糖尿病患者心脏手术的体外循环管理  

Management of Extracorporeal Circulation during Cardiac Surgery in Patients with Diabetes

作　　者：鲍玫[1] 郭斌[1] 董天剑[1] 范玉红[1] 

机构地区：[1]解放军白求恩国际和平医院心胸外科,河北石家庄050082

出　　处：《中国体外循环杂志》2007年第2期105-106,共2页Chinese Journal of Extracorporeal Circulation

摘　　要：目的 探讨糖尿病患者心脏手术的体外循环方法。方法 采用浅低温、高流量、高灌注压的方法,并于麻醉后定时检测血糖,以普通胰岛素0.15-0.3 u/kg控制血糖在8-12 mmol/L,避免使用儿茶酚胺、皮质醇等升高血糖的药物。结果 体外循环40 min时血糖升至（10±1.1）mmol/L,单次或多次应用胰岛素后,转中血糖控制在（11.3±2.1）mmol/L,除2例患者外,均自动复跳,未发生糖尿病相关并发症,全部康复出院。结论 对于伴有糖尿病的心脏病患者,术前对其进行全面评估,减少或避免体外循环的应激和损伤,平稳控制血糖变化,是保证手术成功的关键之一。OBJECTIVE To explore the perfusion methods for cardiac surgery in patients with diabetes. METHODS The blood glucose was monitored every 20minites after the induction of anesthesia till the end of extracorporeal circulation（ECC）. The insulin （from 0.15 to 0.3u/kg） was infused to control the blood glucose at from 8 to 12mmol/L. Epinephrine,norepinephrine and cortiso that can elevate the blood glucose were avoided. RESULTS The blood glucose rose to （ 10 ± 1.1 ） mmol/L at the 40 minutes after ECC, whereas it was controlled to （ 11.3 ± 2.1 ） mmol/L by adequate insulin. All patients resumed sinus rhythm spontaneously, except for two who were easily defibrillated. There were no deaths or complications. CONCLUSION The patients with diabetes should be evaluated before they undergoing cardiac surgery. The factors can affect patients during ECC must be avoided, and the blood glucose should be strictly controlled below 12mmol/L.

关 键 词：糖尿病 体外循环 

分 类 号：R654.1[医药卫生—外科学]