何斌血糖.pptVIP

深低温停循环围术期的高血糖监测及控制 Perioperative hyperglycemia monitoring and control during deep hypothermic circulatory 何 斌 Abstract Objective Method Result Conclusion Objective To observe the perioperative blood glucose trends during deep hypothermic circulatory arrest (DHCA), to evaluate the influencing factors of hyperglycemia and the clinical effects of insulin control Method In department of cardiothoracic surgery of X hospital, 176 patients with aortic operation were performed under DHCA from 2000 to 2010. All patients’ blood glucose, arterial blood gas and lactate were tested at four time points of pre-CPB, pre-DHCA, post-DHCA and in-ICU. Hyperglycemia after surgery was controlled within 6~8 mmol/L by intermittent subcutaneous injection or intravenous micropump injection of insulin. At the same time, the amount of insulin within 24 h after surgery was calculated Result The blood glucose (mmol/L) level of the time point of pre-DHCA was significantly higher than that of pre-CPB (9.62±1.79 vs 5.04±1.401, P0.05), the blood glucose level was further increased at the time point of post-DHCA (14.91±2.36) and in-ICU (15.32±2.47) than that of pre-CPB (P0.01). And the blood glucose elevated level was positively correlated with blood lactate level. 134 patients (76.1%) changed to use intravenous micropump injection of insulin due to poor effectiveness of intermittent subcutaneous injection of insulin to control blood glucose. Of whom 30 patients (17.0%) using continuous intravenous insulin still couldn’t control blood glucose effectively, which was the phenomenon of insulin resistance. Perioperative hyperglycemia during DHCA was associated with eld (≥ 50 y), hypertension, diabetes, serious aortic valve disease or coronary heart disease, emergency operation, CPB time, ≥ 3 h and DHCA time≥ 45 min (P0.05). The amount of insulin within 24 h after surgery was statistically significant (P0.05). Conclusion DHCA can cause perioperative blood glucose and lactate increased si