应用胰岛素调控心脏瓣膜术中血糖水平探究.docVIP

应用胰岛素调控心脏瓣膜术中血糖水平探究 　【摘要】 目的 探讨成人非糖尿病患者心脏瓣膜手术中应用胰岛素持续输注调控血糖水平的临床效果。方法 选择60例成人择期行心脏瓣膜手术的非糖尿病患者随机分为胰岛素组和对照组。胰岛素组从麻醉诱导后开始持续输注胰岛素至手术结束时，比较心脏瓣膜手术中从麻醉诱导后、体外循环(CPB)前、CPB主动脉阻断后10 min、二次灌注停搏液后10 min、复温后10 min、主动脉开放后10 min、停CPB后10 min、手术结束时血糖值和血乳酸值，观察变化趋势;同时对术后两组患者血糖和乳酸水平变化进行观察。结果 ① 两组患者一般情况差异均无统计学意义(Pgt;0.05)，胰岛素组与对照组相比，术后住院时间显著缩短(Plt;0.01);术后房颤发生率降低(36.7% vs 53.3%，Plt;0.05);术后感染发生率降低(6.7% vs 20%，Plt;0.05);② 胰岛素组术中维持血糖水平在6.1～8.3 mmol/L,与对照组相比血糖显著降低(Plt;0.01),CPB中血糖峰值降低(7.85±1.57) vs (9.72±3.09)mmol/L，(Plt;0.05)。③ 两组随着手术时间延长血乳酸水平均明显升高，并发生高乳酸血症。胰岛素组与对照组相比血乳酸水平降低(Plt;0.05)。④ 术后两组均未控制血糖，胰岛素组术后ICU 1 h和24 h血糖水平与对照组比较明显降低(Plt;0.05)，血乳酸水平两组差异无统计学意义(Pgt;0.05)。结论 成人非糖尿病患者心脏瓣膜手术围术期血糖升高对预后不利。应用胰岛素输注方案控制术中血糖，可以维持血糖在6.1～8.3 mmol/L。控制心脏瓣膜手术中血糖对控制术中血乳酸水平和术后血糖有利，有利于降低术后感染率，缩短住院时间，对改善预后有利。 【关键词】 胰岛素;血糖;血乳酸;体外循环;心脏瓣膜手术 　　Abstract: OBJECTIVE To study the effect of continuous insulin infusion on perioperative blood glucose control in adult nondiabetic patients undergoing cardiac valvular surgery. METHODS Sixty adult nondiabetic patients undergoing selective cardiac valvular surgery were divided randomly into two groups: Insulin Group and Control Group. Insulin was infused constantly in Insulin Group from the point of immediate after anesthesia induction to the point of leaving operation room. The blood glucose and lactate were compared among two groups at following point(anesthesia induction, before cardiopulmonary bypass (CPB), aortic cross-clamping(ACC), second infusing of cold blood cardioplegia, rewarming, clamp off, termination of CPB, leaving operating room, ICU 1 h to 48 h. RESULTS 1.There were no significant differences in patient’s general conditions between two groups (Pgt;0.05). The postoperative length of stay in ICU of group insulin was significant shorter than Group Control (Plt;0.01), the incidence of postoperative atrial fibrillation (AF) are decreased(36.7% vs 53.3%，Plt;0.05), and the incidence of postoperative infection are also decreased(6.7% vs 20%，Plt;0.05). 2. Blood glucos