Aalst胰岛素输注方案调控心脏瓣膜术中血糖水平的研究

目的探讨成人非糖尿病患者心脏瓣膜手术中应用Aalst胰岛素输注方案调控血糖水平的临床效果。方法选择100例成人择期行心脏瓣膜置换手术的非糖尿病患者随机分为试验组和对照组。试验组从麻醉诱导后开始持续输注胰岛素；对照组输注生理盐水直至手术结束时。比较麻醉诱导后、体外循环（CPB）后主动脉阻断前、主动脉阻断后5rain、二次灌注停搏液后5min、复温开始、复温结束、停CPB前、手术结束前、术后ICU即刻血糖值，观察变化趋势以及术后恢复情况。结果①两组患者术前、术中一般情况差异均无统计学意义（P〉0．05）。②患者术中维持血糖水平均值在5．7-7．9mmol／L；与对照组相比从停搏液灌注后至手术结束实验组血糖水平均显著降低（P〈0．01）。③由于术中持续输注胰岛素，术中K^＋使用量显著增加（P〈0．01）。④试验组与对照组相比，术后ICU停留时间缩短（P〈0．05），术后住院时间显著缩短（P〈0．01），术后心律失常发生率降低（P〈0．05）；术后感染发生率降低（P〈0．05）。结论成人非糖尿病患者心脏瓣膜手术围术期血糖升高对预后不利，应用Aalst胰岛素输注方案可以简单、方便、安全、有效的控制术中血糖小于8．3mmol／L。控制术中血糖有利于降低术后感染和心律失常的发生率，缩短住院时间，可以改善预后。但是应密切注意血钾水平的变化。

Efficiency of aalst glycemia insulin protocol on perioperative blood glucose control for patients undergoing cardiac valvular surgery

Objective To determine the effect of Aalst glycemia insulin protocol on perioperative blood glucose control for adult patients without metabolism diabetes undergoing cardiac valvular surgery.Methods One hundred adult patients without metabolism diabetes undergoing selective cardiac valvular surgery were divided randomly into two groups: experimental group and control group.Insulin was infused constantly in experimental group according to Aalst glycemia insulin protocol from the point of immediate after anesthesia induction to the point of leaving operation room.The blood glucose was compared among two groups at following time point: anesthesia induction,beginning of cardiopulmonary bypass,aortic cross-clamping,second infusing of cold blood cardioplegia,rewarming,termination of rewarming,termination of cardiopulmonary bypass,leaving operation room,entering ICU.Results 1.There were no significant differences in patients’ general conditions between two groups(P>0.05).The postoperative length of stay in ICU and hospital of experimental group was significant shorter than control group(P<0.05 and P<0.01).Compeared with that in the control group,the incidence of postoperative arrhythmia and infection were lower in the experimental group(P<0.05).2.Blood glucose of experimental group was controlled within the average range of 5.7-7.9 mmol/L during surgery.Comparing with control group,blood glucose significantly decreased during the period from aortic cross-clamping to patients’ leaving operation room(P<0.01).3.Comparing with control group,dosage of potassium chloride was increased significantly(P<0.01).Conclusion Aalst Glycemia Insulin Protocol can control perioperative blood glucose below 8.3 mmol/L for adult patients without metabolism diabetes undergoing cardiac valvular surgery feasibly,safely,and effectively.It is benefit to a better outcome for patients undergoing cardiac valvular surgery by decreasing the incidence of postoperative infection and arrhythmia,shortening the length of stay in ICU and hospital.But hypopotassemia should be avoided.