摘要
目的探讨成人非糖尿病患者心脏瓣膜手术中应用胰岛素持续输注调控血糖水平的临床效果。方法选择60例成人择期行心脏瓣膜手术的非糖尿病患者随机分为胰岛素组和对照组。胰岛素组从麻醉诱导后开始持续输注胰岛素至手术结束时,比较心脏瓣膜手术中从麻醉诱导后、体外循环（CPB）前、CPB主动脉阻断后10 min、二次灌注停搏液后10 min、复温后10 min、主动脉开放后10 min、停CPB后10 min、手术结束时血糖值和血乳酸值,观察变化趋势; 同时对术后两组患者血糖和乳酸水平变化进行观察。结果①两组患者一般情况差异均无统计学意义（P〉0.05）,胰岛素组与对照组相比,术后住院时间显著缩短（P〈0.01）; 术后房颤发生率降低（36.7%vs 53.3%,P〈0.05）; 术后感染发生率降低（6.7%vs 20%,P〈0.05）; ②胰岛素组术中维持血糖水平在6.1～8.3 mmol/L,与对照组相比血糖显著降低（P〈0.01）,CPB中血糖峰值降低（7.85±1.57）vs（9.72±3.09）mmol/L,（P〈0.05）。③两组随着手术时间延长血乳酸水平均明显升高,并发生高乳酸血症。胰岛素组与对照组相比血乳酸水平降低（P〈0.05）。④术后两组均未控制血糖,胰岛素组术后ICU1 h和24 h血糖水平与对照组比较明显降低（P〈0.05）,血乳酸水平两组差异无统计学意义（P〉0.05）。结论成人非糖尿病患者心脏瓣膜手术围术期血糖升高对预后不利。应用胰岛素输注方案控制术中血糖,可以维持血糖在6.1～8.3 mmol/L。控制心脏瓣膜手术中血糖对控制术中血乳酸水平和术后血糖有利,有利于降低术后感染率,缩短住院时间,对改善预后有利。
OBJECTIVE To study the effect of continuous insulin infusion on perioperative blood glucose control in adult nondiabetic patients undergoing cardiac valvular surgery. METHODS Sixty adult nondiabetic patients undergoing selective cardiac valvular surgery were divided randomly into two groups： Insulin Group and Control Group. Insulin was infused constantly in Insulin Group from the point of immediate after anesthesia induction to the point of leaving operation room. The blood glucose and lactate were compared among two groups at following point（ anesthesia induction, before cardiopulmonary bypass （CPB）, aortic cross - clamping （ACC）, second infusing of cold blood cardioplegia, rewarming, clamp off, termination of CPB, leaving operating room, ICU 1 h to 48 h. RESULTS 1. There were no significant differences in patient＇s general conditions between two groups （ P 〉 0.05 ）. The postoperative length of stay in ICU of group insulin was significant shorter than Group Control （ P 〈 0.01 ）, the incidence of postoperative atrial fibrillation （AF） are decreased（36.7% vs 53.3%, P 〈 0.05）, and the incidence of postoperative infection are also decreased （6.7% vs 20% , P 〈 0.05 ）. 2. Blood glucose of Group Insulin was well controlled within the range of 6.1 - 8.3 mmol/L during surgery. Comparing with Group Control, blood glucose significantly decreased from the point of rewarming to the point of leaving operating room（ P 〈0.01 ）. The perioperative peak blood glucose also decreased （7.85 ± 1.57 vs 9.72 ± 3.09 mmol/L , P 〈 0.05）. 3. The blood lactate level of the two groups respectively raised during the surgery. Blood lactate of Group Insulin significantly decreased comparing with Group Control（ P 〈 0.05 ）. 4 Continuous insulin infusion was terminated in two groups after the patients were transfer to ICU. The blood glucose of Group Insulin was significant lower than Group Control（ P 〈 0.05 ） at 1 h and 24 h. CONCLUSION The present protocol of eontinuous insulin infusion is feasible to control periopertive blood glucose ranging from 6.1 to 8.3 mmol/L for adult nondiabetic patients undergoing cardiac valvular surgery. It is benefit to intraoperative blood lactate control and postoperative blood glucose maintaining. The incidence of postoperative infection decrease following the protocol application, the length of stay in ICU is shortened as well. It suggests that intraoperative blood glucose control is benefit to a better outcome for the patients undergoing cardiac valvular surgery.
出处
《中国体外循环杂志》
2009年第3期148-151,共4页
Chinese Journal of Extracorporeal Circulation
关键词
胰岛素
血糖
血乳酸
体外循环
心脏瓣膜手术
Insulin
Blood glucose
Blood lactate
Cardiopulmonary bypass
Cardiac valvular surgery
