蛋白酶抑制剂对体外循环瓣膜置换术围术期胰岛素抵抗的影响  

Effect of protease inhibitors on perioperative insulin resistance during cardiopulmonary bypass heart valve replacement

作　　者：江继端 蒋鹏飞[1] JIANG Jiduan;JIANG Pengfei(The Second Department of Hand Anesthesia,Suining Central Hospital in Sicuan Province,Suining629000,China)

机构地区：[1]四川省遂宁市中心医院手麻二部,四川遂宁629000

出　　处：《中国现代医生》2020年第31期110-113,共4页China Modern Doctor

摘　　要：目的研究体外循环心脏瓣膜置换术中蛋白酶抑制剂的应用对围术期胰岛素抵抗的影响。方法选取2018年5月~2019年5月于我院行体外循环瓣膜置换术患者40例,按随机数字表法分为乌司他丁组(U组)和对照组(C组),每组各20例。术中U组于CPB前给予乌司他丁1.2×104 U/kg静滴,C组予等量生理盐水。两组分别于CPB前(T1)、CPB 15 min(T2)、主动脉开放后15 min(T3)、CPB后15 min(T4)、手术结束时(T5)5个时间点,抽取桡动脉血及冠状静脉窦血,比较两组间相应时间点血糖、胰岛素、血浆TNF-α浓度、心肌葡萄糖净摄取量、胰岛素敏感指数的变化及其之间的关系。结果C组患者血糖(桡动脉血糖和冠状静脉窦血糖)自CPB开始后明显增高,U组患者血糖自主动脉开放后15 min显著增高,两组患者血糖均于CPB后15 min达峰值;与CPB前比较,两组患者CPB期间和CPB后胰岛素、TNF-α浓度较CPB前均显著增加。T2~T5,U组血糖、胰岛素及TNF-α浓度均显著低于C组相应时点;心肌葡萄糖净摄取量于CPB 15 min时开始下降,说明心肌在CPB期间对葡萄糖的摄取和利用发生障碍;胰岛素敏感指数均显著降低,差异有统计学意义(P<0.001)。U组心肌葡萄糖净摄取量明显高于C组相应时点,表明U组患者心肌对葡萄糖的利用较C组有明显改善,差异有统计学意义(P<0.05)。结论体外循环心脏瓣膜置换术患者应用蛋白酶抑制剂可显著降低TNF-α的分泌,减轻胰岛素抵抗,增加心肌对葡萄糖的摄取、利用,有利于术中心肌保护。Objective To study the effect of protease inhibitors on perioperative insulin resistance during cardiopulmonary bypass heart valve replacement.Methods Forty patients who underwent cardiopulmonary bypass heart valve replacement in our hospital from May 2018 to May 2019 were selected and divided into ulinastatin group(group U)and control group(group C)according to the random number table method,with 20 cases in each group.During the operation,group U was given ulinastatin 1.2×104 U/kg intravenously before CPB,and group C was given the same amount of normal saline.Radial artery blood and coronary sinus blood of the two groups were taken at 5 time points before CPB(T1),CPB 15 min(T2),15 min after the aorta opening(T3),15 min after CPB(T4),and at the end of the operation(T5).The changes of blood glucose,insulin,plasma TNF-αconcentration,net myocardial glucose uptake,insulin sensitivity index and their relationship between the two groups at the corresponding time point were compared.Results The blood glucose(radial artery blood glucose and coronary sinus blood glucose)in group C was significantly increased after CPB,and that in group U was significantly increased at the 15 min afteropening of autonomic artery.The blood glucose of both groups reached the peak at 15 min after CPB.Compared with that before CPB,the concentrations of insulin and TNF-αduring and after CPB in both groups were significantly increased compared with those before CPB.The concentrations of blood glucose,insulin and TNF-αin group U were significantly lower than those in group C at T2-T5.The net glucose uptake of myocardium began to decrease at 15 min after CPB,which indicated that glucose uptake and utilization were impaired during CPB.The insulin sensitivity index was significantly reduced,and the difference was statistically significant(P<0.001).The net glucose uptake of group u was significantly higher than that of group C at the corresponding time point,indicating that the utilization of glucose in group u was significantly improved compare

关 键 词：蛋白酶抑制剂 体外循环 肿瘤坏死因子-Α 胰岛素抵抗 

分 类 号：R654.2[医药卫生—外科学]