胰岛素强化治疗对心脏直视术预后影响研究  

Effect of intensive insulin therapy on patients undergoing open heart surgery with cardiopulmonary bypass and its mechanism

作　　者：林静[1] 章渭方[1] 王国彬[1] 方俊君[1] 

机构地区：[1]浙江大学医学院附属第一医院SICU,杭州市310003

出　　处：《临床合理用药杂志》2016年第20期15-16,12,共3页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的对胰岛素强化治疗对体外循环心脏直视手术预后影响及其机制进行分析。方法选取2014年7~12月的行非糖尿病体外循环下心脏直视手术患者100例,随机分为胰岛素强化治疗组（强化组）和常规治疗组（常规组）各50例。比较2组患者手术麻醉前和入SICU后0h、6h、12h、24h、48h的血糖和血浆胰岛素水平以及患者的预后情况,并对其作用机制进行探讨。结果强化组血糖水平在相同时间节点一直低于常规组,血糖始终维持在4~10mmol/L水平。而常规组胰岛素水平在手术后上升,并且于入SICU6h（T3）时达高峰,随后下降;胰岛素强化组的胰岛素水平在手术后入SICU即刻比常规组高（P〈0.05）。相比常规组,通过胰岛素强化治疗能够促进ICU留滞时间及患者术后呼吸机辅助时间显著缩短（P〈0.05）,2组院内感染率和病死率无显著差异。结论胰岛素强化治疗可改善体外循环心脏直视术患者术后恢复情况。Objective Study the effect and mechanism of intensive insulin therapy on patients undergoing open heart surgery with cardiopulmonary bypass. Methods 100 nondiabetic patients undergoing open heart surgery with cardiopulmonary bypass were randomly divided into two groups： one with intensive insulin therapy（ 50 patients） and the other with conventional treatment（ 50 patients）. The blood glucose and plasma insulin levels of patients were measured before anesthesia and 0h,6h,12 h,24h and 48 h after the patients were sent to SICU and the Results of these two groups were compared. The mechanism of intensive insulin therapy was discussed. Results Plasma insulin level of the intensive insulin therapy group is much higher than that of the conventional treatment group（ P〈0. 05 or P〈0. 01）. Intensive insulin therapy can reduce mechanical ventilation time and shorten postoperative ICU stay（ P〈0. 05）. Conclusion Intensive insulin therapy can improve the recovery of patients undergoing open heart surgery with cardiopulmonary bypass.

关 键 词：体外循环 心脏直视术 胰岛素强化治疗 

分 类 号：R654.2[医药卫生—外科学]