胰岛素强化治疗对体外循环心脏瓣膜置换术患者胃黏膜分泌的影响

Effects of intensive insulin therapy on gastrointestinal organ in patients undergoing heart valve replacement with cardiopulmonary bypass

目的:探讨术前强化胰岛素治疗对体外循环(CPB)心脏瓣膜置换手术各消化脏器功能的影响。方法:100例非糖尿病CPB下心脏瓣膜置换手术患者,随机分为常规治疗组(C组,n=50)和强化胰岛素治疗组(IT组,n=50)。IT组患者术中血糖控制在6.1～10.0 mmol/L(110～180 mg/dl),术后控制在3.9～8.3mmol/L(70～150 mg/dL);C组患者术前、术后没有胰岛素治疗。分别于麻醉诱导、CPB开始后及CPB结束0 h、6 h、12 h、24 h和48 h(T1-T7)测定两组患者的胃液、胃黏膜pH、胃液红细胞以及促胃液素(Gastrin)的改变并比较分析。结果:对照组患者的胃液pH、胃黏膜pH(phi)在CPB开始时即略有下降,CPB结束后6h达到最低,CPB结束后48 h时接近术前水平,CPB结束开始各时间点对照组较强化治疗组下降更为明显(P<0.05);两组患者的胃液RBC以及促胃液素含量在CPB开始时即开始升高,CPB结束后6h达高峰(P<0.01);此后下降,至CPB结束后48 h时尚未降至术前水平。在此过程中,对照组明显高于强化治疗组。结论:胰岛素强化治疗可显著抑制心脏瓣膜置换患者的胃液pH、胃黏膜pH(phi)的降低以及促胃液素的分泌,防止胃肠道出血。

Objective：To investigate the effects and mechanisms of intensive insulin therapy on gastrointestinal organ in patients undergoing heart valve replacement surgery with cardiopulmonary bypass.Methods： 100 non-diabetic in-patients undergoing valve replacement were randomly assigned to a control group or an intensive insulin therapy group（IT group）.Perioperative Gastric intramuco-sal pH（pHi）,pH and red blood cell of gastric juice and levelsof gastrin in blood serum were monitored.Results： After initiation of CPB,pH and pHi in control group began to decrease and reach the wave hollow at 6h after the termination of CPB and then increased,but did not reach the preoperative level 48 h after CPB in either group.pH and pHi was significantly higher in the IT group than in the controlgroup at each time point after the termination of CPB;Red blood cell of gastric juice and plasma gastrin began to increase and reach the peak at 6h after the termination of CPB and then decreased,but did not reach the preoperative level 48 h after CPB in either group.Red blood cell of gastric juice and plasma gastrin was significantly higher in the control group than in the IT group at each time point after the termination of CPB.Conclusion： Intensive insulin therapy can significantly attenuate the damage of CPB on gastrointestinal organ.