Intensive Insulin Therapy and Glycemic Control to Alleviate Acute Lung in Jury in Cardiac Surgery under Cardiopulmonary Bypass

摘要

Aim and objective Insulin has been shown to have anti-inflammatory effects and also reducingthe systemic inflammation during cardiopulmonary bypass (CPB), whereashyperglycemia is known to increase the proinflammatory cytokines. In thisstudy we aimed to assess the effect of Intensive Insulin Therapy(IIT) oncardiopulmonary bypass induced acute lung injury during cardiac surgeries.
　　 Methods Patients (n=40) undergoing elective cardiac surgery with medianstemotomy under cardiopulmonary bypass were selected and wererandomly divided int0 2 groups, group C and group T. Group C (n=20) wasthe control group of the study and did not receive any intensive insulintherapy. Group IIT (n=20) was the Intensive Insulin Therapy with patientsreceiving insulin therapy throughout the operation according to the ALGIPprotocol. Bio markers: High Mobility Group Box-1, Tumor NecrosisFactor-alpha, Neutrophil Elastase, and Myeloperoxidase levels weremeasured at different timing point.
　　 Results Bio markers levels were found to be lower in group IIT compared to groupC. There was a significant decrease in the blood markers at two timingpoints(T2 and T3) in group IIT. High Mobility Group Box-l had a biphasicincrease in both groups but with values lower (p<0.05) in group IIT at 10mins(T2) and 2 hours(T3) after unclamping of aorta. The same tendencywas observed with Tumor Necrosis Factor-alpha, Neutrophil Elastase, andMyeloperoxidase levels at same timing points but with a monophasicincrease. Conclusion Our results show that Intensive Insulin Therapy has a beneficial effect onthe suppression of some of the inflammatory markers associated with acutelung injury during cardiopulmonary bypass.