体外循环围术期患儿血糖变化的临床观察

Clinical Observation of Blood Glucose Perioperation in CPB Children

目的探讨体外循环 (CPB)围术期血糖 (BS)变化规律 ,为围术期监护提供指导。方法对 30例CPB心内直视手术的先天性心脏病患儿分别于手术前 (麻醉前 )、麻醉诱导后切皮前、体外循环转机 30min、复温后停机前和手术次日晨 5个时点取桡动脉血测定BS。结果麻醉后切皮前BS比手术前明显升高 (P <0 0 1) ,转机 30min时仍保持在切皮前水平 (P >0 0 5 ) ,随着CPB时间的延长 ,至停机前逐步上升达最高峰 ,与其它各时点相比 ,均P <0 0 1,差异有极显著性意义。手术结束后BS开始下降 ,但至术后次日晨仍保持在高于术前的水平 (P <0 0 1)。结论CPB心内直视手术过程中 ,BS发生了明显变化 ,应加强围术期BS的监护。

Objective To investigate the changes of blood glucose perioperation during cardiopulmonary bypass (CPB) and provide guide for perioperative monitoring. Methods Blood glucose was determined in 30 congenital heart disease children receiving CPB under open heart surgery before operation (pre-anesthesia), before skin incision pos- tanesthesia induction, CPB running for 30 min, before stopping post-rewarming and next morning after operation. Results The blood glucose before skin incision post-anesthesia was obviously increased (P<0.01) and maintained after CPB running for 30 min (P>0.05). With the prolongation of CPB duration, blood glucose was gradually increased to the peak before stopping with the difference compared with those at other time points being very significant (all P<0.01). After operation, blood glucose was gradually decreased, but higher next morning than that before operation (P<0.01). Conclusion In CPB under open heart surgery, blood glucose obviously changed. So it is necessary to strengthen the blood glucose monitoring during operation.