强化胰岛素治疗对心肺转流术患者心血管功能的影响

目的 探讨强化胰岛素治疗对心肺转流术(CPB)患者血浆一氧化氮(NO)和内皮缩血管肽1(ET-1)表达的影响.方法 36例心脏瓣膜置换术患者随机分为常规治疗组(RT,n=18)和强化胰岛素治疗组(IT,n=18).RT组术中血糖变化不作处理,术后控制在13.9 mmol/L以内;IT组血糖术中控制在3.9～10.0 mmol/L,术后在3.9～6.1 mmol/L.分别于术前、CPB开始时及CPB结束后不同时间点测量两组患者的血浆NO和ET-1水平.结果 RT组血浆NO含量在CPB开始时即略有下降,CPB结束时达到最低(P＜0.05);此后回升,CPB结束后48 h时接近术前水平.RT组血浆ET-1含量在CPB开始时即开始升高,CPB结束时达高峰(P＜0.01);此后下降,至CPB结束后24 h时降至术前水平.IT组各时间点的血浆NO和ET-1含量与术前比较均无差异.结论 强化胰岛素治疗可减小CPB心脏手术中所致NO和ET-1的变化幅度,对心血管功能具有保护作用.

Effects of intensive insulin therapy on plasma nitric oxide and endothelin-1 levels in patients undergoing cardiac surgery under cardiopulmonary bypass

OBJECTIVE: To investigate the effects of intensive insulin therapy on plasma nitric oxide (NO) and endothelin-1 (ET-1) levels in patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB). METHODS: A total of 36 patients were randomly assigned to routine therapy (RT) group and intensive insulin therapy (IT) group, with 18 patients in each group. The blood glucose levels during surgery were maintained at 3.9 to 10.0 mmol/L and those after surgery at 3.9 to 6.1 mmol/L in IT group, whereas patients in RT group didn't undergo the treatment of controlling glucose levels during operation and maintained below 13.9 mmoVL after operation. Levels of plasma NO and ET-1 in both groups were respectively measured before surgical anesthesia, at the initiation of CPB, and 0 h, 4 h, 12 h, 24 h and 48 h after the termination of CPB. RESULTS: In RT group, plasma NO concentration was decreased since the initiation of CPB [from (68.2 +/- 16.3) micromol/L to (67.8 +/- 8.4) micromol/L] and reached the trough at the termination of CPB [ (60.0 +/- 10.2) micromol/L, P < 0.05 compared with that before anesthesia]. Then it began to increase and neared to the preoperational level 48 h after the termination of CPB. In contrast, plasma ET-1 concentration was increased since the initiation of CPB [from (62.2 +/- 10.2) ng/L to (68.3 +/- 10.8) ng/L] and reached the peak at the termination of CPB [ (112.5 +/- 18.6) ng/L, P < 0.01 compared with that before anesthesia]. Then it began to decrease and reached the preoperational level 24 h after the termination of CPB. In IT group, however, the changes of NO and ET-1 levels at different time points during CPB and thereafter didn't reach the significance as compared with those before anesthesia. CONCLUSIONS: Intensive insulin therapy may relieve the changes of CPB-induced NO and ET-1 levels during cardiovascular surgery, which suggests its protective effects on cardiovascular function.