强化胰岛素治疗对老年非糖尿病患者体外循环冠脉搭桥术的影响

The impact of prognosis after intensive insulin therapy in non-diabetic patients of old ages on CABG with cardiopulmonary bypass

目的探讨强化胰岛素治疗对老年非糖尿病患者体外循环（CPB）冠状动脉旁路移植术（CABG）后炎症反应的及其预后的影响。方法对2005年6月至2010年6月在本科行体外循环下冠状动脉旁路移植术的非糖尿病老年患者（〉60岁）进行回顾性分析。将前期共24例未行胰岛素强化治疗的患者作为对照组：自术后将血糖控制在10．0～11．1mmol／L；将后期36例行胰岛素强化治疗的患者作为治疗组：从麻醉开始起即用胰岛素泵严格控制血糖，将血糖控制在4．4-6．1mmo／／L。对两组患者术后感染、呼吸机辅助通气时间、住院时间及死亡率等指标进行对比研究。结果60例非糖尿病老年冠心病患者被纳入研究，两组患者的性别、体质量、诊断及合并疾病、手术方法及体外循环时问等手术资料差异无统计学意义（P〉0．05）。强化胰岛素治疗组术后白细胞计数[（12．6±2．8）×10^9／LVS（18．8±3．1）×10^9／L]，呼吸道感染（6／36VS10／24）及切口感染率（2／36VS6／24）、术后恶性心律失常发生率（2／36VS6／24）等指标降低，术后住院时间缩短[（12．2±3．7）dVS（15．6±5．4）d）]，与常规治疗组比较差异均有统计学意义（P〈0．05）。结论围手术期强化胰岛素治疗可降低老年非糖尿病体外循环冠脉搭桥患者术后并发症发生率，缩短住院时间，改善临床预后。

Objective To observe the clinical effects of intensive insulin therapy on postoperative infection, inflammatory response and prognosis in the non-diabetic patients of different ages undergoing coronary artery bypass grafting （CABG） with eardiopulmonary bypass （CPB）. Methods 60 cases of non-diabetic patients （ 〉 60） undergoing coronary artery bypass grafting with cardiopulmonary bypass between June 2005 ～June 2010 were selected and analyzed retrospectively. 60 patients were divided into 2 groups, the previous 24 cases were included in a routine treatment group and later 36 cases were included in the intensive therapy group. The blood sugar of intensive therapy group was strictly controlled starting from the anesthesia. The routine treatment group was controlled starting from backing to ICU according to blood glucose results. Patients were assigned to the routine therapy group with the blood glucose maintained at 10. 0 - 11.1 mmol/L and the intensive therapy group received tight glycemic control with the target blood glucose maintained at 4.4 - 6. 1 mmol/L. Postoperative infection, mechanical ventilation time, hospital stay and mortality indicators were compared between the 2 groups. Results There were no significant difference （ P 〉 0. 05） in gender, body weight, disease diagnosis and combined surgical methods and surgical materials such as cardiopulmonary bypass time between the 2 groups. Neutrophil count [ （ 12. 6 ± 2. 8 ）Х109/L vs （18. 8 ±3.1 ） Х 109/L] , blood infections, respiratory tract infection（6/36 vs 10/24） and wound infection rates （2/36 vs 6/24） and other indicators of intensive of insulin therapy group were lower than the regular therapy group （ P 〈0. 05）. The postoperative hospital stay of intensive therapy group[ （ 12. 2 ± 3.7） d vs （ 15.6 ±5.4）d） ] was statistically significant shorter compared with the conventional treatment group （ P 〈 0. 05 ）. There was no significant difference in postoperative mortality between the 2 groups （ P 〉 0.05 ）. Conclusions Intensive insulin therapy may significantly reduce postoperative infection rate in the old age patients, thus leading to an improved prognosis in the non-diabetic patients undergoing coronary artery by pass grafting with cardiopulmonary bypass.