体外循环心内手术对胰腺β细胞功能的影响

Influence of open heart surgery under cardiopulmonary bypass on pancreatic beta cell function

目的:了解体外循环心内手术对胰岛β细胞功能的影响。方法:20例病人分为先天性心脏病组(先心组)10例和风湿性心脏病组(风心组)10例。分别于麻醉前、CPB前、CPB15分、松主动脉后5分、停机20分取血样,用放免法测定血浆胰岛素和C肽,用GOD-POD法测定血糖,I/G为胰岛素与血糖比值。结果:两组血糖和胰岛素浓度在CPB期间及CPB后显著高于CPB前(P<0.01);C肽浓度及I/G在CPB期间及CPB后也高于CPB前(P<0.05)。结论:CPB时胰腺β细胞功能并没有被抑制,但组织对胰岛素的敏感性降低,提示CPB期间补充外源性胰岛素有利于改善CPB中的胰岛素抵抗。

Objective:To determine the influence of cardiopulmonary bypass(CPB) on human pancreatic bate cell function. Method:Twenty patients were divided into 2 group, groupⅠ(congenital heart disease,n=10). group Ⅱ(valvular heart disease,n=10). Blood samples were obtained from 20 patients at the following intervals:before anesthesia, before CPB, 15 min following CPB, 5 min after relaxing aorta, 20 min after CPB. The plasma insulin and C-peptide levels were measured with radioimmunoassay double-antibody technique,and blood glucose level with GOD-POD method. Result:The significant increases of blood glucose and insulin levels were observed during and after CPB in both groups(P<0.01),similar changes in C-peptide level and the insulin to blood glucose ratio(I/G)were also observed(P<0.05). Conclusion:Pancreatic beta cell function is not suppressed during and after CPB,but insulin sensitivity of tissue decreases. It is suggested that insulin supplement therapy may be beneficial to improve insulin resistance following CPB.