Kuntschen F R, Galletti P M, Hahn C, Arnulf J J, Isetta C, Dor V
J Thorac Cardiovasc Surg. 1985 Jan;89(1):97-106.
Anesthesia, surgical trauma, heparinization, priming volume composition, and temperature control of the heart-lung machine individually affect carbohydrate, protein, or lipid metabolism during cardiac operations. The impact of some of these factors on glucose and insulin regulation was assessed before, during, and after normothermic cardiopulmonary bypass in nondiabetic patients with use of a servo-controlled insulin delivery system. With a glucose-free prime, cardiopulmonary bypass induced a slight hyperglycemia but no endogenous insulin response, suggesting a partial inhibition of insulin secretion. Nonetheless, insulin release could be stimulated by exogenous glucagon. A glucose load in the priming fluid led to marked and persistent hyperglycemia without commensurate insulin release. Elevated stress hormone levels, a concomitant reduction of insulin release and insulin action, and a depression of peripheral glucose utilization, as demonstrated by glucose clamp experiments, contributed to these perturbations of glucose and insulin metabolism. Although the metabolic alterations observed are not critical in routine cardiac operations, they may become clinically significant in postoperative states with unusual persistence of stress conditions.
麻醉、手术创伤、肝素化、预充液成分以及体外循环机的温度控制，在心脏手术过程中分别对碳水化合物、蛋白质或脂质代谢产生影响。在非糖尿病患者进行常温体外循环期间及之后，使用伺服控制胰岛素输注系统评估了其中一些因素对葡萄糖和胰岛素调节的影响。采用无葡萄糖预充时，体外循环导致轻度高血糖，但无内源性胰岛素反应，提示胰岛素分泌受到部分抑制。尽管如此，外源性胰高血糖素可刺激胰岛素释放。预充液中加入葡萄糖负荷会导致明显且持续的高血糖，而胰岛素释放却未相应增加。如葡萄糖钳夹实验所示，应激激素水平升高、胰岛素释放和胰岛素作用同时降低以及外周葡萄糖利用受抑制，共同导致了这些葡萄糖和胰岛素代谢紊乱。尽管观察到的代谢改变在常规心脏手术中并不严重，但在应激状态异常持续的术后阶段，它们可能具有临床意义。
