心脏瓣膜手术中适度血糖控制对术后康复进程的影响  

Influence of moderate blood glucose control during heart valve surgery on a postoperative rehabilitation process

作　　者：林丽珠[1] 李东涛[2] 范海鸥[1] 梁友君[1] Lin Lizhu;Li Dongtao;Fan Haiou;Liang Youjun(Department of Anesthesia,the First People's Hospital of Qinzhou,Guangxi 535099,China)

机构地区：[1]钦州市第一人民医院麻醉科,广西壮族自治区535099 [2]钦州市第一人民医院胸心外科,广西壮族自治区535099

出　　处：《中国体外循环杂志》2023年第1期37-42,共6页Chinese Journal of Extracorporeal Circulation

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z20200172)。

摘　　要：目的探讨适度血糖控制对心脏瓣膜手术患者术后康复进程和临床预后的影响。方法选取2018年8月至2022年3月在本院心肺转流(CPB)下施行心脏瓣膜手术符合条件的患者92名,采用前瞻性队列研究的方式,根据术中采用胰岛素持续静脉泵注控制血糖情况分为两组:A组和B组。A组57例,为血糖控制良好组,表示术中最高血糖值<10 mmol/L;B组35例,为血糖控制不良组,表示术中最高血糖值≥10 mmol/L。分析两组血糖控制情况与术后康复进程和临床预后的关系。结果两组患者在年龄、女性比例、体重指数、脑梗塞病史、冠心病病史、高血压病史、慢性肝肾病史、急诊入院比例、心房颤动发生率、术前后左室射血分数、心胸比值、纽约心脏协会心功能分级≥Ⅲ级比例、术中后悬浮红细胞输注率、术中后血浆输注率、CPB时间、主动脉阻断时间、手术方式、术后气管导管留置时间、术后ICU停留时间方面差异无统计学意义(P>0.05);A组术中总出血量明显高于B组(P<0.05);A组术后住院时间短于B组(Z=-2.738,P<0.05);B组术后住院总费用明显高于A组(t=-3.232,P<0.05);两组术毕乳酸组间比较差异具有统计学差异(Z=-5.581,P<0.001),两组术毕乳酸均较CPB前明显升高(P<0.05);两组术后血糖均较术前明显升高(P<0.001),组间比较结果显示B组血糖在术后当天和术后第1天时间段高于A组(P<0.05)。结论适度血糖控制并保持血糖值<10 mmol/L与心脏瓣膜手术术后康复进程的缩短和总住院费用的减少存在相关性。Objective To investigate the effect of moderate blood glucose control on the postoperative rehabilitation process and the clinical outcome of patients with heart valve surgery.Methods A total of 92 eligible patients who underwent heart valve surgery with cardiopulomnary bypass(CPB)in our hospital from August 2018 to March 2022 were selected.In this prospective cohort study,the patients were divided into group A and group B according to the results of intraoperative continuous intravenous infusion of insulin to control blood glucose.Fifty-seven patients in group A,who had reasonable blood glucose control,showed that the highest intraoperative blood glucose value was less than 10 mmol/L.There were 35 cases in group B,the poor blood glucose control group,indicating that the highest blood glucose value during the operation was greater than or equal to 10 mmol/L.The relationship between blood glucose control and the postoperative rehabilitation process and the clinical prognosis in the two groups was analyzed.Results There were no significant differences in general data between the two groups,including age,female proportion,body mass index,history of cerebral infarction,history of coronary heart disease,history of hypertension,history of chronic liver and kidney disease,emergency admission rate,the incidence of atrial fibrillation,left ventricular ejection fraction before and after surgery,cardiothoracic ratio,cardiac function class(NYHA class)≥grade III ration,intraoperative and postoperative suspended red blood cell and plasma infusion rate,CPB time,aortic crossclamp time,surgical method,postoperative tracheal intubation and ICU stay time(P>0.05).The total intraoperative blood loss in group A was significantly higher than that in group B(P<0.05).Postoperative hospital stay in group A was shorter than that in group B(Z=-2.738,P<0.05);The total cost of hospitalization after operation in group B was significantly higher than that in group A(t=-3.232,P<0.05).There was a statistically significant difference between the

关 键 词：血糖控制 心脏瓣膜手术 心肺转流 乳酸 住院费用 康复进程 

分 类 号：R654.2[医药卫生—外科学]