体外循环瓣膜置换术中持续胰岛素泵入的临床应用

目的研究胰岛素对体外循环下非糖尿病瓣膜置换术患者的心肌保护作用。方法2010年3月2日～2011年3月5日，选择156例择期首次在体外循环下行瓣膜置换术患者。随机分为实验组80例，对照组76例；实验组术中静脉持续泵入胰岛素，使血糖术中控制在4．0～11．0mmol／L，术后在3．9～12．0mmol／L；对照组术中血糖变化不作处理，术后控制在3．9～12．0mmol／L。分别于切皮前（T1）、主动脉开放后2h（T2）、主动脉开放后12h（T3）、主动脉开放后24h（T4）、主动脉开放后48h（T5）抽取桡动脉血，测量肌钙蛋白I（eTnI）水平。记录体外循环时间、主动脉阻断时间、心脏复跳情况及术后48h正性肌力药物的应用情况。结果（1）两组患者的体外循环时间、主动脉阻断时间均差异无统计学意义（P〉0．05）。（2）主动脉开放后心脏自动复跳率实验组为75．00％，对照组为27．63％，实验组自动复跳率明显高于对照组（P〈0．05）。（3）cTnI术前两组差异无统计学意义（P〉0．05），术后各时间点均较术前显著升高（P〈0．05）。各个时刻实验组cTnI含量均显著低于对照组（P〈0．05）。（4）术后48h内正性肌力药物应用，实验组与对照组相比多巴胺用量、肾上腺素用量差异有统计学意义（P〈0．05）。结论对体外循环下非糖尿病瓣膜置换术患者进行持续胰岛素泵入治疗，能减轻心肌缺血再灌注损伤，减少术后血管活性药物用量，发挥心肌保护作用。

Clinical application of continuous infusion of insulin in cardiopulmonary valve replacement surgery

Objective To study the myocardial protection effect of insulin on non-diabetes mellitus patients with cardiopulmonary valve replacement surgery.Methods One hundred and fifty-six cases of patients with cardiopulmonary valve replacement surgery from March 2,2010 to March 5,2011 were selected,and randomly divided into experimental group(n = 80) and control group(n = 76).The experimental group was treated with continuous infusion of insulin,and the blood sugar level was controlled between 4.0 to 11.0 mmol/L intraoperation,3.9 to 12.0 mmol/L postoperation.The control group was not disposed of blood sugar change intraoperation,and which was controlled between 3.9 to 12.0 mmol/L postoperation.Radial artery blood was collected before cutting skin(T1),2(T2),12(T3),24(T4),48 h(T5) after aortic open,and the cTnI level was detected.The extracorporeal circulation time,aortic blocking time,heart re-jump condition and positive inotropic drugs application 48 h after operation were recorded.Results(1)The extracorporeal circulation time and aortic blocking time of the two groups had no significant differences(P > 0.05).(2)The heart re-jump rate after aortic open of the experimental group was 75.00%,which was 27.63% of the control group,the heart re-jump rate of the experimental group was significant higher than the control group(P < 0.05).(3)The cTnI level before operation of the two groups had no significant differences(P > 0.05),but the cTnI level after operation was significant higher than before operation(P < 0.05),and the cTnI levels of different time points after operation of the experimental group were significant lower than those of the control group(P < 0.05).(4)The condition of positive inotropic drugs application 48 hours after operation showed that the Dopamine dosage and Adrenaline dosage of the two groups had significant differences(P < 0.05).Conclusion Continuous infusion of insulin in the treatment of non-diabetes mellitus patients with cardiopulmonary valve replacement surgery can reduce the myocardial ischemia and reperfusion injury,reduce postoperative blood vessels active drug consumption,and play a myocardial protection effect.