围体外循环手术期胰岛素抵抗对婴儿先天性心脏病的预后影响

Effect of insulin resistance during cardiopulmonary bypass on prognosis of infants with congenital heart disease

目的:通过对婴儿围体外循环(cardiopulmonary bypass,CPB)期间胰岛素抵抗(insulin resistance,IR)进行观察,探讨IR对婴儿先天性心脏病预后的影响。方法:选取2012年3月至2013年3月先天性室间隔缺损行CPB手术的婴儿60例作为研究对象。选取麻醉诱导后5 min、CPB启动前、CPB启动后15 min、主动脉开放5 min、CPB结束15 min 5个时间点采集外周血查血糖及血浆胰岛素,计算胰岛素抵抗指数(insulin resistance index,HOMA-IR),同时记录患儿主动脉阻断时间、CPB时间及术后机械通气时间。取HOMA-IR峰值时间点将患儿分为高IR组和低IR组,比较两组机械通气时间的差别。结果:患儿围CPB期胰岛素、血糖及HOMA-IR在麻醉后逐渐升高,于主动脉开放后达到峰值,各时间点与麻醉诱导后5 min比较,差异有统计学意义(P<0.05或P<0.01)。高IR组机械通气时间长于低IR组,差异有统计学意义(P<0.05)。结论:CPB手术强烈应激刺激引起的代谢紊乱程度能够影响先天性心脏病患儿的预后,降低CPB手术中患儿机体IR程度以及内分泌和代谢紊乱的程度非常重要。

Objective：To observe insulin resistance（IR） during infant cardiopulmonary bypass（CPB）,and determine the effect of IR on prognosis of infants with congenital heart disease.Methods：We collected 60 infants with congenital ventricular septal defect who were performed CPB surgery from March 2012 to March 2013,and selected 5 time points,including 5 min after anesthesia induction,before CPB starting,15 min after the CPB starting,5 min after aortic clamping,and 15 min at the end of CPB.Blood glucose and plasma insulin were checked to calculate insulin resistance index（HOMA-IR）.We also simultaneously recorded the infants＇ s aortic clamping time,CPB time,and postoperative duration of mechanical ventilation.The peak value of HOMA-IR was used as a cut-off point between high and low IR group and the difference in duration of mechanical ventilation between 2 groups was compared.Results：The insulin,glucose,and HOMA-IR value in the perioperative period increased gradually at 5 min after anesthesia induction,and achieved the peak value at 5 min after aortic clamping.There were significant difference between other time points and the point of 5 min after anesthesia induction（P0.05 or P0.01）.The duration of mechanical ventilation in the high IR group was much longer than that in the low IR group（P0.05）.Conclusion：The degree of metabolic disorder stress caused by CPB surgery can affect the prognosis of infants with congenital heart disease and reducing IR level and easing the endocrine and metabolic disorder are important for improving the prognosis.