文章摘要
术中持续输注胰岛素对心肺转流心脏手术患者心肌血流灌注的影响
Effect of intraoperative continuous infusion insulin on myocardial perfusion in patients after cardiac surgery under cardiopulmonary bypass
  
DOI：10.12089/jca.2024.05.010
中文关键词: 胰岛素  心肺转流  灌注  心肌灌注显像  冠状静脉窦
英文关键词: Insulin  Cardiopulmonary bypass  Perfusion  Myocardial perfusion imaging  Coronary sinus
基金项目:江苏省中医药科技发展计划项目（MS2022151）；扬州市科技局社会发展项目（YZ2022108）
作者单位E-mail
张转 225012,扬州大学附属医院麻醉科  
殷佳佳 225012,扬州大学附属医院麻醉科  
李宁 225012,扬州大学附属医院麻醉科  
陈超 225012,扬州大学附属医院麻醉科  
张凯 225012,扬州大学附属医院麻醉科  
马蓉蓉 225012,扬州大学附属医院麻醉科  
贯士玉 225012,扬州大学附属医院心脏大血管中心  
张建友 225012,扬州大学附属医院麻醉科  
王强 225012,扬州大学附属医院心脏大血管中心  
李虎 225012,扬州大学附属医院麻醉科 lihu8735@163.com 
摘要点击次数: 1015
全文下载次数: 437
中文摘要:
      
目的： 探讨术中持续输注胰岛素对心肺转流（CPB）心脏手术患者心肌血流灌注的影响。
方法： 选择择期行CPB心脏手术患者48例，男21例，女27例，年龄55～80岁，BMI 18～28 kg/m2，ASA Ⅱ—Ⅳ级。将患者随机分为两组：胰岛素组（I组，n=25）和对照组（C组，n=23）。两组采用相同麻醉方案。麻醉诱导后I组静脉输注胰岛素30 mU·kg-1·h-1、葡萄糖0.12 g·kg-1·h-1、氯化钾0.06 mmol·kg-1·h-1混合液，C组予以生理盐水10 ml/h输注，均输注至术毕。术中目标血糖值为6.1～11.1 mmol/L。于麻醉诱导后10 min（T2）和术毕（T6）行经食管超声心动图（TEE）检测，记录冠状静脉窦（CS）血流频谱、直径及肺静脉血流频谱，并计算CS净向前血流流速时间积分（VTI）。记录T2、CPB前2 min（T3）、CPB结束时（T52）和T6时的股动脉平均动脉压（MAP）、中心静脉压（CVP）、每搏量（SV）、心脏指数（CI）及外周血管阻力指数（SVRI）。记录麻醉诱导前5 min（T1）、T3、CPB后30 min（T4）、T5、T6、术后6 h（T7）、术后12 h（T8）及术后24 h（T9）时血糖及乳酸浓度。记录术前1 d、术后1、2 d时超敏C反应蛋白（hs-CRP）、高敏肌钙蛋白I（hs-TnI）和肌酸激酶同工酶（CK-MB）水平。
结果： 与C组比较，I组T6时CS净前向血流VTI及每分钟CS血流量均明显增加（P<0.05），肺静脉心房收缩期峰值流速（ARp）明显减小（P<0.05），T5、T6时SV和CI明显增大、SVRI明显降低（P<0.05），T7、T8时乳酸浓度明显降低（P<0.05），术后1、2 d时hs-CRP和CK-MB水平明显降低（P<0.05），术后2 d时hs-TnI明显降低（P<0.05）。
结论： CPB心脏手术中持续输注胰岛素，同时维持血糖6.1～11.1 mmol/L，可改善心肌血流灌注，减轻术后炎症反应及心肌损伤。
英文摘要:
      
Objective: To investigate the effect of continuous intraoperative insulin infusion on myocardial blood perfusion after cardiac surgery under cardiopulmonary bypass (CPB).
Methods: Forty-eight patients, 21 males and 27 females, aged 55-80 years, BMI 18-28 kg/m2, ASA physical status Ⅱ-Ⅳ, who underwent elective cardiac surgery with CPB were selected and randomly divided into two groups: the insulin group (group I, n = 25) and the control group (group C, n = 23). The same anesthesia protocol was implemented in both groups. After induction of anesthesia, group I received intravenously infusion of insulin 30 mU·kg-1·h-1, glucose 0.12 g·kg-1·h-1, and potassium chloride 0.06 mmol·kg-1·h-1, and group C received saline 10 ml/h, all of which were infused until the end of surgery. The targeted blood glucose range for both groups was set at 6.1-11.1 mmol/L. Transesophageal echocardiography (TEE) was performed 10 minutes after induction of general anesthesia (T2) and before the end of surgery (T6) to examine the coronary sinus (CS) flow spectrum and diameter, pulmonary venous flow spectrum, and calculate CS net antegrade flow velocity time integral (VTI). Femoral mean arterial pressure (MAP), central venous pressure (CVP), stroke volume (SV), cardiac index (CI) and peripheral vascular resistance index (SVRI) were recorded at T2, 2 minutes before CPB (T3), the end of CPB (T5), and T6. The concentrations of blood glucose and lactate 5 minutes before anesthesia induction (T1), T3, 30 minutes after CPB (T4), T5, T6, 6 hours after surgery (T7), 12 hours after surgery (T8), and 24 hours after surgery (T9) were recorded. The levels of high-sensitivity C-reactive protein (hs-CRP), high-sensitivity troponin I (hs-TnI), and creatine kinase isoenzyme (CK-MB) were recorded 1 day preoperatively, 1 and 2 days postoperatively.
Results: Compared with group C, in group I, CS net antegrade flow VTI and blood flow per minute were significantly increased (P < 0.05), and pulmonary venous peak atrial reversal wave velocity (ARp) was significantly reduced at T6(P < 0.05), SV and CI were significantly increased and SVRI was significantly decreased at T5 and T6(P < 0.05), lactate concentration was significantly decreased at T7 and T8(P < 0.05), hs-CRP and CKMB were significantly decreased 1 and 2 days postoperatively (P < 0.05), hs-TnI was significantly reduced 2 days postoperatively (P < 0.05).
Conclusion: Continuous insulin administration during cardiac surgery with CPB while maintaining blood glucose at 6.1-11.1 mmol/L can enhance myocardial blood perfusion, mitigate postoperative inflammatory response, and reduce myocardial injury.
查看全文   查看/发表评论  下载PDF阅读器
关闭