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|本期目录/Table of Contents|

先天性心脏病外科手术后的血糖控制

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2012年第4期
页码:
493-495
栏目:
临床研究
出版日期:
2012-08-25

文章信息/Info

Title:
Postoperative glycemic control in pediatric cardiac surgery patients
作者:
柳 梅1; 郑 萍2; 尚小珂2
(1.武汉市第一医院ICU，湖北 武汉 430000;2.武汉亚洲心脏病医院心血管外科，湖北 武汉 430022)
Author(s):
LIU Mei1;  ZHENG Ping2;  SHANG Xiao-ke2
(1.ICU Department, Wuhan First Hospital, Wuhan 430000, Hubei, China; 2.Cardiovascular Surgery, Wuhan Asia Heart Hospital, Wuhan 430022, Hubei, China)
关键词:
心脏手术; 血糖; 胰岛素
Keywords:
cardiac surgery;  blood glucose;  insulin
分类号:
R541.1；R654.1
DOI:
-
文献标识码:
A
摘要:
目的:观察先天性心脏病外科术后血糖控制对并发症发生率及预后的影响。方法： 156例先天性心脏病患儿被随机分为加强控制组（A组），积极控制组（B组），一般控制组（C组）。患儿入ICU后每2 h查静脉血糖，A组、B组、C组分别在血糖超过8.3 mmol/L、10.0 mmol/L、15.0 mmol/L静脉给予胰岛素治疗。比较3组患儿术后72 h血白细胞计数、呼吸道感染发生率、伤口感染发生率、低血糖发生率、手术死亡率、ICU滞留时间、住院时间。结果： A组的低血糖发生率明显高于B组和C组，A组和B组的72 h血白细胞计数、肺部感染发生率、伤口感染发生率、手术死亡率、ICU滞留时间、住院时间均无统计学差异。C组的72 h血白细胞计数、肺部感染发生率明显高于A组和B组。结论： 术后过高的血糖能增加患儿的白细胞计数及肺部感染发生率。 但过于积极的控制血糖并不能改善患者的疗效，反而会增加低血糖的发生率。
Abstract:
AIM:To compare postoperative glucose levels for prediction of adverse outcomes. METHODS: One hundred and fifty-six patients undergoing open-heart surgery were randomized into groups A, B and C. Arterial blood glucose concentrations were determined every 2 h after surgery. Insulin therapy was administrated if blood glucose concentrations in groups A, B and C were >8.3 mmol/L, >10.0 mmol/L and >15.0 mmol/L, respectively. Parameters including white blood count, pulmonary infection rate, wound infection rate, hypoglycemic rate, mortality, length of ICU stay, and length of hospital stay were compared after operation. RESULTS: Hypoglycemic rate in group A was statistically higher than in groups B and C. No statistical difference was observed in white blood count, pulmonary infection rate, wound infection rate, mortality, length of ICU stay, and length of hospital stay between groups A and B. White blood count and pulmonary infection rate in group C was statistically higher than in groups A and B. CONCLUSION: Severe hyperglycemia can increase white blood count and pulmonary infection rate. Rather than improving survival and reducing morbidity, “too-tight” glycemic control increases the hypoglycemic rate.

参考文献/References

[1]Verhoeven JJ,Hokken-Koelega AC,den Brinker M,et al.Disturbance of glucose homeostasis after pediatric cardiac surgery[J].Pediatr Cardiol,2011,32(2):131-138.

[2]Hogue CW,Palin CA, Arrowsmith JF.Cardiopulmonary bypass management and neurologic outcomes. An evidence-based appraisal of current practices[J].Anesth Analg,2006,103(1):21-37.

[3]Hanazaki K,Maeda H,Okabayashi T.Relationship between perioperative glycaemic control and post operative infections[J].World J Gastroenterol,2009,15(33):4122-4125.

[4]Haga KK,McClymont KL,Clarke S,et al.The effect of tight glycaemic control,during and after cardiac surgery, on patient mortality and morbidity:A systematic review and meta-analysis[J].J Cardiothorac Surg,2011,6:3.

[5]Polito A,Thiagarajan RR,Laussen PC,et al.Association between intraoperative and earlypostoperative glucose levels and adverse outcomesafter complex congenital heart surgery[J].Circulation,2008,118(22):2235-2242.

[6]Vlasselaers D,Milants I,Desmet L,et al.Intensive insulin therapy for patients in paediatric intensive care:A prospective,randomized controlled study[J].Lancet,2009,373(9663):547-556.

[7] Rossano JW,Taylor MD,Smith EO,et al.Glycemic profile in infants who have undergone the arterial switch operation:Hyperglycemia is not associated with adverse events[J].J Thorac Cardiovasc Surg,2008,135(4):739-745.

备注/Memo

备注/Memo:
收稿日期：2011-09-07.作者简介：柳梅，硕士生Email：66799073@qq.com
更新日期/Last Update: 2012-07-20