Cardic-valve Replacment Perioperative The Effect Of Blood Glucose Control On Levels Of Blood Lactic Acid And Clinical Study

Objective Through the blood glucose control during perioperative, check the different blood glucose levels of blood lactic acid changes in different time,to further explore the glucose, lactic acid variation,the relationship between blood glucose and blood lactic acid, seeking a new way to reduce blood glucose and blood lactic acid, to recuperate patients'health and myocardial protection with perioperative, to reasonable control of blood glucose level with intraoperative and postoperative provide experimental basis.Methods Selected 63 patients ,who had underwent cardiac valve replacement with the CPB assisted at cardiac surgery department of Affiliated Hospital of Ningxia Medical University from April 2010 to February 2011, and patients who meet the requirements by randomly divided into an experimental group(n=35) and control group(n=28). The control group received traditional standard t therapy (blood glucose concentration was maintained at 7.5-11.1mmol / l) and the experimental group received intensive therapy (blood glucose concentration was maintained at 3.6-7.5 mmol / l) by subcutaneous infusion or continuous insulin infusion, and then cheke the different blood glucose levels and blood lactic acid changes in the perioperative different time. Record the cardiopulmonary bypass time,the clamping time, the assisted ventilation time,the length of stay inICU , the hospitalization time , the rate of postoperative complications and the drainage of fluid of pericardium.Result 1.There were no significant differences in patients'general conditions between two groups(p>0.05). 2. Compared with the control group, The experimental group blood glucose levels were significantly lower during CPB and postoperative (P<0.05). The amplitude and the degree were smaller than the control group. 3. The blood lactic acid level of the two group were significantly increased with prolonged operative time, and occurred Lactic acidosis. Experimental group blood lactic acid during were lower than the control group duringr CPB and postoperative (P<0.05). 4.The blood glucose level and the blood lactic acid level in the two groups decreased firstly ,then decreased,and recoverd finally. The highest level of the blood glucose level and the blood lactic acid level were found 6 hours after the operation. There were significant differences in blood glucose levels after aortic cross-clamping, aortic open ,stop CPB,stop operation and after the operation 1h,6h,12h,24h in the two groups(P<0.05). There were significant differences in blood lactic acid levels after aortic open ,stop CPB,stop operation and after the operation 1h,6h,12h,24h in the two groups(P<0.05). 5. The blood glucose level and the blood lactic acid level similar trend in the two groups, By linear regression analysis of glucose and lactic acid in the correlation , the Correlation coefficient is 0.838, sided P <0.01, that two variables have linear relationship. 6.Compared with the control group, The experimental group at the length of stay in ICU , the hospitalization time, the rate of postoperative complications and the drainage of fluid of pericardium were significantly lower(P<0.05).Conclusion 1. During the Cardic-valve replacment perioperative ,the blood glucose level and the blood lactic acid level decreased were unfavorable prognosis for patients. 2. During the Cardic-valve replacment perioperative, the blood glucose level and the blood lactic acid level were positively correlated. 3. Tight blood gulucose control by insulin infusion can maintain the blood glucose concentration at 3.6-7.5 mmol / l,can reduce the injury on the body. 4. Tight blood gulucose control by insulin infusion at perioperative can lower the rate of complications, shorten the stay in ICU time and hospitalization time, enhance the curative effect, reduece the useage of antibiotics in patients after Cardic-valve replacment, and improve prognosis.