胰岛素治疗对体外循环心脏手术患者红细胞糖代谢和脂质过氧化的影响  

Effects of insulin therapy on erythrocyte glucose metabolism and lipid peroxidation in patients undergoing heart valve replacements with cardiopulmonary bypass

作　　者：马亚飞[1] 冯毅[2] 贾可源[1] 郭仲辉[1] 魏利娟[1] 陈小莉[1] 

机构地区：[1]河南科技大学附属第一医院心外科麻醉组,洛阳市471000 [2]河南科技大学附属第一医院儿科,洛阳市471000

出　　处：《实用医学杂志》2014年第2期287-289,共3页The Journal of Practical Medicine

摘　　要：目的：探讨术前和术后胰岛素治疗对体外循环（CPB）心脏瓣膜置换手术患者红细胞糖代谢和脂质过氧化的影响。方法：60例拟行体外循环心脏瓣膜置换手术患者，随机分为常规治疗组（cT组）和胰岛素治疗组（IT组），每组30例。IT组术中和术后血糖水平在4．7～6．1mmol／L。分别于麻醉诱导后、CPB前、CPB结束、手术结束、术后第1天、术后第2天时收集红细胞，检测磷酸果糖激酶（PFK）、葡萄糖-6-磷酸脱氢酶（G-6PD）、醛糖还原酶（AR）活性以及红细胞脂质过氧化物（ELPO）浓度和红细胞谷胱甘肽（EGSH）活性。结果：IT组CPB开始后各时间点G-6PD、AR、ELPO水平明显低于对照组，PFK、ESOD活性在CPB开始后各时间点明显高于对照组（P〈0．05），并显著缩短了患者的呼吸机辅助通气时间和ICU停留时间（P〈0．05）。结论：术中和术后胰岛素治疗可以明显改善红细胞糖代谢功能，提高红细胞的抗氧化能力，减轻细胞脂质过氧化损伤，缩短患者的呼吸机辅助通气时间和ICU停留时间。Objective To investigate the protective effect of intraoperative and postoperative insulin therapy on erythrocyte glucose metabolism and lipid peroxidation in patients undergoing heart valve replacements with eardiopulmonary bypass （CPB）. Method Sixty patients undergoing elective heart valve replacements with CPB were randomly divided into control group （n = 30） and insulin treatment group（n = 30）. In control group received insulin infusion when their glucose levels were higher than 11.1 mmol/L; insulin was infused constantly in insulin treatment group according to the Aalst Glycemia Insulin Protocol（ALGIP） to control the intraoperative and postoperative blood glucose levels in 4.7 - 6.1 mmol/L. The erythrocyte phosphofructokinase （PFK）, glucose-6-phosphate dehydrogenase （G-6PD）, aldose reductase （AR） activity,etythrocyte lipid peroxidation （ELPO） and glutathione （EGSH） were determined after induction of anesthesia, at the initiation of CPB, at the termination of CPB, leaving operation room, the first postoperative day,the second postoperative day. Results The levels of G-6PD, AR, ELPO were significantly lower in the insulin treatment group than those in the control group while PFK, ESOD level were markedly higher than those in the control group （P 〈 0.05）. And significantly shorten the patient＇s mechanical ventilation and ICU stay. Conclusion Intraoperative and postoperative insulin therapy can significantly improve erythrocyte glucose metabolism, enhancement the antioxidant capacity of erythrocytes, alleviate lipid peroxidation, improve the prognosis.

关 键 词：胰岛素 体外循环 红细胞 糖代谢异常 脂质过氧化 

分 类 号：R654.1[医药卫生—外科学]