强化胰岛素治疗对体外循环炎症反应的影响

发布时间：2018-05-27 12:01

本文选题：体外循环 + 强化胰岛素治疗　；参考：《中国老年学杂志》2015年13期

【摘要】：目的探讨强化胰岛素治疗对体外循环(CPB)下心脏瓣膜置换术炎性反应的影响。方法 30例CPB下行心脏瓣膜置换术患者随机分为强化胰岛素组(强化组,n=15)和对照组(n=15)。强化组术中血糖控制在3.9~10.0 mmol/L,术后控制在4.4~8.3 mmol/L;对照组血糖11.1 mmol/L时给予胰岛素治疗。分别于麻醉诱导后(T0)、CPB开始(T1)、CPB结束即刻(T2)、6 h(T3)、24 h(T4)和48 h(T5)时点测定血浆白细胞介素(IL)-6、肿瘤细胞坏死因子(TNF)-α浓度,并记录术后临床情况。结果两组TNF-α、IL-6浓度在T2、T3、T4时点均明显高于T0时点(P0.05);在T2、T3、T4时点,强化组TNF-α、IL-6浓度明显低于对照组(P0.05);强化组呼吸机支持时间明显短于对照组(P0.05)。结论强化胰岛素治疗能降低TNF-α、IL-6浓度表达,缩短呼吸机支持时间,减弱CPB引起的炎性反应。
[Abstract]:Objective to investigate the effect of intensive insulin therapy on inflammatory response of cardiac valve replacement under cardiopulmonary bypass (CPB). Methods Thirty patients undergoing cardiac valve replacement with CPB were randomly divided into two groups: the intensive insulin group (n = 15) and the control group (n = 15). In the intensive group, the blood glucose was controlled at 3.9V 10.0 mmol / L during the operation and at 4.4 卤8.3 mmol / L after the operation, while the control group was treated with insulin at 11.1 mmol/L. After anesthesia induction, plasma IL-6 and TNF- 伪 concentrations were measured at the beginning of T _ (1) and T _ (1) T _ (1) and T _ (2) T _ (6) T _ (3) and T _ (4) and 48 h / T _ (5), respectively, and the postoperative clinical data were recorded. The results were as follows: (1) after anesthesia induction, the plasma levels of interleukin (IL) -6 and tumor cell necrosis factor (TNF- 伪) were measured. Results the concentration of TNF- 伪 IL-6 at T2T3T4 was significantly higher than that at T0, and at T2T3T4, the concentration of TNF- 伪 IL-6 was significantly lower than that of control group (P0.05), and the time of ventilator support was shorter than that of control group (P0.05). Conclusion intensive insulin therapy can reduce the expression of TNF- 伪 IL-6, shorten the time of ventilator support, and weaken the inflammatory response induced by CPB.
【作者单位】：川北医学院附属医院麻醉科;川北医学院附属医院胸心外科;
【基金】：四川省卫生厅资助课题(No.090153)
【分类号】：R654.1

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