二尖瓣置换术围术期血糖变化的研究

Clinical study of perioperative blood glucose in mitral valve replacement patients

目的探讨二尖瓣置换术围术期血糖变化规律。方法对78例二尖瓣置换术患者分别于手术前、切皮前、体外循环中、停机后、术后6h和手术次日晨6个时点取桡动脉血测定血糖。结果切皮前血糖比手术前明显升高(P<0.01),体外循环开始后进一步上升,到停机后达最高峰,手术结束后血糖开始下降,但至术后次日晨仍保持在高于术前的水平(P<0.01),差异有极显著性意义。结论二尖瓣置换术中,病人血糖发生了明显变化,密切监测血糖浓度,预防高糖血症、低血糖反应,对提高手术的成功率起到十分重要的作用。

Objective To investigate the changes of perioperative blood glucose during mitral valve replacement. Methods Blood glucose was determined in 78 patients with rheumatic heart disease receiving mitral valve replacement before operation, before skin incision, during cardiopulmonary bypass （CPB） , the end of CPB, 6 hour after operation and next morning after operation respectively. Results The blood glucose before skin incision increased obviously（P 〈 0. 01 ） and maintained after CPB onset （P 〉 0.05 ）. With the prolongation of CPB duration, blood glucose gradually increased to the peak before stopping. After operation, blood glucose gradually decreased, but higher next morning than that before operation（P 〈 0.01 ）. The difference compared with those at other time points was significant （all P 〈 0. 01 ）. Conclusions Blood glucose changed obviously in patients with rheumatic heart disease during operation of mitral value replacement. Therefore, perioperative monitoring of blood glucose should be emphasized, and it is very important for prevention of hyperglycemia and hypoglycemia.