| Objective To investigate the effects of organ function and prognosis of patients after cardiac valve replacement with CPB who used continuous insulin infusion to control blood glucose during CPB. Methods Thirty six patients (from 2010.3 to 2010.10) undergoing cardiac valve replacement with CPB were divided randomly into two groups: Insulin Group (n=18) and Control Group (n=18). In Insulin Group, insulin was infused constantly into central venous with microperfusion pump from the point of immediate after anesthesia induction to the end of the operation. The blood glucose of insulin group during the operation ranged from 3.9 mmol/L to 6.1mmol/L, but had not been controlled after the operation. The control Group had not control the blood glucose all the time. The blood glucose, blood lactate , blood potassium, value plasma levels of TNF-αand cTnI were detected at different time during and after the operation. After the operation, all the patients were given assessment of cardiac fuction, and liver and kidney functions of them were determined. To record the CPB time, aortic cross-clamp time, mechanical ventilation time, ICU monitoring time, hospital stay time, complication formation rate and mortality. Removes a piece of myocardium for electron microscope to observe the ultrastructural changes of myocardium before and after the CPB. Results①The difference of the general condition of the two groups was not statistically significant (P>0. 05). Compared with control group, the blood glucose level of the insulin group decreased (P<0.01), and the blood glucose peak also decreased (4.87±0.93) vs(8.35±1.41)mmol/L, and the incidence of blood potassium peak≧6.0mmol/L also decreased (P<0.05).②The blood lactate levels of the two groups were increased with prolonged operation time, and the blood lactate level of the insulin group was significant lower than that of the control group. (P<0. 05 or p<0.01)③Atfer the CPB, both the two groups had not control the blood glucose. The blood lactate level of the insulin group was significant lower than that of the control group after CPB 1h (P<0.05), and the difference of the blood lactate levels of the two groups was not statistically significant (P>0. 05) .④The value plasma levels of TNF-αand cTnI of both the two groups were increased during and after the CPB, and the value plasma levels of TNF-αreached the peak after CPB 3h, and the value plasma levels of cTnI reached the peak after CPB 24h. Compared with control group, the value plasma levels of TNF-αand cTnI of the insulin groups were increased during and after the CPB. (P<0. 05 or p<0.01)⑤Both groups had varying degree ultrastructural damage of myocardium, and the insulin group got a lower score for ultrastructure of cardiac muscle cell such as mitochondrion, cardiac muscle fibers and nuclei (P<0.01).⑥Compared with control group, the insulin group got a better score for the mark of liver and kidney functions and using inotropic drugs. And the ICU monitoring time were shorter (P<0.05). But for Breathing machines auxiliary breath of time,patients postoperative infection, AF incidence and hospitalization time not significantly influenced..Conclusions①Infusing insulin constantly during the CPB, which let the blood glucose of insulin group during the operation ranged from 3.9 mmol/L to 6.1mmol/L, has salutary effects on the blood lactate after surgery. And after aortic open-clamp, the spontaneous return rate can be rose.②Infusing insulin constantly during the CPB to control the blood glucose can relieve the value plasma levels of TNF-αand systemic inflammatory response syndrome, and promote recovery of patients.③Using continuous insulin infusion to control blood glucose can relieve the value plasma levels of cTnI, and improve the varying degree ultrastructural damage of myocardium.④Using continuous insulin infusion to control blood glucose has the effects of reducing glutamic-pyruvic transaminasecan (ALT), and can improve the kidney function, reduce the the ICU monitoring. But can not influence the prognosis of patients . |
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