Perioperative effects of continuous insulin infusion during surgery on adult cardiac valve replacement patients
10.3969/j.issn.1009-0754.2014.02.002
- VernacularTitle:术中持续胰岛素输注对成人非糖尿病患者瓣膜置换术围术期血糖影响的临床观察
- Author:
Bo KANG
1
;
Yu-Feng ZHANG
;
Jian XIAO
;
Jiang HONG
;
Deng-Ke HE
;
Qian XUE
;
Wei-Yao BAI
;
Ting CHEN
;
Zhi-Nong WANG
Author Information
1. 200003 上海，第二军医大学附属长征医院胸心外科; 解放军77620 部队卫生队
- Keywords:
Insulin;
Blood glucose;
Cardiopulmonary bypass;
Valve replacement;
Prognosis
- From:
Journal of Navy Medicine
2014;(2):88-92
- CountryChina
- Language:Chinese
-
Abstract:
Objective To study the clinic effects of continuous insulin infusion on non-diabetic patients during perioperative period of cardiac valve replacement .Methods Eighty non-diabetic adult patients who underwent elective cardiac valve replacement from November 2010 to November 2012 in Changzheng Hospital were chosen for the study .With the knowledge and consent of the pa-tients and following the signing of the letter of agreement and with the approval of the Ethic Committee , the patients were randomly di-vided into 2 groups, each consisting of 40 patients.The patients in the treatment group were given continuous insulin infusion .Infusion was performed through cardiopulmonary bypass (CPB) with the micro-pump, and blood glucose was maintained at 6.1-10.0 mmol/L. The patients in the control group were intermittently infused with insulin and equal amount of saline , also through CPB and with the mi-cro-pump.If the blood glucose level of patients was higher than 10.0 mmol/L, intermittent insulin infusion was administered to control the glucose level below 10.0 mmol/L.Levels of glucose and lactic acid of the patients were monitored at the following different time points:before operation , after anesthesia induction ,10 min after obstruction of aorta , 10 min after second infilling of the heart arresting fluid, 10 min after rewarming, 10 min after the opening of aorta, 10 min after termination of CPB, and after completion of surgery. Blood glucose levels of patients were monitored at the following time points: the moment after they returned to the intensive care unit (ICU), and at hours 1, 2, 4, 8, 16 and 24.Intraoperative automatic cardioversion rate , atrial fibrillation 24h after surgery, rate of hy-popotassemia 24 h after surgery , and the length of hospital stay after surgery were recorded accordingly .Results ①For patients in the treatment group, blood glucose levels during surgery were maintained at 6.1-10.0mmol/L, which were significantly lower than those of the control (P<0.05).Peak glucose level of the patients in the treatment group was lower than that of the control group patients during CPB (7.85 ±1.57) vs (10.60 ±3.09) mmol/L, with statistical significance (P<0.05).②The level of lactic acid in the patients of the treatment group was lower than that of the control group patients , with statistical significance (P<0.05).③Automatic cardiover-sion rate during surgery for the patients in the treatment group was higher than that of the control group patients (77.5%vs 52.5%), also with statistical significance (P<0.05).④Blood glucose level at hour 24 for the experiment group was lower than that of the con-trol group.Rate of hypopotassemia for the experiment group was lower than that of the control group (19.5%vs 37.5%), with statisti-cal significance (P<0.05).And the rate of postoperative atrial fibrillation in 24 h for the experiment group was lower that of the con-trol group (27.5%vs 52.5%) (P<0.05).The length of postoperative hospital stay for the patients in the treatment group was shor -ter than that of the patients of the control group (10.8 ±2.4) d vs (13.2 ±3.2)d, all with statistical significance (P<0.05). Conclusion For the non-diabetic adult patients who underwent elective cardiac valve replacement , continuous insulin infusion during surgery could maintain blood glucose and potassium level , increase the rate of automatic cardioversion , decrease the rate of postoperative atrial fibrillation in intraoperative and early postoperative periods , and shorten the length of hospital stay after surgery .It was obviously beneficial to the prognosis of patients .
