胰岛素强化血糖管理对器官捐献者循环及心功能的影响  

Effect of insulin-targeted glucose therapy on hemodynamics and cardiac function in organ donors

作　　者：窦晓婧[1] 王清平[1] 张玮晔[2] 王金山[2] 翁亦齐[1] 喻文立[1] Dou Xiaojing;Wang Qingping;Zhang Weiye;Wang Jinshan;Weng Yiqi;Yu Wenli(Department of Anesthesiology,Tianjin First Center Hospital,Tianjin 300192,China;The Second Department of the ICU,Tianjin First Center Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院麻醉科,天津300192 [2]天津市第一中心医院重症二科,天津300192

出　　处：《中华器官移植杂志》2022年第3期156-160,共5页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金面上项目(82072219);天津市卫生健康科技项目(ZC20052)。

摘　　要：目的探讨胰岛素强化血糖管理对器官捐献者循环及心功能的影响。方法选取2019年1~12月期间天津市第一中心医院维护的脑死亡器官捐献者作为研究对象,根据数字随机法分成胰岛素强化治疗组(强化组,30例)和对照组(30例)。强化组将血糖控制在4.4~6.1 mmol/L,对照组血糖控制在6.2~10.0 mmol/L。记录维护期间每次血糖值及每日胰岛素用量,同时比较两组入院时和捐献时的心功能指标以及血清炎性因子浓度。结果维护期间强化组血糖低于对照组[(5.1±0.6)mmol/L比(8.2±1.5)mmol/L,P<0.05],胰岛素用量高于对照组[(9.5±3.2)U/h比(5.8±1.5)U/h,P<0.05];捐献时,强化组心动周期效率(CCE)、左心室收缩指数(DP/DTmax)和左室射血分数(LVEF)高于对照组;血清肌钙蛋白I(cTnI)、N末端血浆脑利钠肽前体(NT-pro-BNP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和高迁移率族蛋白B1(HMGB1)的浓度以及血管活性药物评分(VIS)均低于对照组(均P<0.05)。强化组心脏捐献比率高于对照组(30%比16.7%,P<0.05)。结论强化胰岛素治疗目标血糖管理可减轻器官捐献者的炎性反应,减轻心肌损伤及心肌抑制,稳定血流动力学,增加心脏捐献率。Objective To explore the effect of intensive insulin therapy on hemodynamics and cardiac function in organ donors.Methods A total of 60 organ donors were randomly divided into two groups of intensive insulin therapy(IIT)and control(30cases each group).Blood glucose was adjusted at 6.2~10.0 mmol/L in control group and 4.4~6.1 mmol/L in IIT group.Blood glucose and insulin dosage during maintenance were recorded.Cardiac function values as well as serum inflammatory factor concentrations at admission and during donation were compared between two groups.Results During maintenance,blood glucose was significantly lower in IIT group than that in control group[(5.1±0.6)vs(8.2±1.5)mmol/L,P<0.05]and insulin dosage was higher than that in control group[(9.5±3.2)vs(5.8±1.5)U/h,P<0.05].As compared with control group,cardiac cycle efficiency(CCE),maximal rate of elevated pressure(DP/DTmax)and left ventricular ejection fraction(LVEF)in were significantly higher in IIT group than those of control group.And serum cardiac troponin I(cTnI),N-terminal B-type natriuretic peptide(NT-Pro-BNP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and high mobility group box-1 protein(HMGB1)as well as vasoactive-inotropic score(VIS)were significantly lower than those in control group(P<0.05).As compared with control group,cardiac donation rate of IIT group was significantly higher(30%vs 16.7%,P<0.05).Conclusions Intensive insulin therapy and blood glucose control may blunt inflammatory response in organ donors,lessen myocardial injury and myocardial depression,stabilize hemodynamics and boost the rate of cardiac donation.

关 键 词：器官捐献 胰岛素 血糖 

分 类 号：R617[医药卫生—外科学]