Smith Charles E, Styn Nicholas R, Kalhan Satish, Pinchak Alfred C, Gill Inderjit S, Kramer Richard P, Sidhu Tejbir
Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, USA.
J Cardiothorac Vasc Anesth. 2005 Apr;19(2):201-8. doi: 10.1053/j.jvca.2005.01.032.
The purpose of this study was to evaluate intraoperative glucose control.
Prospective unblinded study.
Tertiary care center.
Diabetic (n = 17) and nondiabetic (n = 23) patients undergoing elective cardiac surgery.
Diabetics received a modified insulin regimen consisting of a fixed rate infusion of regular insulin, 10 U/m2/h, and a variable infusion of D10W, adjusted to maintain glucose between 101 to 140 mg/dL.
Baseline glucose was higher in diabetics versus nondiabetics (mean +/- standard error of the mean: 203 +/- 27 v 117 +/- 3 mg/dL, p < 0.005). After baseline, insulin levels were increased in diabetics to 410 to 568 microU/mL. Corresponding insulin levels in nondiabetics were 12 to 40 microU/mL. Compared with baseline, glucose was decreased by 10% +/- 29% in diabetics during hypothermic cardiopulmonary bypass and increased by 21% +/- 30% in nondiabetics (p < 0.005). After discontinuation of bypass, glucose was lower in diabetics (137 +/- 12 mg/dL) versus nondiabetics (162 +/- 8 mg/dL, p < 0.005). Nine diabetics had adequate intraoperative glycemic control during hypothermic bypass (glucose 123 +/- 8 mg/dL, insulin 550 +/- 68 microU/mL, glucose infusion rate 1.87 +/- 0.29 mg/kg/min), 6 approached adequate control near the end of surgery (glucose 147 +/- 8 mg/dL, insulin 483 +/- 86 microU/mL, glucose infusion rate 0.35 +/- 0.05 mg/kg/min), and 2 never achieved control. Diabetics with elevated initial glucose >300 mg/dL did not achieve adequate glycemic control. Four diabetics (3 with renal failure) required injection of 50% dextrose after bypass for hypoglycemia.
Adequate glycemic control can be achieved in most diabetics during cardiac surgery using a modified insulin clamp technique provided initial glucose is <300 mg/dL.
本研究旨在评估术中血糖控制情况。
前瞻性非盲法研究。
三级医疗中心。
接受择期心脏手术的糖尿病患者（n = 17）和非糖尿病患者（n = 23）。
糖尿病患者接受改良胰岛素方案，包括以10 U/m²/h的固定速率输注正规胰岛素，以及根据血糖调整输注速度的10%葡萄糖溶液（D10W），以维持血糖在101至140 mg/dL之间。
糖尿病患者的基线血糖高于非糖尿病患者（均值±均值标准误：203±27 vs 117±3 mg/dL，p < 0.005）。基线后，糖尿病患者的胰岛素水平升至410至568微单位/毫升。非糖尿病患者相应的胰岛素水平为12至40微单位/毫升。与基线相比，糖尿病患者在低温体外循环期间血糖降低了10%±29%，而非糖尿病患者血糖升高了21%±30%（p < 0.005）。体外循环结束后，糖尿病患者的血糖低于非糖尿病患者（137±12 mg/dL vs 162±8 mg/dL，p < 0.005）。9名糖尿病患者在低温体外循环期间术中血糖控制良好（血糖123±8 mg/dL，胰岛素550±68微单位/毫升，葡萄糖输注速率1.87±0.29 mg/kg/min），6名患者在手术接近尾声时接近良好控制（血糖147±8 mg/dL，胰岛素483±86微单位/毫升，葡萄糖输注速率0.35±0.05 mg/kg/min），2名患者从未实现血糖控制。初始血糖>300 mg/dL的糖尿病患者未实现充分的血糖控制。4名糖尿病患者（3名伴有肾衰竭）在体外循环后因低血糖需要注射50%葡萄糖。
使用改良胰岛素钳夹技术，多数糖尿病患者在心脏手术期间可实现充分的血糖控制，前提是初始血糖<300 mg/dL。
