Comparison of the Effect of Intensive versus Conventional Insulinotherapy in Patients with Cardiac Surgery after Cardiopulmonary Bypass

Huey-Ling Liou ； Chun-Che Shih ； Kwei-Chun Chung ； Hsing-I Chen

《The Chinese Journal of Physiology》 56卷2期 (2013/04) Pp. 101-109

https://doi.org/10.4077/CJP.2013.BAA078

並列摘要

Hyperglycemia occurs commonly in clinically ill patients. Insulin therapy and glycemic control have been recommended for patients with septic shock. The present study investigated the effect of intensive (INIT) versus conventional insulinotherapy (COIT) in cardiac surgery patients who received cardiopulmonary bypass (CPB). In this quasi-experimental study, a total of 50 patients undergoing coronary artery bypass grafting (CABG) were recruited into the INIT and COIT groups. Study measures included serum glucose levels, cardiac output, cytokines, C-reactive protein (CRP), duration of mechanical ventilation and length of stay in the intensive care unit (ICU), and ICU mortality rate. In the INIT group, mean blood glucose level during the first two postoperative days was significantly lower than that in the COIT group. Cardiac output was significantly greater at the second postoperative days in the INIT patients than those in the COIT group. There were no differences in cytokines, CRP levels and the outcome data between two groups. Intensive insulinotherapy reduced the blood glucose and led to improve cardiac output after CABG in comparison with conventional insulinotherapy.

並列關鍵字

cardiac surgery patients ； cardiopulmonary bypass ； intensive insulinotherapy

參考文獻

Biffl, W.L.,Moore, E.E.,Moore, F.A.,Barnett, C.C., Jr.(1996).Interleukin-6 delays neutrophil apoptosis via a mechanism involving platelet-activating factor.J. Trauma.40,575-579.

Boudina, S.,Sena, S.,O''Neill, B.T.,Tathireddy, P.,Young, M.E.,Abel, E.D.(2005).Reduced mitochondrial oxidative capacity and increased mitochondrial uncoupling impair myocardial energetics in obesity.Circulation.112,2686-2695.

Bruemmer-Smith, S.,Avidan, M.S.,Harris, B.,Sudan, S.,Sherwood, R.,Desai, J.B.,Sutherland, F.,Ponte, J.(2002).Glucose, insulin and potassium for heart protection during cadiac surgery.Brit. J. Anaesth..88,489-495.

Buchanan, J.,Mazumder, P.K.,Hu, P.,Chakrabarti, G.,Roberts, M.W.,Yun, Ui.Y.,Cooksey, R.C.,Litwin, S.E.,Abel, E.D.(2005).Reduced cardiac efficiency and altered substrate metabolism precedes the onset of hyperglycemia and contractile dysfunction in two mouse models of insulin resistance and obesity.Endocrinology.146,5341-5349.

Bugger, H.,Abel, E.D.(2010).Mitochondria in the diabetic heart.Cardiovasc. Res..88,229-240.