不同糖代谢状态冠心病患者CCABG围手术期胰岛素抵抗的变化

目的 观察不同糖代谢状态的冠状动脉粥样硬化性心脏病(冠心病)患者体外循环冠状动脉旁路移植术(CCABG)围手术期及胰岛素抵抗的变化.方法 以择期行CCABG的60例冠心病患者作为研究对象,根据术前糖代谢状况分为空腹血糖正常组(正常对照组,n=20)、空腹血糖受损组(n=20)和糖尿病组(n=20).各组患者于围手术期各时点(术前、麻醉后体外循环前、体外循环开始后5 min、复温后10 min、鱼精蛋白中和后5 min、体外循环后2 h、术后第3天和第7天)采集血样检测空腹血糖和胰岛素水平,稳态模型评估法计算胰岛素抵抗指数(HOMA-IR).结果 空腹血糖受损组和糖尿病组手术前HOMA-IR均显著高于正常对照组(P＜0.05).正常对照组和空腹血糖受损组体外循环开始后5 min及其后各时点空腹血糖水平和HOMA-IR均较手术前显著升高(P＜0.05);在糖尿病组,体外循环开始后5 min空腹血糖水平及HOMA-IR均较手术前显著升高(P＜0.05),但术后第7天的空腹血糖水平及术后第3、7天的HOMA-IR与手术前比较差异均无统计学意义(P＞0.05).结论 CCABG围手术期冠心病患者的空腹血糖浓度升高,胰岛素抵抗加重.了解患者术前的糖代谢状况,有利于采取积极且合理的措施纠正糖代谢失衡及改善胰岛素抵抗.

Changes of perioperative insulin resistance during CCABG in patients with coronary atherosclerotic heart disease and different status of glucose metabolism

Objective To observe the changes of perioperative insulin resistance during conventional coronary artery bypass grafting (CCABG) in patients with coronary atherosclerotic heart disease and different status of glucose metabolism. Methods Sixty patients with coronary atherosclerotic heart disease undergoing CCABG were divided into normal fasting plasma glucose group (normal control goup, n=20), fasting plasma glucose impairment group (n=20) and diabetes mellitus group (n=20) according to status of glucose metabolism before operation. Blood samples were taken from each group at different perioperative time points (before surgery, immediately after anesthesia, 5 min after the beginning of cardiopulmonary bypass, 10 min after rewarming, 5 min after protamine neutralization, 2 h after cardiopulmonary bypass, the third day after surgery and the seventh day surgery), the levels of fasting plasma glucose and fasting insulin were detected, and homeostatic model assessment of insulin resistance (HOMA-IR) was calculated. Results HOMA-IR of fasting plasma glucose impairment group and diabetes mellitus group was significantly higher than that of normal control group before surgery (P<0.05). Fasting plasma glucose levels and HOMA-IR of time points from 5 min after the beginning of cardiopulmonary bypass to the seventh day after surgery were significantly higher than those before surgery in normal control group and fasting plasma glucose impairment group (P<0.05). Fasting plasma glucose levels and HOMA-IR 5 min after the beginning of cardiopulmonary bypass were significantly higher than those before surgery in diabetes mellitus group (P<0.05), while there was no significant difference between fasting plasma glucose level of the seventh day after surgery and that before surgery and between HOMA-IR of the third day after surgery and the seventh day after surgery and that before surgery in diabetes mellitus group (P>0.05). Conclusion Fasting plasma glucose and insulin resistance increase during CCABG in patients with coronary artery disease, and the information of status of glucose metabolism before surgery may help to manage glucose metabolism disorder and improve insulin resistance.