Crock P A, Ley C J, Martin I K, Alford F P, Best J D
University of Melbourne Department of Medicine, Fitzroy, Victoria, Australia.
Diabet Med. 1988 Jan;5(1):47-52. doi: 10.1111/j.1464-5491.1988.tb00940.x.
Hormonal and metabolic responses to hypothermic coronary artery bypass grafting (CABG) were studied in three groups: 8 non-diabetic patients, 8 patients with non-insulin-dependent diabetes mellitus (NIDDM) given a glucose pump priming solution and 8 NIDDM patients given a non-glucose infusion. There were no significant differences in stress hormone responses between NIDDM and non-diabetic patients, with adrenaline concentrations rising 10-fold, noradrenaline 4-fold and cortisol 2 to 3-fold. Glucagon rose significantly during bypass only in the NIDDM patients who did not receive a glucose prime. Comparable marked hyperglycaemia was seen in both glucose primed groups during bypass and exclusion of glucose from the prime in NIDDM patients prevented this major rise. Postoperatively, the rise in insulin in the glucose primed NIDDM patients contrasted with the slower rise in the non-glucose primed NIDDM patients who were also hyperglycaemic by this stage. Perioperative hyperglycaemia in NIDDM patients undergoing CABG can be prevented by using a non-glucose priming solution and by giving insulin infusion, particularly postoperatively.
对三组患者进行了低温冠状动脉旁路移植术（CABG）的激素和代谢反应研究：8名非糖尿病患者、8名接受葡萄糖泵预充液的非胰岛素依赖型糖尿病（NIDDM）患者和8名接受非葡萄糖输注的NIDDM患者。NIDDM患者和非糖尿病患者之间的应激激素反应无显著差异，肾上腺素浓度升高10倍，去甲肾上腺素升高4倍，皮质醇升高2至3倍。仅在未接受葡萄糖预充的NIDDM患者中，旁路手术期间胰高血糖素显著升高。在旁路手术期间，两个接受葡萄糖预充的组均出现了相当明显的高血糖，而在NIDDM患者中从预充液中排除葡萄糖可防止这种大幅升高。术后，接受葡萄糖预充的NIDDM患者胰岛素升高，与此形成对比的是，此时同样处于高血糖状态的未接受葡萄糖预充的NIDDM患者胰岛素升高较慢。对于接受CABG的NIDDM患者，围手术期高血糖可通过使用非葡萄糖预充液和输注胰岛素来预防，尤其是在术后。
