Portland胰岛素输注方案对非糖尿病患者在非体外循环冠状动脉旁路移植术中的应激性高血糖的影响

目的:观察Portland胰岛素输注方案对非糖尿病患者在非体外循环冠状动脉旁路移植术(OPCAB)中的应激性高血糖(SHG)的控制效果。方法:将140例拟行OPCAB的非糖尿病患者随机分为2组。分别接受Portland胰岛素输注方案(试验组)或生理盐水输注(对照组)。观察术中血糖、血钾、脑电双频谱指数(BIS)值,记录围手术期正性肌力药应用、肾、脑功能障碍的情况。结果:试验组在开胸后、搭桥前、搭桥后及关胸后的血糖值明显低于对照组(P<0.01),试验组围手术期正性肌力药应用、肾、脑功能障碍、呼吸机使用率均少于对照组(P<0.01)。结论:Portland胰岛素输注方案用于OPCAB可以有效的控制血糖,对心、脑、肾有保护作用。

Effect of Portland protocol on stress hyperglycemia in nondiabetic patients undergoing off-pump coronary artery bypass grafting

Objective:To observe the effect of Portland protocol on stress hyperglycemia in nondiabetic patients undergoing off-pump coronary artery bypass grafting.Method:A prospective,randomized,double-blind,placebo-controlled trial was conducted at a single-center hospital performing cardiac surgery.One hundred and forty nondiabetic adult patients undergoing first-time elective multivessel coronary artery bypass grafting were prospectively randomize to receive Portland protocol or placebo,record the blood glucose,potassium,BIS,inotrope requirement and myocardial injury.Result:The blood glucose levels of group A was lower than that of group B during operation(P<0.01).However inotrope requirement and myocardial injury in group A were more than that of group B.Conclusion:Portland protocol can be used safely and effectively for the blood glucose control and maintenance of glucose homeostasis during OPCAB.Insulin therapy improves operative cardiovascular performance,reduces inotrope requirement,and reduce myocardial injury.