Rates and Outcomes Postimplementation of Sodium Glucose Cotransporter 2 Inhibitor Use Stoppage 5 Days Before Open Heart Surgery

Objectives

Outcomes of stopping sodium-glucose cotransporter 2 inhibitors (SGLT2i) 5 days before open heart surgery (euglycemic diabetic ketoacidosis [eDKA] rate, mortality, infection, hospital, and cardiovascular intensive care unit [CVICU] length of stay [LOS]).

Design

Retrospective study.

Setting

Academic university hospital.

Participants

Adult open heart surgery patients.

Exposures

Patients on SGLT2i who stopped medications 5 days before open heart surgery versus non–SGLT2i-using patients.

Measurements and Main Results

We evaluated patients who were told to stop SGLT2i 5 days before receiving open heart surgery for eDKA development within 24 hours of hospital admission (12/14/2022 to 10/25/2023). Non-eDKA outcomes were compared between SGLT2i users and non-users using Wilcoxon rank sum and Chi-square testing as appropriate. Of 540 open heart surgery patients, 48 (8.9%) were prescribed SGLT2i's before surgery; of these, 0 (0%) developed eDKA within 24 hours of hospital admission. Hospital LOS was statistically longer for patients with SGLT2i use (median [interquartile range]: 4 [4-5] v 4 [3-6] days, p = 0.003; mean [standard deviation]: 4 [3] v 5 [2], p = 0.03). We found no significant difference between patients with and without SGLT2i use in CVICU LOS (median [interquartile range]: 1.67 [0.95-2.09] v 1.17 [0.96-1.88] days, p = 0.14), in-hospital mortality (2.1% [1] v 0.6% [3], p = 0.3), or sternal infections (0 [0.0%] v 2 [0.4%], p > 0.9).

Conclusion

Postoperative eDKA was absent in SGLT2i patients told to stop medications 5 days before open heart surgery. LOS and infection and mortality rates appeared similar between the two cohorts. Stopping SGLT2i medications 5 days before open heart surgery appears safe.

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来源期刊

Journal of cardiothoracic and vascular anesthesia 医学-呼吸系统

CiteScore

4.80

自引率

17.90%

发文量

606

审稿时长

37 days

期刊介绍： The Journal of Cardiothoracic and Vascular Anesthesia is primarily aimed at anesthesiologists who deal with patients undergoing cardiac, thoracic or vascular surgical procedures. JCVA features a multidisciplinary approach, with contributions from cardiac, vascular and thoracic surgeons, cardiologists, and other related specialists. Emphasis is placed on rapid publication of clinically relevant material.