阿司匹林联合胰岛素预防心脏瓣膜置换术后血糖波动及急性肾损伤的效果观察

Effect Observation on Aspirin Combined with Insulin in Prevention of Acute Blood Glucose Fluctuation and Renal Injury after Cardiac Valve Replacement

目的观察阿司匹林联合胰岛素预防心脏瓣膜置换术后血糖波动及急性肾损伤的效果。方法对本院2013年1月—2015年1月择期行心脏瓣膜置换术患者86例按照围术期不同干预方法分为对照组与观察组各43例,观察组围术期给予阿司匹林联合胰岛素治疗,对照组给予围术期常规治疗,比较两组围术期血糖变化、血流动力学变化、机械通气时间、ICU入住时间、住院时间及术后并发症等情况。结果观察组体外循环开始后30 min(T1)、体外循环结束后30 min(T2)和术后24 h(T3)血糖水平均明显低于对照组,而术后48 h(T4)血糖水平高于对照组(P<0.05)。观察组术毕入室、入室后24 h心率明显高于对照组(P<0.05),平均动脉压明显低于对照组(P<0.05)。观察组机械通气时间、ICU入住时间、住院时间均显著短于对照组(P<0.05)。观察组急性肾损伤、感染和心房颤动发生率均显著低于对照组(P<0.05)。结论围术期阿司匹林联合胰岛素干预能有效控制血糖水平,维持血流动力学稳定,缩短机械通气时间,显著降低急性肾损伤发生率。

Objective To observe effects of Aspirin combined with Insulin in prevention of blood glucose fluctuation and acute renal injury（ AKI） after cardiac valve replacement. Methods A total of 86 patients undergoing cardiac valve replacement during January 2013 and January 2015 were divided into control group（ n = 43） and observation group（ n = 43） according to different intervention methods during peroperative period. The observation group was given Aspirin combined with Insulin therapy during peroperative period,while the control group received routine therapy during peroperative period. Changes of blood glucose,hemodynamics,duration of mechanical ventilation,ICU stay,hospitalization time and postoperative complications during peroperative period were compared between the two groups. Results In observation group,levels of blood glucose at 30 min after extracorporeal circulation beginning（ T1）,30 min after extracorporeal circulation ending（ T2） and postoperative 24 h（ T3） were significantly lower,while the level at postoperative 48h（ T4） was higher than those in control group（ P〈0. 05）. Values of heart rate（ HR） upon entering ICU at the moment of finishing surgery and 24 h after entering ICU were significantly higher（ P〈0. 05）,while mean arterial pressure（ MAP） were significantly lower in observation group than those in control group（ P〈0. 05）. Duration of mechanical ventilation,ICU stay and hospitalization time in observation group was significantly shorter than that in control group（ P〈0. 05）. Incidence rates of ARI,infection and atrial fibrillation in observation group were significantly lower than those in control group（ P〈0. 05）. Conclusion Aspirin combined with Insulin can effectively control blood glucose levels,maintain hemodynamic stability,shorten duration of mechanical ventilation and significantly reduce ARI incidence rate during peroperative period.