Scohy Thierry V, Golab Hanna D, Egal Mohamud, Takkenberg Johanna J M, Bogers Ad J J C
Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Paediatr Anaesth. 2011 Aug;21(8):872-9. doi: 10.1111/j.1460-9592.2011.03571.x. Epub 2011 Apr 4.
Many studies are reporting that the occurrence of hyperglycemia in the postoperative period is associated with increased morbidity and mortality rates in children after cardiac surgery for congenital heart disease. This study sought to determine blood glucose levels in standard pediatric cardiac anesthesiological management without insulin infusions.
The study population consisted of 204 consecutive pediatric patients aged from 3 days to 15.4 years undergoing open cardiac surgery for congenital heart disease between June 2007 and January 2009. Glucose-containing fluids were not administrated intraoperatively, and all patients received high dose of opioids (sufentanil 10 mcg·kg(-1) ) and steroids (30 mg·kg(-1) methylprednisolone) iv. Glucose levels were measured before CPB, 10 min after initiation of CPB, every hour on CPB, post-CPB, and on arrival at intensive care unit (ICU).
Intraoperatively, only one patient had a glucose level <50 mg·dl(-1) (=34.2 mg·dl(-1) ), 57/204 patients (27.9%) had at least one intraoperative glucose >180 mg·dl(-1) , but only 12 patients (5.8%) had a glucose level >180 mg·dl(-1) at ICU arrival. Thirty-day mortality was 1.5% (3/204). Younger age, lower body weight, and lower CPB temperature were associated with hyperglycemia at ICU arrival, as were higher RACHS and Aristotle severity scores.
A conventional (no insulin, no glucose) anesthetic management seems sufficient in the vast majority of patients (96.5%). Special attention should be paid to small neonates with complex congenital heart surgery, in whom insulin treatment may be contemplated.
许多研究报告称，先天性心脏病心脏手术后患儿术后高血糖的发生与发病率和死亡率增加相关。本研究旨在确定在不进行胰岛素输注的标准儿科心脏麻醉管理下的血糖水平。
研究对象为2007年6月至2009年1月期间连续204例年龄在3天至15.4岁之间接受先天性心脏病心脏直视手术的儿科患者。术中未输注含糖液体，所有患者静脉注射高剂量阿片类药物（舒芬太尼10 mcg·kg⁻¹）和类固醇（30 mg·kg⁻¹甲泼尼龙）。在体外循环（CPB）前、CPB开始后10分钟、CPB期间每小时、CPB后以及到达重症监护病房（ICU）时测量血糖水平。
术中，只有1例患者血糖水平<50 mg·dl⁻¹（=34.2 mg·dl⁻¹），57/204例患者（27.9%）至少有一次术中血糖>180 mg·dl⁻¹，但只有12例患者（5.8%）在到达ICU时血糖水平>180 mg·dl⁻¹。30天死亡率为1.5%（3/204）。年龄较小、体重较低和CPB温度较低与到达ICU时的高血糖相关，较高的RACHS和亚里士多德严重程度评分也与之相关。
传统的（不使用胰岛素、不使用葡萄糖）麻醉管理在绝大多数患者（96.5%）中似乎足够。对于接受复杂先天性心脏病手术的小新生儿应给予特别关注，可能需要考虑对其进行胰岛素治疗。
