浅低温体外循环术中血糖、胰岛素、皮质醇、胰高糖素和生长激素的变化和相关分析

Alterations of plasma glucose,insulin,cortisol,GH and glucagon levels during mild hypothermic CPB

目的 观察浅低温ＣＰＢ心脏术中血糖和应激激素的变化并分析相关性。方法 １２例行浅低温ＣＰＢ心脏手术患者。术中和机器预充使用无糖溶液。在麻醉前、ＣＰＢ前、ＣＰＢ期间和停机后采血，测定血糖和激素浓度。结果 血糖在ＣＰＢ期间明显升高（Ｐ＜ ００１）；胰岛素在麻醉后明显下降（Ｐ＜ ００５）；胰岛素和血糖的比值在ＣＰＢ期间明显下降（Ｐ＜ ００１）；皮质醇在ＣＰＢ期间比麻醉前后明显下降（Ｐ＜ ００１）；生长激素和胰高糖素在ＣＰＢ期间比麻醉前和ＣＰＢ前明显升高（（Ｐ＜ ００５）。结论 （１）浅低温ＣＰＢ成人心脏术中和机器预充使用无糖溶液是安全的；（２）在浅低温ＣＰＢ期间，胰岛素和皮质醇的分泌受到抑制，胰高糖素和生长激素的分泌明显升高；（３）浅低温ＣＰＢ术中血糖的升高与胰高糖素和生长激素的变化呈非常显著相关。

Objective Alterations of plasma glucose,insulin,cortisol,GH and glucagon concentrations during mild hypothermic CPB were observed,linear regression were studied Methods Twelve selective adults without diabetes mellitus and other metabolic diseas,ASA grade Ⅱ Ⅲ,underwent cardiac surgery under mild hypothermic CPB Blood samples were taken at before induction,before bypass,30,60 and 90min during bypass, and 60min after bypass All solutions were dextrose free solutions Results Plasma glucose level significantly increased during bypass (P<0 01) Plasma insulin level from induction to 30th min during CPB significantly decreased (P<0 05) Compared with before induction and before bypass,cortisol significantly decreased during CPB(P<0 01),GH and glucagon levels significantly increased during CPB(P<0 05) Conclusion (1) Moderate hyperglycemia occurred with dextrose free intravenous and priming solutions during mild hypothermic CPB (2) Insulin and cortisol secretions are inhibited,GH and glucagon secretion increases during bypass (3) Linear regressions show that hyperglycemia during bypass was significantly related to alterations of growth hormone and glucagon (P<0 01),and was not related to alterations of cortisol (P>0 05)