体外循环后胰腺功能的变化

目的观察体外循环下行心脏瓣膜替换术患者胰腺内、外分泌功能的变化,研究其对围手术期治疗的意义。方法采集１６例心脏瓣膜病患者８个时相点全血,测定血糖、乳酸、胰岛素、Ｃ肽、淀粉酶及脂肪酶,分析其变化规律。结果术后围手术期显现出高糖血症和高乳酸血症,二者呈现显著正相关（Ｐ＝０００５）,其峰值于术日１９点,至术后第３日缓慢降到基线水平。胰岛素水平于８个观测时相点测定平均数值基本处于正常水平,仅第３日晨显示轻度升高。血中Ｃ肽水平一直处在稍高于正常范围,在术日１９点达高峰,接近正常倍值。血中淀粉酶与脂肪酶的统计平均数基本处于正常值范围,仅术后第４日脂肪酶稍高出正常值。本组淀粉酶正常１２例,异常４例（２５％）：单纯高淀粉酶血症２例,淀粉酶与脂肪酶均升高者２例（１６％）。高脂肪酶血症８例（５０％）。结论体外循环对围手术期胰腺功能产生病理生理学影响,表现出内、外分泌功能均有一定的改变

The changes of pancreatic function after cardiopulmonary bypass

Objective To evaluate the changes of endocrine and exocrine pancreatic function in patients who underwent heart valve replacement under cardiopulmonary bypass(CPB) in order to optimally conside clinical management perioperatively. Method Sixteen patients with heart valve disease were selected. Serum glucose, lactate, insulin, C peptide,amylase and lipase were measured. Result Hyperglycemia and hyperlactacemia were noted after CPB and peaked at 19:00 on the operative day. Their changes were correctly correlatied. Serum glucose and lactate retturned to the baseline level on the third postoperative day. The average level of serum insulin were normal,but higher on the third postoperative day. However, the level of serum C peptide was higher than the baseline. It doubled the baseline level at 19:00 on the operative day. The average level of serum amylase and lipase was normal, except the higher level of serum lipase on the fourth postoperative day.In our group, 12 patients had normal serum amylase level perioperatively, and 4 increased serum amylase level (25%), among them 2 patients accompanied with hyperlipasimia(16%). There were 8 patients with hyperlipasimia(50%). Conclusion The endocrine and exocrine pancreatic functions were influenced by CPB and did produce pathophysiologic changes.