CAJ | 학술논문

目的探讨强化胰岛素治疗对体外循环手术后患儿近期预后的影响.方法 2009年1月至2010年12月成都心血管病医院在体外循环下行心内畸形矫治手术患儿320例,其中男192例,女128例;年龄3个月-12岁.根据胰岛素给药时间和血糖控制的程度不同,将320例患儿分为两组:A组165例,术后给予胰岛素,将血糖控制在4.4 ～6.1 mmo/L;B组155例,当血糖超过11.1 mmol/L时,给予胰岛素,将血糖控制在6.1～11.1 mmo/L;比较分析两组患儿术后血糖控制情况和并发症.结果对320例患儿的4 800次血糖值进行分析.A、B两组平均血糖分别为(5.58±0.54) mmol/L和( 7.73±0.85) mmol/L,差异有统计学意义(P＜0.01),均在血糖控制目标范围内.A、B两组低血糖( ＜3.3 mmol/L)发生率分别为1.65％ (38/2 310)和1.04％( 26/2 490),严重低血糖(＜2.2 mmol/L)发生率分别为0.13％ (3/2 310)和0.08％ (2/2 490),A组低血糖、严重低血糖发生率明显高于B组(P＜0.01).A组院内感染发生率低于B组[3.03％ (5/165) vs 9.68％ (15/155),P＜0.05],而两组心律失常、循环衰竭或休克、多器官功能障碍的发生率和住院病死率比较差异无统计学意义(P＞0.05).结论现有数据尚不足以证实强化胰岛素治疗能改善体外循环手术后患儿的近期预后.
목적 탐토강화이도소치료대체외순배수술후환인근기예후적영향.방법 2009년1월지2010년12월성도심혈관병의원재체외순배하행심내기형교치수술환인320례,기중남192례,녀128례;년령3개월-12세.근거이도소급약시간화혈당공제적정도불동,장320례환인분위량조:A조165례,술후급여이도소,장혈당공제재4.4 ～6.1 mmo/L;B조155례,당혈당초과11.1 mmol/L시,급여이도소,장혈당공제재6.1～11.1 mmo/L;비교분석량조환인술후혈당공제정황화병발증.결과 대320례환인적4 800차혈당치진행분석.A、B량조평균혈당분별위(5.58±0.54) mmol/L화( 7.73±0.85) mmol/L,차이유통계학의의(P＜0.01),균재혈당공제목표범위내.A、B량조저혈당( ＜3.3 mmol/L)발생솔분별위1.65％ (38/2 310)화1.04％( 26/2 490),엄중저혈당(＜2.2 mmol/L)발생솔분별위0.13％ (3/2 310)화0.08％ (2/2 490),A조저혈당、엄중저혈당발생솔명현고우B조(P＜0.01).A조원내감염발생솔저우B조[3.03％ (5/165) vs 9.68％ (15/155),P＜0.05],이량조심률실상、순배쇠갈혹휴극、다기관공능장애적발생솔화주원병사솔비교차이무통계학의의(P＞0.05).결론 현유수거상불족이증실강화이도소치료능개선체외순배수술후환인적근기예후.
Objective To investigate the influence of intensive insulin therapy on the short-term prognosis in children after cardiac surgery.Methods A total of 320 children including 192 males and 128 females who underwent cardiac surgery were enrolled in this study from Jan 2009 to Dec 2010 at the cardiac surgery department of Chengdu cardiovascular hospital.The age of these children ranged from 3 months to 12years old.According to insulin administration time and blood glucose control level,they were randomly divided into two groups.In group A,there were 165 patients who received continuous insulin infusion to maintain postoperative gloucose levels between 4.4 and 6.1 mmol/L,while 155 patients in group B received insulin infusion when their glucose levels were higher than 11.1 mmol/L to control the levels between 6.1 and 11.1 mmol/L.Then the postoperative complications and blood glucose controlling were compared and analyzed.Results A total of 320 children were enrolled,and 4 800 recorded data were analyzed.The mean blood glucose level was (5.58 ±0.54) mmol/L in group A and (7.73 ±0.85) mmol/L in group B (P ＜0.01 ),and both of them were controlled within the target range.The incidence of hypoglycemia ( ＜3.3 mmor/L) was 1.65％ (38/2310)in group A and 1.04％ (26/2490) in group B.The incidence of severe hypoglycemia ( ＜2.2 mmol/L) was 0.13 ％ ( 3/2 310 ) in group A and 0.08 ％ ( 2/2 490 ) in group B.The incidences of hypoglycemia and severe hypoglycemia were significantly increased in group A compared to group B ( P ＜0.01 ).The incidence of infection in group A was lower than that in group B [3.03％ (5/165) vs 9.68％ (15/155),P ＜0.05],but there was no significant difference between the two groups in the incidences of malignant arrhythmia,circulation failure or shock,multiple organ dysfunctive syndrome and mortality.Conclusion Intensive insulin therapy can't improve the short-term prognosis in children after cardiac surgery.