体外循环围术期血糖及相关激素的变化

Alterations of plasma glucose and relative hormones during perioperative CPB

观察围心脏手术期糖代谢及相关激素的变化规律和影响因素。方法用放免法测定４０例先心病麻醉前、术中和术后的血浆胰岛素、胰高血糖素、皮质醇和生长激素的浓度，同时观察血糖的变化。结果ＣＰＢ围术期血糖成倍增高，急剧升高的生长激素可能是高血糖的一个重要因素。发绀型先心病、ＣＰＢ时间≥６０ｍｉｎ、降温、术后输糖和使用多巴胺者，血糖均明显增高。ＣＰＢ早期，胰岛素分泌受抑制，ＣＰＢ后期及术后一天，胰岛素反应明显。ＣＰＢ中及术后，胰高血糖素和皮质醇降低。结论体外循环围术期血糖及相关激素变化剧烈，麻醉和ＣＰＢ技术等有待于进一步改善。

Objective To observe changes and affecting factors of glucose metabolism and relative hormones during heart surgery. Methods The concentration of plasma insulin , glucagon, cortisol and growth h ormone (GH ) were measured with radioimmunoassay in 40 patients with congenital heart diseases during perioperative CPB, and the blood glucose was observed at the same time .Results: The blood glucose increased twice as much during and after CPB as that before anesthesia. The sharp increase of GH was one of main factors in high glucose. Cyanotic congential heart disease, , CPB time≥60min, hypothermia ,sugar infusion in postoperation and usage of dopamine induced high blood glucose . The se - cretion of insulin was depressed in early period of CPB. The insulin reaction was very strong in later period of CPB and within the first day of postoperation. The glucagon and cortisol decreased during CPB and after operation. Conclusion: The dramatic change of the plasma glucose and relative hormones during perioperative CPB suggest that the methods and techniques of anesthesia and CPB should be improved.