先天性心脏病外科手术后的血糖控制

目的:观察先天性心脏病外科术后血糖控制对并发症发生率及预后的影响。方法: 156例先天性心脏病患儿被随机分为加强控制组（A组），积极控制组（B组），一般控制组（C组）。患儿入ICU后每2 h查静脉血糖，A组、B组、C组分别在血糖超过8.3 mmol/L、10.0 mmol/L、15.0 mmol/L静脉给予胰岛素治疗。比较3组患儿术后72 h血白细胞计数、呼吸道感染发生率、伤口感染发生率、低血糖发生率、手术死亡率、ICU滞留时间、住院时间。结果: A组的低血糖发生率明显高于B组和C组，A组和B组的72 h血白细胞计数、肺部感染发生率、伤口感染发生率、手术死亡率、ICU滞留时间、住院时间均无统计学差异。C组的72 h血白细胞计数、肺部感染发生率明显高于A组和B组。结论: 术后过高的血糖能增加患儿的白细胞计数及肺部感染发生率。 但过于积极的控制血糖并不能改善患者的疗效，反而会增加低血糖的发生率。

Postoperative glycemic control in pediatric cardiac surgery patients

AIM: To compare postoperative glucose levels for prediction of adverse outcomes.METHODS: One hundred and fifty-six patients undergoing open-heart surgery were randomized into groups A,B and C.Arterial blood glucose concentrations were determined every 2 h after surgery.Insulin therapy was administrated if blood glucose concentrations in groups A,B and C were >8.3 mmol/L,>10.0 mmol/L and >15.0 mmol/L,respectively.Parameters including white blood count,pulmonary infection rate,wound infection rate,hypoglycemic rate,mortality,length of ICU stay,and length of hospital stay were compared after operation.RESULTS: Hypoglycemic rate in group A was statistically higher than in groups B and C.No statistical difference was observed in white blood count,pulmonary infection rate,wound infection rate,mortality,length of ICU stay,and length of hospital stay between groups A and B.White blood count and pulmonary infection rate in group C was statistically higher than in groups A and B.CONCLUSION: Severe hyperglycemia can increase white blood count and pulmonary infection rate.Rather than improving survival and reducing morbidity,"too-tight" glycemic control increases the hypoglycemic rate.