心脏瓣膜置换围手术期血糖控制对血乳酸水平的影响

Blood glucose control in the perioperative stage of cardiac value replacement influences levels of blood lactic acid

背景:心脏瓣膜置换后极易发生高血糖,对患者预后不利,而围术期血糖和患者的乳酸有密切的关系。目的:观测心脏瓣膜置换患者不同时间血糖及血乳酸水平变化,并进行相关性分析。方法:将63例心脏瓣膜置换患者随机分为两组,对照组进行传统标准治疗,血糖浓度维持于7.5-11.1mmol/L;实验组通过胰岛素持续输注进行强化治疗,血糖浓度维持于3.6-7.5mmol/L。结果与结论:实验组患者体外循环中及瓣膜置换后血糖水平较对照组显著降低(P<0.05);两组患者随着瓣膜置换时间延长血乳酸水平都明显升高,并发生高乳酸血症,实验组并发症发生率显著低于对照组(P<0.05);两组病例都有血糖、血乳酸逐渐升高到再恢复正常的过程,尤其以置换后6h为最高;血糖值与血乳酸值的变化趋势大致相同。通过一元线性回归分析血糖与乳酸的相关系数为0.838,单侧P<0.01,证明两个变量间有直线相关关系。结果提示,应用胰岛素严格控制血糖,对控制心脏瓣膜置换中及瓣膜置换后血糖、血乳酸水平有利,可以降低患者置换后并发症的发生率。围术期血糖与血乳酸的水平呈正相关。

BACKGROUND： Hyperglycemia after cardiac-valve replacement can happen easily that is unfavorable on the prognosis. However, the perioperative blood glucose has close relationship with the level of lactic acid in patients. OBJECTIVE： To observe the changes of blood glucose and blood lactic acid levels in the patients with cardiac-valve replacement, and to perform the correlation analysis. METHODS： Sixty-three patients with cardiac-valve replacement were randomly divided into two groups. The control group received traditional standard therapy, and the blood glucose concentration was maintained at 7.5-11.1 mmol/L. The experimental group received intensive therapy by subcutaneous infusion or continuous insulin infusion, and the blood glucose concentration was maintained at 3.6-7.5mmol/L. RESULTS AND CONCLUSION： The concentration of blood glucose during cardiopulmonary bypass and after valve replacement in experimental group was lower than that in the control group （P 0.05）; with the time of the cardiac-valve replacement increased, the blood lactic acid levels of two groups were significantly increased, and the hyperlactacidemia could be seen, the incidence of complications in the experimental group was lower than that in the control group （P 0.05）. The blood glucose and blood lactic acid levels in two groups were gradually increased and returned to the normal levels, the blood glucose and blood lactic acid levels were highest at 6 hours after replacement. The changes of blood glucose level and blood lactic acid level were the same. One variant linear regression analysis showed the correlation coefficient of blood glucose and lactic acid was 0.838 and P 0.01 in one side, which proved that there was a linear relationship between the two variables. Strict application of insulin is beneficial to the control intraoperative and postoperative blood glucose and blood lactic acid levels of cardiac-valve replacement and can reduce the incidence of complication after replacement. Perioperative blood glucose and blood lactic acid levels are positively correlated.