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J Thorac Cardiovasc Surg 2005;129:576-583
© 2005 The American Association for Thoracic Surgery
Cardiopulmonary Support and Physiology |
a Department of Intensive Care, Gunma University, Graduate School of Medicine, Gunma, Japan,
b Department of Anesthesiology, Gunma University, Graduate School of Medicine, Gunma, Japan,
c Department of Anesthesiology, Keiyu Orthopedic Hospital and Saitama Cardiovascular and Pulmonary Center, Gunma, Japan
Presented in part at the Eighth Annual Meeting of Japanese Cardiothoracic and Vascular Anesthesia, Nara, Japan, 2003.
Received for publication January 12, 2004; revisions received July 1, 2004; accepted for publication July 14, 2004. * Address for reprints: Yuji Kadoi, MD, Department of Intensive Care, Gunma University, Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan (E-mail: kadoi{at}med.gunma-u.ac.jp).
OBJECTIVES: The mechanisms of postoperative cognitive dysfunction in patients with diabetes after coronary artery bypass grafting are not fully understood. We sought to determine which type 2 diabetes–related factors contributed to postoperative cognitive dysfunction at 7 days and 6 months after coronary artery bypass grafting.
METHODS: One hundred eighty patients with type 2 diabetes who were scheduled for elective coronary artery bypass grafting were studied. As a control group, 100 patients without diabetes mellitus matched for age, sex, and educational level were examined. Hemodynamic parameters (arterial and jugular venous blood gas values) were measured during cardiopulmonary bypass. All patients underwent a battery of neurologic and neuropsychologic tests the day before surgery, 7 days after surgery, and 6 months after surgery.
RESULTS: Age (odds ratio 1.5, 95% confidence interval 1.3-1.8, P = .03), presence of hypertension (odds ratio 1.8, 95% confidence interval 1.3-2.0, P = .01), jugular venous oxygen saturation less than 50% time (odds ratio 1.5, 95% confidence interval 1.1-2.0, P = .045), presence of ascending aorta atherosclerosis (odds ratio 1.5, 95% confidence interval 1.1-2.6, P = .01), diabetic retinopathy (odds ratio 2.0, 95% confidence interval 1.3-3.0, P = .01), and insulin therapy (odds ratio 2.0, 95% confidence interval 1.3-3.0, P = .05), were associated with cognitive impairment at 7 days. Insulin therapy (odds ratio 2.0, 95% confidence interval 1.3-3.8, P = .01), diabetic retinopathy (odds ratio 1.3, 95% confidence interval 1.2-2.9, P < .01), and hemoglobin A1c (odds ratio 1.9, 95% confidence interval 1.3-3.1, P = .047) were associated with cognitive impairment at 6 postoperative months.
CONCLUSIONS: Insulin therapy, diabetic retinopathy, and hemoglobin A1c were factors in cognitive impairment at 7 days and 6 months after coronary artery bypass grafting in patients with type 2 diabetes.
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