胰岛素对体外循环心脏术后应激性高血糖患者的疗效

摘要

目的:观察胰岛素控制血糖对心脏术启发生应激性高血糖患者预后的疗效.方法:选择80例体外循环心脏术后发生应激性高血糖的非糖尿病患者,随机分为A组(40例)和B组(40例),给予胰岛素静脉泵入,每2h监测1次血糖,A组控制血糖:8.4～11.1mmol/L,B组控制血糖:4.4～8.3mmol/L,每日记录急性生理功能和慢性健康状况评分系统(APACHE)Ⅲ评分及相关监测指标.结果:与A组比较,B组呼吸功能不全(25.0％比7.5％),肾功能不全(12.5％比2.5％)、中枢神经功能不全(15.0％比5.0％)、院内感染率(62.5％比20.0％)、死亡率(10.0％比2.5％)明显降低(P均＜0.05),较之A组,B组APACHEⅢ评分自术后第1d起均明显降低(P均＜0.05)；住ICU时间[(11.3±8.9)d比(6.6±3.7)d]、使用呼吸机时间[(412±3.2)h比(18.5±4.5) h]明显减少(P均＜0.05).结论:胰岛素控制体外循环心脏手术后危重患者血糖在4.4～8.3mmol/L水平,可保护脏器功能,减少院内感染,降低死亡率,改善预后.%Objective: To observe effect of control blood glucose with insulin on prognosis of patients with stress hyperglycemia after cardiac operation with cardiopulmonary bypass (CPB). Methods: A total of 80 patients without diabetes mellitus, who occurred stress hyperglycemia after cardiac operation with CPB, were randomly divided into A group (n=40) and B group (n -40). All patients received insulin using venous pump, and blood glucose was measured every two hours. Level of blood glucose of A group was maintained in 8. 4-11. 1 mmol/L and B group in 4. 4~ 8. 3 mmol/L. Scores of acute physiology and chronic health evaluation (APACHE) 1 and relative indicators were recorded. Results: Compared with A group, there were significant decrease in rates of respiratory dysfunction (25.0% vs. 7.5%), renal dysfunction (12.5% vs. 2.5%), central nerval dysfunction (15.0% vs. 5.0%), nosoco-mial infections (62. 5% vs. 20. 0%) and mortality (10. 0% vs. 2. 5%) , P<0. 05 all; scores of APACHE DI significantly lower since first day after operation ( P<0. 05 all), admission time in ICU [ (11. 3±8. 9) d vs. (6. 6±3- 7) d] and time of using respirator [ (41. 2±3. 2) h vs. (18. 5 + 4. 5) h] significant decreased in B group, P<0. 05 both. Conclusion: Maintain blood glucose in 4.4~ 8. 3 mmol/L with insulin can protect organic function, reduce nosocomial infections , mortality rate, and improve prognosis in patients with stress hyperglycemia after cardiac operation with cardiopulmonary bypass.