小儿CPB心内直视手术对胰岛素抵抗的影响  

Insulin resistance during cardiac operations with cardiopulmonary bypass in children

作　　者：王萍[1] 房秀生[1] 

机构地区：[1]重庆医科大学临床学院麻醉科,重庆400016

出　　处：《重庆医科大学学报》2004年第5期684-686,共3页Journal of Chongqing Medical University

摘　　要：目的 :本研究旨在探讨CPB对激素、糖代谢和胰岛素抵抗的影响。方法 :19例先心病患儿分别在麻醉前、CPB前、CPB15min开放主动脉 5min、停机 2 0min采血测定血糖、胰岛素、C肽、生长激素和皮质醇 ,计算胰岛素敏感性指数和胰岛素血糖比。结果 :CPB期胰岛素、生长激素和皮质醇浓度较CPB前有显著增高 ;血糖、C肽和胰岛素血糖比也有类似变化 ,但CPB期胰岛素敏感性指数明显低于CPB前。结论 :CPB期应激激素和血糖明显增高 ,胰岛素抵抗加重 ,并且这些变化随应激刺激的加强而加强 ,CPB期胰腺 β细胞分泌功能并未被抑制。Objective:Anesthesia,surgery and cardiopulmonary bypass (CPB) are conventionally considered the major stress factors in the hormonal and metabolic responses to cardiac surgery.This study was to determine the influence of CPB on hormones,carbohydrate metabolism and insulin resistance.Methods:Blood samples were obtained from 19 patients at the following intervals:(1)before anesthesia(2)before CPB(3) 15 min after begining of CPB(4)5min after declamping of aorta(5)20min after CPB.Insulin,C-peptide,cortisol,growth hormone and blood glucose were measured.The ratio of insulin to glucose in blood(I/G) and insulin-sensitivity index [1/(I×G)] were obtained.Results:Insulin,growth hormone and cortisol were higher during and after CPB than that before CPB.Similar changes in levels of blood glucose,I/G and C-peptide were also observed,even though there was a significant decrease of insulin-sensitivity index.Conclusion:There are an obvious increase of concentrations in stress hormones and blood glucose and an aggravation of insulin resistance.All changes above do reflect the degree of surgical stress.The secretion of pancreatic beta cells is not suppressed during and after CPB.It is suggested that insulin supplement therapy may be beneficial to improve insulin resistance in the period of CPB.

关 键 词：体外循环 胰岛素抵抗 激素 胰腺Β细胞 

分 类 号：R654.1[医药卫生—外科学]