非心脏术后应激性高血糖对心脏疾病患者心肌功能的影响  

The effect of stress-related hyperglycemia on myocardial function of patients with cardiac disease after non-cardiac surgery

作　　者：章宝云 赵擎宇[1] 何新荣[1] 顾葆春[1] 李燕娴[1] 李欢[1] 

机构地区：[1]华南肿瘤学国家重点实验室,中山大学肿瘤防治中心重症医学科,广东广州510060

出　　处：《中国中西医结合急救杂志》2015年第4期342-346,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：卫生部卫生科技发展中心基金（卫技WH2011-01-02）

摘　　要：目的探讨非心脏手术后应激性高血糖对心脏疾病患者心肌功能的影响。方法回顾性分析中山大学肿瘤防治中心重症医学科收治211例接受胸部或腹部手术的非心脏手术患者的临床资料。根据患者术后3d内平均血糖水平和既往有无心血管疾病分为无高血糖（血糖≤10mmol／L）无心血管疾病组（HG0CV0组），无高血糖有心血管疾病组（HG0CV1组），有高血糖（血糖〉10mmol／L）无心血管疾病组（HG1CV0组），有高血糖有心血管疾组（HG1CV1组）。观察各组血糖与超敏心肌肌钙蛋白I（hs—cTnI）水平、B型钠尿肽（BNP）及心肌酶谱天冬氨酸氨基转移酶（AST）、肌酸激酶（CK）、肌酸激酶同工酶（CK—MB）、乳酸脱氢酶（LDH）、乳酸脱氢酶同工酶（LDH-1）、肌红蛋白（MYO）、α-羟丁酸脱氢酶（HBDH）的相关性。结果211例患者术后血糖均明显高于术前（mmol／L：8．7±0．2比5．7±0．2，P〈0．05），术后血糖〉6．1mmol／L的患者占84．8％（179例）。HG0CV0组术后血糖与MYO、AST水平呈正相关[r值分别为0．193、0．307，95％可信区间（95％C1）分别为0．010—0．362、0．096～0．479，P值分别为0．038、0．003]，与hs—cTnI、BNP、LDH、LDH-1、HBDH、CK、CK—MB均无相关性（均P〉0．05）；HG0CV1组术后血糖与hs—cTnI水平呈负相关（r=-0．609，95％CI为-0．810- -0．264，P=0．001），与BNP、MYO、AST、LDH、LDH-1、HBDH、CK、CK—MB均无相关性（均P〉0．05）；HG1CV0组术后血糖水平与hs-cTnI、BNP、MYO、AST、LDH、LDH—1、HBDH、CK、CK—MB均无相关性（均P〉0．05）；HG1CV1组术后血糖与hs—cTnI水平呈正相关（r=0．837，95％CI为0．476—0．984，P=0．001），与BNP、MYO、AST、LDH、LDH-1、HBDH、CK、CK—MB均无相关性（均P〉0．05）。结论非心脏手术后早期应激性高血糖对心脏疾病患者心肌功能可能有保护作用。Objective To investigate the effect of stress-related hyperglycemia on myocardial function of patients with cardiac disorder after non-cardiac surgery. Methods The clinical data of 211 patients having undergone thoracic or abdominal operations in Department of Critical Care Medicine of Sun Yat-sen University Cancer Center were retrospectively analyzed. According to the postoperative average blood glucose level in the following 3 days after surgery and the patients＇ history of cardiac disorder, they were divided into four groups： without hyperglycemia （blood glucose ≤ 10 retool/L） and cardiac disorder group （HGoCV0 group）, without hyperglycemia but with cardiac disorder group （HG0CV1 group）, with hyperglycemia （blood glucose 〉 10 retool/L） but without cardiac disorder group （HG1CV0 group） and with hyperglycemia and cardiac disorder group （HG1CV1 group）. The correlations between the blood glucose and each level of the following items： high-sensitivity cardiac troponin I （hs-cTnI）, brain natriuretic peptide （BNP）, myocardial zymogram aspartate aminotransferase （AST）, creatine kinase （CK）, MB isoenzyme of creatine kinase （CK-MB）, lactic dehydrogenase （LDH）, lactic dehydrogenase isoenzyme （LDH-1）, myoglobin （MYO）, α- hydroxybutyrate dehydrogenase （HBDH） in each group were analyzed. Results The postoperative blood glucose levels of all 211 patients were significantly higher than those before operation （retool/L： 8.7 ± 0.2 vs. 5.7 ± 0.2, P 〈 0.05）, and the blood glucose level more than 6.1 mmol/L in postoperative 179 patients accounted for 84.8% of the total. In HG0CV0 group, the postoperative blood glucose level was positively correlated with MYO and AST [r values were 0.193, 0.307; 95% confidence intervals （95%CI） were 0.010 - 0.362, 0.096 - 0.479; P values were 0.038, 0.003]. There were no correlations between postoperative blood glucose level and hs-cTnI, BNP, LDH, LDH-1, HBDH, CK and CK-MB （all P 〉 0.05）. In HG0CV1 group, the

关 键 词：非心脏手术 心脏疾病 心肌功能 应激性高血糖 超敏心肌肌钙蛋白I 

分 类 号：R619.9[医药卫生—外科学]