非体外循环冠状动脉旁路移植术中血糖调控的应用

Application of perioperative blood glucose control in nondiabetic patients undergoing off-pump coronary artery bypass grafting

目的探讨非糖尿病患者非体外循环冠状动脉旁路移植术（OPCAB）围术期血糖调控的效果。方法将70例行OPCAB的非糖尿病患者随机分为2组，每组35例，分别接受胰岛素输注（试验组）和生理盐水输注（对照组），观察麻醉诱导前、搭桥前、搭桥后、关胸后、术后ICU1h、ICU6h、ICU12h血糖值。结果①试验组与对照组相比，术后呼吸机使用时间[（13．78±6．42）h比（19．02±9．74）h]、术后住院时间[（19．54±5．72）d比（22．48±6．45）d]均显著缩短，术后心律失常发生率显著降低。②试验组与对照组相比较，血糖在麻醉诱导前未见统计学差异，而搭桥前、搭桥后、关胸后、ICU1h、ICU6h、ICU12h的血糖显著降低。结论非糖尿病患者行OPCAB围术期高血糖可能影响预后，输注胰岛素可有效控制血糖、改善预后。

Objective To determine the effect of blood glucose control protocol on perioperative blood glu- cose control for nondiabetic patients undergoing off-pump coronary artery bypass grafting. Methods 70 adult pa- tients without metabolism diabetes undergoing OPCAB were divided randomly into Experimental Group and Control Group. Insulin was infused constantly in experimental group from the point of immediate before anesthesia induction to the point of ICU 12 h. The blood glucose on each time point was recorded. Results （1）The postoperative length of mechanical ventilation [（13.78±6.42）h vs （19.02±9.74）h] and stay in hospital [（19.54±5.72）d vs （22.48± 6.45 ）d ] of experimental group was significant shorter than control group （P〈0.05）. The incidence of postoperative arrhythmia were decreased （P〈0.05）. （2）Comparing with control group, blood glucose significantly decreased from the point of before CABG to the point of ICU 12 h（P〈0.05 ）. Conclusion Blood glucose was controlled below 8.3 mmol/L or nondiabetic patients undergoing OPCAB are safely and effectively.