先心病患儿常温体外循环期间胰岛素抵抗的观察及意义

目的　本文探讨先心病患儿常温体外循环 (CPB)下胰岛素抵抗的情况。方法　 10例 CPB心内直视术患儿 ,分别在麻醉 15分钟、CPB15分钟、主动脉开放 10分钟、停机 30分钟及术后 6小时采集血样 ,测定血浆葡萄糖 (G)及胰岛素 (Ins)浓度 ,并计算胰岛素敏感性指数 [1/ (I× G) ]。结果　麻醉 15分钟时 G无明显改变 ,CPB开始后明显增高 (P<0 .0 5 ) ,至主动脉开放 10分钟后最高 (P<0 .0 1)。CPB开始后 Ins逐渐升高 (P<0 .0 5 ) ,至停机 30分钟后达到最高 (P<0 .0 1) ,术后 6小时后降低。胰岛素敏感性指数在 CPB开始后下降 (P<0 .0 5 ) ,至停机30分钟时最低 (P<0 .0 1)。结论　常温体外循环对于婴幼儿的胰腺内分泌功能无明显抑制作用 ,但在此期间胰岛素敏感性降低 ,提示 CPB期间存在胰岛素抵抗现象

Clinical study on insulin resistance of infants and young children with normothermic cardiopulmonary bypass

Objective To study the insulin resistance of infants and young children with congenital heart disease during normothermic cardiopulmonary bypass(CPB).Methods Blood samples were collected in 5 diferent time points from 10 young patients undergoing open-heart surgery with normothermic CPB. The plasma insulin and blood glucose were measured,and the insulin-sensitivity index obtained.Results The blood glucose was increased since starting CPB(P<0.05),and at its top 10min after declamping of aorta(P<0.01). The insulin was higher after starting CPB(P<0.05),and at its peak at 30min after ending CPB(P<0.01),and dropped down gradually in 6 hours after the operation.The significant decrease of insulin-sensitivity index was observed at 30min after ending CPB(P<0.01).Conclusions There is no significant inhibition on the internal secretion of pancreas of the infants and young children with normothermic CPB.But the insulin resistance can be observed during this procedure of strong stress.