心脏瓣膜置换术中应用胰岛素调控血糖水平的初步研究  

Effect of Insulin on Blood Glucose Control for Patients undergoing Cardiac Valve Replacement with Cardiopulmonary Bypass

作　　者：张斌[1] 吴继红[1] 刘燕萍[1] 

机构地区：[1]宁夏医科大学总医院心脏外科,银川750004

出　　处：《宁夏医科大学学报》2013年第1期44-48,共5页Journal of Ningxia Medical University

摘　　要：目的探讨体外循环术中应用胰岛素持续输注控制血糖水平对患者术后TNF-α浓度、肝、肾功能和近期疗效的影响,为临床上更合理地控制体外循环术中血糖水平提供一定的临床依据。方法将2010年3月至10月于宁夏医科大学总医院行体外循环下瓣膜置换术的患者(36例)随机分为胰岛素组(18例)和对照组(18例)。胰岛素组从麻醉诱导后开始以微量泵持续泵注胰岛素至手术结束时,控制术中血糖水平在3.9～6.1mmol.L-1,术后未作血糖控制;对照组患者术中、术后均未控制血糖。检测患者术中、术后不同时间点血糖、血乳酸、血钾和血浆TNF-α的浓度,检查患者术后的肝肾功能,并记录患者术中体外循环时间、主动脉阻断时间、术后呼吸机辅助通气时间、ICU停留时间、住院时间、房颤发生率、感染率及死亡率。结果胰岛素组患者体外循环术中血糖、血乳酸水平明显低于对照组,术后1 h血糖水平低于对照组,血乳酸水平两组差异无统计学意义;胰岛素组患者血浆TNF-α浓度明显降低于对照组,患者术后肝、肾功能指标均优于对照组,且术后ICU停留时间与对照组相比明显缩短,但两组患者术后呼吸机辅助呼吸时间、感染率、房颤发生率和住院时间无明显差异。结论①应用胰岛素持续输注控制体外循环瓣膜置换术中血糖水平于3.9～6.1mmol.L-1,有利于控制术中血乳酸和血糖水平,对术后血糖控制也有一定的作用。②应用胰岛素控制患者术中血糖水平可以降低患者血浆TNF-α浓度,减轻患者全身炎性反应,对患者的肝、肾功能有一定的保护作用,但是对患者近期疗效无明显影响。Objective To investigate the effect of organ function and prognosis of patients after cardiac valve replacement with CPB who used continuous insulin infusion to control blood glucose during CPB. MethodsThirty six patients （from 2010.3 to 2010.10） undergoing cardiac valve replacement with CPB were divided randomly into two groups： Insulin Group （n = 18） and Control Group （n = 18）. In Insulin Group, insulinwas infused constantly into central venous with microperfusion pump from the point of immediate after anesthesia induction to the end of the operation. The blood glucose of insulin group during the operation ranged from3.9 mmol·L^-1 to 6.1 mmol·L^-1, but had not been controlled after the operation. The control Group had not control the blood glucose all the time. The blood glucose, blood lactate , blood potassium, value plasma levelsof TNF - α were detected at different time during and after the operation. After the operation, all the patients were given assessment of liver and kidney functions of them were determined. To record the CPB time, aorticcross - clamp time, mechanical ventilation time, ICU monitoring time, hospital stay time, complication formation rate and mortality. Results Compared with control group, the blood glucose and blood lactate level ofthe insulin group decreased significantly during the CPB. Compared with control group, the plasma levels of TNF - α of the insulin groups were increased significantly during and after the CPB. Compared with controlgroup, the insulin group got a better score for the mark of liver and kidney functions and the ICU monitoring time were significantly shorter. However, breathing machines auxiliary breath of time, patients postoperativeinfection, AF incidence and hospitalization time showed no significant difference between two groups. Conclusion ①Infusing insulin constantly during the CPB, which let the blood glucose of insulin group during theoperation ranged from 3.9 mmol·L^-1 to 6.1 mmol·L^-1, has salutary effects on the blood lactate durin

关 键 词：胰岛素 血乳酸 炎性细胞因子 体外循环 

分 类 号：R654.2[医药卫生—外科学]