中国药房2017，Vol.28Issue(21)：2915-2918,4.DOI:10.6039/j.issn.1001-0408.2017.21.10
胰岛素-葡萄糖对体外循环下联合瓣膜置换术患者的心肌保护作用
Protective Effects of Insulin-glucose on Myocardium in Patients Receiving Combined Cardiac Valve Re-placement under Cardiopulmonary Bypass
秦建华 1张雪容 1马庆军 1何亮 1田永芳1
作者信息
- 1. 新疆维吾尔自治区人民医院,乌鲁木齐 830001
- 折叠
摘要
Abstract
OBJECTIVE:To investigate the protective effects of insulin-glucose on myocardium in patients receiving cardiac valve replacement under cardiopulmonary bypass. METHODS:Totally 120 patients receiving combined cardiac valve replacement under cardiopulmonary bypass were divided into control group and observation group according to random number table,with 60 cases in each group. All patients were given routine operation. Control group was given Thomas cardioplegia and oxygenated blood with a ratio of 1:4(V:V)to protect myocardium at 4 ℃. Besides that,the observation group was additionally given Insulin injec-tion 10 IU/L and Glucose injection 10 g/L added into Thomas cardioplegia at 4 ℃ to protect myocardium. The levels of plasma brain natriuretic peptide(BNP)and cardiac troponinⅠ(cTnⅠ)before anesthesia induction(T0),at the end of cardiopulmonary by-pass(T1),12 h(T2),24 h(T3),48 h(T4),and 72 h(T5)after surgery,the rate of recovery of automatic heartbeat after opening aor-ta,the application of vasoactive agent(dopamine)at T1 and the occurrence of postoperative complications were observed and com-pared between 2 groups. RESULTS:At T0,there was no statistical significance in the levels of plasma BNP and cTnⅠ between 2 groups(P>0.05). The levels of plasma BNP and cTnⅠin 2 groups at T1-5 were significantly higher than T0,with statistical signifi-cance(P<0.05);the levels of cTnⅠ began to decrease at T4 and cTnⅠbegan to decrease at T5. However,the levels of BNP and cTnⅠwere significantly lower in observation group than in control group at T1-5,with statistical significance(P<0.05). After open-ing aorta,there was no statistical significance in the rate of recovery of automatic heartbeat between 2 groups(P>0.05). The dos-age of dopamine (at T1) and the incidence of complications in observation group were statistically lower than control group,with statistical significance(P<0.05). No severe ADR was found in 2 groups during or after surgery. CONCLUSIONS:Insulin-glucose can alleviate myocardial damage, reduce the dosage of vasoactive agent and the incidence of postoperative complications in pa-tients receiving combined cardiac valve replacement under cardiopulmonary bypass with significant protective effect on myocardium with good safety.关键词
胰岛素/体外循环/联合瓣膜置换术/心肌保护/脑钠肽/心肌肌钙蛋白ⅠKey words
Insulin/Cardiopulmonary bypass/Combined cardiac valve replacement/Myocardial protection/Brain natriuretic peptide/Cardiac troponinⅠ分类
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秦建华,张雪容,马庆军,何亮,田永芳..胰岛素-葡萄糖对体外循环下联合瓣膜置换术患者的心肌保护作用[J].中国药房,2017,28(21):2915-2918,4.
