患儿体外循环围术期胰岛素变化的临床研究

Clinical Study of Insulin Change during Cardiopulmonary Bypass in Children

目的 探讨体外循环 (CPB)围术期胰岛素、血糖变化规律 ,为围术期监护提供恰当指导。方法 对 30例行体外循环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后次日晨五个时点取桡动脉血测定胰岛素、血糖。结果 胰岛素除在CPB 30min时与术前水平相近外 (P >0 .0 5 ) ,随着CPB的进行呈现增高趋势 (P <0 .0 1 )。麻醉后切皮前血糖明显升高 (P <0 .0 1 ) ,转机 30min时仍保持在切皮前的水平 (P >0 .0 5 ) ,随着CPB时间的延长 ,至停机前逐步上升达最高峰 ,与其他各时点相比 ,P <0 .0 1 ,手术结束后开始下降 ,但至术后次日晨仍保持在高于术前的水平 (P <0 .0 1 )。结论 体外循环心内直视手术时 ,胰岛素、血糖发生了明显变化 。

Objective To observe insulin and blood glucose changes during cardiopulmonary bypass (CPB) and propose guidelines for perioperative monitoring.Methods Insulin and blood glucose were determined in 30 children with congenital heart disease who were receiving open heart surgery for CPB (pm anesthesia), before operation(after anesthesia),at 30 min of CPB 30 min, before stopping post rewarming and the next morning after operation.Results Insulin level increased with prolongation of CPB in all cases (P<0.01) ,and was similar to the preoperative level at 30 min of CPB (P>0.05); blood glucose level increased significantly between skin incision and post-anesthesia (P<0.01) and was similar to the preoperative level 30 min after CPB (P>0.05). With the prolongation of CPB, blood glucose increased gradually to the peak before the end of CPB; the difference was significant as compared with that at the other time points (P<0.01). After operation, blood glucose began to decrease gradually, and was still higher than that before anesthesia the next morning (P<0.01).Conclusion In CPB open heart surgery , insulin and blood glucose levels changed significantly,it is necessary to monitor insulin and blood glucose levels during operation.