先天性心脏病婴儿术后不同控糖方案的控制效果及最佳控制水平  

Control effect and the best blood glucose control level of different glucose control scheme in infants with congenital heart diseases after surgery

作　　者：陈妙云[1] 高向民[2] 朱卫中[1] 曾嵘[1] 

机构地区：[1]广东省心血管病研究所心外科,广东省华南结构性心脏病重点实验室,广东省人民医院(广东省医学科学院),广州510100 [2]广东省心血管病研究所流行病学研究室,广东省华南结构性心脏病重点实验室,广东省人民医院(广东省医学科学院),广州510100

出　　处：《岭南心血管病杂志》2017年第4期444-447,485,共5页South China Journal of Cardiovascular Diseases

基　　金：“十二五”国家科技支撑计划重点项目(项目编号:2011BAI11B22)

摘　　要：目的研究胰岛素及非胰岛素控糖不同方案对先天性心脏病(先心病)术后婴儿的血糖控制效果及最佳控制水平。方法纳入广东省人民医院100例行先心病矫治术婴儿作为研究对象,采用随机数字表法分为胰岛素组(A组)和非胰岛素组(B组),各50例,每组随机分为(A1~A3)和(B1~B3)三亚组,各组目标值达到:A1低水平组(≤8.3 mmol/L)、A2中水平组(8.3~15.0 mmol/L)、A3高水平组(15.0~18.0 mmol/L);B1低水平组(≤8.3 mmol/L)、B2中水平组(8.3~15.0 mmol/L)、B3高水平组(15.0~18.0 mmol/L)。A组给予胰岛素干预治疗,B组给予非胰岛素降糖治疗。观察两组干预治疗方案对先心病患儿矫治术后血糖浓度的控制效果,比较不同血糖浓度患儿72 h后乳酸(LA)、谷丙转氨酶(ALT)、血肌酐(Cr)、C-反应蛋白(CRP)浓度及白细胞(WBC)计数,观察肺部感染、低血糖发生率及预后差异。结果 A1组血糖浓度和血糖达标时间为(6.51±0.54)mmol/L和(5.24±0.57)h,显著低于B1组,差异有统计学意义(P<0.05)。A2组血糖浓度与血糖达标时间为(12.62±1.8)mmol/L和(4.91±0.39)h,显著低于B2组,差异有统计学意义(P<0.05)。A2组重症监护病房(intensivecare unite,ICU)停留时间显著低于A3组,B2组ICU停留时间显著低于B3组,差异均有统计学意义(P<0.05)。A、B组内各亚组间乳酸、谷丙转氨酶、血肌酐、C-反应蛋白浓度及白细胞计数比较,差异有统计学意义(P<0.05)。A、B组间乳酸、谷丙转氨酶、血肌酐、C-反应蛋白浓度及白细胞计数比较,差异无统计学意义(P>0.05)。A2组肺部感染发生率低于A1、A3组;B2组各并发症发生率低于B1、B3组;B组不同血糖控制水平患者低血糖发生率比较,差异有统计学意义(P<0.05);各组内并发症发生率比较,差异无统计学意义(P>0.05);A、B两组间并发症发生率比较,亦差异无统计学意义(P>0.05)。A、B两组均无患者病死。结论胰岛素用于先心病术后血糖控制效果显著,能迅速改�Objectives To study the effect of insulin and non-insulin glucose control scheme and the best bloodglucose control level in infants with congenital heart disease（CHD）after surgery. Methods One-hundred infants,who underwent correction of CHD in Guangdong General Hospital,were participated in this study. All the patients were randomly divided into two groups according to random number table method：A group（insulin control group）and Bgroup（non-insulin control group）,50 cases in each. Each group was randomly divided into three subgroups（A1-A3;B1-B3）. Each target value reached：A1 group of low level（less than 8.3 mmol/L）,A2 group of middle level（8.3-15.0 mmol/L）,A3 group of high level（15.0-18.0 mmol/L）;B1 group of low level（less than 8.3 mmol/L）,B2 groupof middle level（8.3-15.0 mmol/L B3）,B3 group of high level（15.0-18.0 mmol/L）. Children in A group were treatedusing the glycemic control therapy with insulin. Children in B group received a glycemic control therapy without insulin.Femoral vein blood was drew in 72 hours after the operation to check concentrations of lactic acid（LA）,alanine aminotransferase（ALT）,creatinine（Cr）,C-reactive protein（CRP）and white blood cell（WBC）count. Duration of intensivecare unite（ICU）,incidence of lung infection,incidence of hypoglycemia and mortality were measured and compared.Results Concentration of blood glucose and blood glucose standar time in A1 group were（6.51±0.54）mmol/L and（5.24±0.57）h,significantly lower than those of B1 group（P〈0.05）;Concentration of blood glucose and blood glucosestandar time in A2 group were（12.62±1.8）mmol/L and（4.91±0.39）h,significantly lower than those of B2 group,the differences were statistically significant（P〈0.05）. Duration of ICU in A2 group was significantly lower than that inA3 group;and duration of ICU in B2 group was significantly lower than that in B3 group,the differences werestatistically significant（P〈0.05）. Differences of concentrations of

关 键 词：先天性心脏病 胰岛素 血糖 控制水平 

分 类 号：R541.7[医药卫生—心血管疾病]