胰岛素对体外循环心脏术后应激性高血糖患者的疗效

目的：观察胰岛素控制血糖对心脏术后发生应激性高血糖患者预后的疗效。方法：选择80例体外循环心脏术后发生应激性高血糖的非糖尿病患者，随机分为A组（40例）和B组（40例），给予胰岛素静脉泵人，每2h监测1次血糖，A组控制血糖：8．4～11．1mmol／L，B组控制血糖：4．4～8．3mmol／L，每日记录急性生理功能和慢性健康状况评分系统（APACHE）Ⅲ评分及相关监测指标。结果：与A组比较，B组呼吸功能不全（25．O％比7．5％），。肾功能不全（12．5％比2．5％）、中枢神经功能不全（15．0％比5．0％）、院内感染率（62．5％比20．0％）、死亡率（10．0％比2．5％）明显降低（P均〈0．05），较之A组，B组APACHEⅢ评分自术后第1d起均明显降低（P均〈0．05）；住ICU时间（11．3±8．9）d比（6．6±3．7）d]、使用呼吸机时间（41．2±3．2）h比（18．5±4．5）h]明显减少（P均〈0．05）。结论：胰岛素控制体外循环心脏手术后危重患者血糖在4．4～8．3mmol／L水平，可保护脏器功能，减少院内感染，降低死亡率，改善预后。

Effect of insulin on prognosis of patients with stress hyperglycemia after cardiac operation with cardiopulmonary bypass

Objective： To observe effect of control blood glucose with insulin on prognosis of patients with stress hyperglycemia after cardiac operation with cardiopulmonary bypass （CPB）. Methods： A total of 80 patients without diabetes mellitus, who occurred stress hyperglycemia after cardiac operation with CPB, were randomly divided into A group （n=40） and B group （n=40）. All patients received insulin using venous pump, and blood glucose was meas- ured every two hours. Level of blood glucose of A group was maintained in 8.4±11.1 mmol/L and B group in 4.4± 8.3 mmol/L. Scores of acute physiology and chronic health evaluation （APACHE） Ⅲ and relative indicators were recorded. Results： Compared with A group, there were significant decrease in rates of respiratory dysfunction （25.0% vs. 7.5%）, renal dysfunction （12.5% vs. 2.5%）, central nerval dysfunction （15.0% vs. 5.0%）, nosoco- mial infections （62.5% vs. 20.0%） and mortality （10.0% vs. 2.5%）, P〈0.05 all scores of APACHE Ⅲ significantly lower since first day after operation （P%0.05 all）, admission time in ICU （11.3±8.9） d vs. （6.6±3.7） d] and time of using respirator （41.2±3.2） h vs. （18.5±4.5） hi significant decreased in B group, P〈0.05 both. Conclusion： Maintain blood glucose in 4.4±8.3 mmol/L with insulin can protect organic function, reduce nosocomial infections , mortality rate, and improve prognosis in patients with stress hyperglycemia after cardiac operation with cardiopulmonary bypass.