浅低温心脏跳动中瓣膜置换手术对空腹血糖受损患者胰岛素抵抗的影响

目的研究浅低温心脏跳动中瓣膜置换手术对空腹血糖受损患者胰岛素抵抗的影响。方法选择择期行体外循环(CPB)人工瓣膜置换手术的空腹血糖受损的风湿性心脏病患者30例,根据患者手术方式分为停跳组与不停跳组,停跳组在中度低温心脏停跳下完成心脏瓣膜置换手术,不停跳组在浅低温心脏跳动中完成手术。分别于手术前、麻醉诱导后、CPB开始后30 min、停CPB时、CPB后2 h和术后第1、3、5天共8时间点采集血样,检测空腹血糖、胰岛素和肿瘤坏死因子-α(TNF-α)浓度变化,并计算胰岛素抵抗指数。结果两组患者手术前和麻醉诱导后各指标差异无统计学意义,停跳组空腹血糖、胰岛素抵抗指数和TNF-α水平在CPB开始后30min至术后第3天较CPB前升高(P<0.05),不停跳组CPB开始后30 min至术后第1天较CPB前升高(P<0.05),两组间比较在CPB开始后30 min至术后第3天时差异有统计学意义(P<0.05);两组患者胰岛素水平在CPB开始后30 min至术后第1天较CPB前显著升高(P<0.05),不停跳组浓度较停跳组低(P<0.05)。结论在空腹血糖受损的患者使用心脏不停跳技术可以减轻机体炎症反应,有助于缓解胰岛素抵抗,维护葡萄糖代谢的稳态。

Effect of on-pump beating-heart technique in patients with fasting plasma impairment undergoing valve replacement with cardiopulmonary bypass on insulin resistance

Objective To investigate the effect of on-pump beating-heart technique on insulin resistance in patients with fasting plasma impairment undergoing valve replacement with cardiopulmonary bypass(CPB).Methods Thirty patients with fasting plasma impairment undergoing elective artificial heart valve replacements with CPB were divided into control group and beating-heart group(n=15 each).While the conventional approach was used for 15 patients in control group,the heart was kept empty and beating throughout the operation in beating-heart group.In all patients,blood samples were collected before surgery,before CPB,30 min after CPB,at end of CPB,2 h after end of CPB,and on the 1st,3rd and 5th day after surgery.Fasting plasma glucose,fasting insulin,and tumor necrosis factor-alpha(TNF-α) were assessed.In addition,homeostatic model assessment of insulin resistance(HOMA-IR) was carried out.Results There was no significant difference in all parameters between the two groups before surgery and after induction of anesthesia.In both groups,comparing with baseline,significant elevation of plasma fasting glucose,fasting insulin,and TNF-α during CPB.Compared to control group,these elevations were significantly alleviated in beating-heart group(P<0.05).In addition,the fasting plasma glucose,fasting insulin,TNF-α and HOMA-IR were significantly earlier recovered in beating-heart group than those in control group.Conclusion On-pump beating-heart technique can alleviate the inflammatory response thus reduce glucose metabolism disorder and insulin resistance in patients with fasting plasma impairment.