心内直视术后应激性高血糖胰岛素强化治疗.docVIP

心内直视术后应激性高血糖胰岛素强化治疗作者：唐白云 刘喜利?? 张希 吴钟凯 杨圣艮 王治平 罗红鹤 童萃文 孙培吾 【摘要】? 目的? 探讨心内直视术后应激性高血糖发生情况及处理原则。方法? 对心内直视术后应激性高血糖的47例患者于术前、术毕、术后2h、术后4h、术后8h、术后12h、术后24h监测血糖变化及对术后出现高血糖（＞8mmol/L）者每2h监测1次。对于术后血糖＞8mmol/L者即行小剂量［0.1U/(kg·h)］胰岛素强化治疗，目标治疗为血糖控制在6～8mmol/L，同时监测生命体征、酸碱平衡、感染等术后情况。结果? 27例术后血糖8～13mmol/L于术后4～6h降至8mmol/L以下，16例术后血糖13～20mmol/L于术后6～8h降至8mmol/L以下，4例大于20mmol/L者其中2例于术后12h降至8mmol/L以下，2例术后出现低心排经处理于术后48h降至8mmol/L以下。本组患者未发生并发症均痊愈出院，胰岛素治疗期间均未出现低血糖。结论? 对应激性高血糖进行胰岛素强化治疗并有效地控制术后血糖于6～8mmol/L水平可以减少术后并发症，改善疾病的预后，研究提示术后应激性高血糖可能是影响患者预后的独立因素。??????? 【关键词】? 心内直视术后? 应激性高血糖? 处理原则??? ??? Intensive insulin therapy of stress hyperglycemia after open-heart surgery??????? 【Abstract】? Objective? To explore the occurrence and treatment principle of stress hyperglycemia after open-heart surgery.Methods? The blood glucose is inspected on 47 patients of stress hyperglycemia after open-heart surgery at preoperation，finished operation，2h，4h，8h，12h and 24h after operation. Blood glucose over 8mmol/L will be treated by intensive insulin at small dosage，objective： the blood glucose must be controlled under 6～8mmol/L，at the same time the life sign，infection and hypoglycemia are inspected.Results? By intensive insulin therapy，the blood glucose(8～13mmol/L after operation) on 27 cases goes lower than 8mmol/L within 4～6h after operation，the blood glucose(13～20mmol/L after operation) on 16 cases goes lower than 8mmol/L within 6～8h after operation，2 cases goes lower than 8mmol/L 12h after operation and 2 cases goes lower than 8mmol/L 48h after operation among 4 cases(＞20mmol/L). The patients were not accompanied with the complication，and did not occur the hypoglycemia during the insulin therapy.Conclusion? When positive-decreasing stress，intensive insulin therapy must be carried out at the same time，and blood glucose is controlled under 6～8mmol/L，which could decrease complication after surgery and improve outcome，stress hyperglycemia is possible an independent element for affecting patient outcome.??? ??