严格血糖控制对体外循环术后致炎性细胞因子的影响

Effects of srict glycemic control on proinflammatory cytokines and prognosis of patients undergoing cardiac surgery under cardiacpulmonary bypass

目的观察严格血糖控制对体外循环术后致炎细胞因子的影响。方法将2006-2008年共64例患者随机分为两组,A组作为强化治疗组从手术开始即行强化胰岛素治疗,将血糖严格控制于3.9～8.3 mmol/L。B组作为对照组将血糖控制在11.1 mmol/L以下。体外循环术后检测血液IL-6、TNF-α浓度,同时记录体外循环时间、术后呼吸机辅助时间、ICU停留时间、住院天数。结果两组病例的一般情况无明显差异。A组IL-6、TNF-α浓度较B组明显降低,并明显缩短了呼吸机辅助时间、住院天数,差异有统计学意义。结论体外循环术中、术后应用胰岛素严格控制血糖可降低机体炎症反应以及呼吸机辅助时间、住院天数,改善预后。

Objective To observe the impact of srict glycemic control on cells induced by inflammatory cytokines which after cardiopulmonary bypass. Methods The non-diabetic patients undergoing cardiac surgery under cardiacpulmonary bypass in our department from 2006 to 2008 were selected and assigned to intensive therapy group（ group A, n = 32 ）and received strict glycemic contral after the initiation of surgery. And those who undergoing cardiac surgery but without strict glycemic control were assigned to routine therapy group（ group B, n = 32）as controls. The blood glucose in group A was maintained at 180-200 mg/dl, whereas the glucose in group B was at 70-150 mg/dl. The concentration of IL-6 and TNF-αwere measured after the surgery. Moreover, the time on ventilator,length of stay in ICU,length of postoperativehospital stay were recorded. Results There were no significant differences in general data between two groups. The concentration of IL-6 and TNF-αin group A was decreased, and there were significant differences between the two groups （ both P 〈 0.05 ）. Compared with group B, strict glycemic control markedly shorten the time on ventilator and length of postoperative hospital stay（ both P 〈 0. 05）. Conclusion Strict glycemic control may significantly mitigate the systemic inflammatory response, and shorten the time on ventilator and length of postoperative hospital stay, leading to an improved prognosis.