严格血糖控制对瓣膜置换术后脏器功能及预后的影响

目的 观察严格血糖控制对体外循环下瓣膜置换术后脏器功能以及预后的影响.方法 245例瓣膜置换术病人作为强化治疗组从手术开始即行强化胰岛素治疗,将血糖严格控制于3.9-8.3mmol/L;并以早期265例血糖控制在10.0-11.1 mmol/L的常规治疗病人作为对照.瓣膜置换术后检测病人的肝、肾功能并进行心脏功能评估,同时记录呼吸机辅助通气时间、ICU停留时间、术后住院天数、院内感染病死率.结果 两组病例的一般情况无明显差异.强化治疗组术后峰值谷丙转氨酶>80 U/L、谷草转氨酶>80U/L、肌酐>221 umol/L及尿素氮>19.3 mmol/L的病人例数明显减少,与常规治疗组比差异有统计学意义,并明显缩短了呼吸机辅助通气时间和术后住院天数(P<0.05);ICU停留时间虽有所减少,院内感染率和病死率有所下降,但差异无统计学意义.结论 瓣膜置换手术中严格血糖控制可显著改善病人术后的肝、肾功能及缩短呼吸机辅助通气时间和术后住院天数,改善预后.

Effects of strict glycemic control on organs function and prognosis of patients undergoing valve replacement under cardiopulmonary bypass

Objective To observe the effects of strict gtycemic control on organ function and prognosis of patients undergoing valve replacement under cardiopulmonary, bypass. Methods The non-diabetic patients undergoing valve repot in our depart-ment between October 2006 and May 2007 were selected and assigned to intensive therapy group ( IT, n = 245) and received strict gly-cemic control after the initiation of surgery. And those non-diabetic patients undergoing valve replacement but without strict glycemic control between December 2005 and September 2006 were assigned to routine therapy group (RT, n = 265) as controls. The blood glucose in BT group was maintained at 180 - 200 mg/dl, whereas the glucose in IT group was at 70 - 150 mg/dl. Liver and renal functions were measured and heart function assessment was performed after the surgery. Moreover, the time on ventilator, length of stay in ICU, length of postoperativehospital stay,in-hospital infection rate and mortality were recorded. Results A total of 510 pa-tients were enrolled into the present study and there were no significant differences in general data between IT and RT groups. After valve replacement, the numbers of patients with the peak ALT higher than 80 U/L, peak AST higher than 80 U/L, peak creatinine higher than 221 umol/L and peak urea nitrogen higher than 19.3 mmol/L were decreased, and there were significant differences be-tween the two groups (all P <0.05). Compared with RT group, strict glycemic control markedly shorten the time on ventilator and length of postoperative hospital stay (both P<0.05). Although the length of stay in ICU, in-hospital infection rate and mortality were decreased, the difference was not significant. Conclusion Strict glycemic control may significantly improve the damaged liver and re-nal function, and shorten the time on ventilator and length of postoperative hospital stay, leading to an improved prognosis.