Pulmonary oxygen transfer deficits of diabetic origin in patients undergoing coronary artery bypass grafting.
The objective of this study was to determine the effects of a diabetic disposition on pulmonary gas exchange by examining 72 patients who underwent coronary artery bypass grafting (CABG), using the arterial/alveolar oxygen tension ratio [(a/A)PO2] as a criterion. Patients were divided into a diabetic (DM) group and a nondiabetic (non-DM) group. The postoperative blood gases and hemodynamic data measured when the blood glucose level was at a maximum on the day of CABG were used as the postoperative pulmonary gas exchange indices, and the physicians who managed these patients were unaware of this study. The preoperative (a/A)PO2 ratio was 0.66 +/- 0.03 (SE) in the DM group and 0.78 +/- 0.02 in the non-DM group (P < 0.01), while the postoperative ratios were 0.42 +/- 0.03 and 0.52 +/- 0.03, respectively (P = 0.01). The correlation coefficient (r) for regression analysis of the relation between the postoperative PaO2/FIO2 ratio and the postoperative (a/A)PO2 ratio was 0.99 in the DM group (P < 0.01) and 0.88 in the non-DM group (P < 0.01). The r values of the relation between (a/A)PO2 and (A-a)PO2 were -0.68 (P < 0.00) and -0.84 (P < 0.01), while those for the respiratory index were -0.87 (P < 0.01), and -0.93 (P < 0.01), respectively. Thus, pulmonary oxygen transfer was compromised before and after CABG in the DM group compared to the non-DM group. Moreover, the PaO2/FIO2, being the simplest pulmonary gas exchange index to calculate, was a reliable substitute for the (a/A)PO2 ratio during the early postoperative management of CABG patients.
Seki
S
S
Department of Acute Medicine, Okayama University School of Medicine, Japan.
Yoshida
H
H
Ooba
O
O
Teramoto
S
S
Komoto
Y
Y
D001026:Coronary Artery Bypass; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000601:surgery*; D010100:Oxygen / Q000378:metabolism*; D011659:Pulmonary Gas Exchange
D010100:Oxygen