体外循环和非体外循环下冠脉搭桥术高血压患者血糖变化的比较

A Clinical Study on Variation of the BG in Hypertensive Patients Undergoing CABG under Extracorporeal Circulation

目的探讨体外循环对高血压患者冠脉搭桥术围手术期血糖变化及胰岛素抵抗的影响。方法高血压择期行冠脉搭桥术患者40例,体外循环组(CABG组)和非体外循环组(OPCAB组)各20例,测定两组患者术前(麻醉前)、术中(手术切皮后1h、2h、3h)、术后(术后2h、术后第一天清晨)的血糖、血浆胰岛素和胰岛素敏感指数。结果两组患者术中、术后各时相血糖值均高于术前(P<0.05),并且术后第一天CABG组血糖值明显高于OPCAB组(P<0.01)。两组患者血清胰岛素水平术中无明显变化,术后第一天显著上升(P<0.01)。胰岛素敏感指数术中逐渐下降,术后第一天降至最低(P<0.01),术后第一天CABG组的胰岛素敏感指数明显低于OPCAB组(P<0.05)。结论体外循环加重了高血压患者冠脉搭桥术后的高血糖和胰岛素抵抗。

Objective To study the effect of extracorporeal circulation on perioperative variation of the blood glucose and insulin resistance in patients with hypertension undergoing CABG. Methods 20 patients were under extracorporeal circulation and 20 patients under nonextracorporeal circulation. Blood concentrations of glucose （BG） and insulin （INS） were measured before anesthesia, 1 h, 2 h and 3 h of the operation, 2 h after the operation and on the first morning after the operation. Results Blood glucose of the patients in group CABG was higher than that of group OPCAB. Sensitivity of insulin decreased significantly in group CABG than in group OPCAB, Conclusion The increased insulin resistance and hyperglycose in patients with hypertension undergoing CABG are caused by the extracorporeal circulation.