CAJ | 학술논문

目的：回顾性分析体外循环（cardiopulmonary bypass，CPB）下心脏手术患者围术期血糖和血乳酸的变化趋势。方法选取2013年1月至12月期间在首都医科大学宣武医院行体外循环心脏手术的成年患者58例，根据术前是否合并糖尿病分非糖尿病组和糖尿病组，根据体外循环时间分为CPB时间小于2 h组（A组）和大于2 h组（B组）。观察围术期血糖值和乳酸值的变化趋势，并对相关临床资料进行分析。结果58例患者体外循环时间59～315 min，平均（126.07±50.74）min，阻断时间35～161 min，平均（67.61±22.95）min，自动复跳率52％，术中血糖及血乳酸从麻醉诱导后呈逐渐升高趋势，Pearson检验示两者之间呈正相关（r＝0.939，P＝0.018），手术结束时血糖升至最高随后逐渐下降。结论体外循环对合并糖尿病患者围术期血糖的影响更明显，控制围术期血糖有助于降低血乳酸。提高CPB的管理水平，有利于术中及术后血糖及乳酸值的改善，从而降低术后相关合并症，改善预后。
목적：회고성분석체외순배（cardiopulmonary bypass，CPB）하심장수술환자위술기혈당화혈유산적변화추세。방법선취2013년1월지12월기간재수도의과대학선무의원행체외순배심장수술적성년환자58례，근거술전시부합병당뇨병분비당뇨병조화당뇨병조，근거체외순배시간분위CPB시간소우2 h조（A조）화대우2 h조（B조）。관찰위술기혈당치화유산치적변화추세，병대상관림상자료진행분석。결과58례환자체외순배시간59～315 min，평균（126.07±50.74）min，조단시간35～161 min，평균（67.61±22.95）min，자동복도솔52％，술중혈당급혈유산종마취유도후정축점승고추세，Pearson검험시량자지간정정상관（r＝0.939，P＝0.018），수술결속시혈당승지최고수후축점하강。결론체외순배대합병당뇨병환자위술기혈당적영향경명현，공제위술기혈당유조우강저혈유산。제고CPB적관리수평，유리우술중급술후혈당급유산치적개선，종이강저술후상관합병증，개선예후。
Objective Retrospective study was carried out for perioperative variation of blood glucose and lactate in cardiac surgery patients with cardiopulmonary bypass.Methods From January to December in 201 3,58 adult patients undergoing cardiac surgery with cardiopulmonary bypass were selected and these patients were divided into non - diabetic group and diabetic group according to whether patients have had diabetes mellitus preoperatively.According to the cardiopulmonary bypass time patients were divided into CPB time less than two hours group(group A)and more than two hours group(group B).The perioperative trends of blood glucose and lactate levels were observed,and the related clinical data were analyzed.Results Totally 58 patients CPB time were 59-31 5 [average time:(1 26.07 ± 50.74)]minutes and aorta cross-clamping time were 35-1 61 [(average time:(67.61 ±22.95 )]minutes,and the automatic heart beat recovery rate is 52%.Blood glucose and lactate levels were increased gradually after induction of anesthesia during operation.The Pearson test shows a positive correlation between blood glucose and lactate.Blood glucose levels rose to the highest level at the end of the surgery and then gradually decreased.Conclusion Effects of cardiopulmonary bypass on perioperative blood glucose in diabetic patients is more obvious,perioperative glycemic control can help lower blood lactate levels.Improving the management of CPB,can help to lower the perioperative blood glucose and lactate levels,thereby reducing complications and improving the prognosis.