Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue · 2012
[Rational control on postoperative blood glucose levels in infants with congenital heart disease].
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Liu Mei, Zheng Ping, Zheng Xiao-ying, Meng Xin-ke
Аннотация
OBJECTIVE: To investigate optimal level of post-operation blood glucose control in infants with congenital heart disease (CHD).
METHODS: One hundred and two infants ≤1 year old undergoing open-heart surgery were randomly divided into three groups: intensive blood glucose control group (group A, n = 35), active blood glucose control group (group B, n = 38), and common glucose control group (group C, n = 29). Insulin injection would be intravenously administrated when blood glucose levels up to 8.3, 15.0, and 18.0 mmol/L in group A, B, and C, respectively. Blood white blood count (WBC), C-reactive protein (CRP), lactic acid, alanine aminotransferase (ALT), creatinine (Cr), incidence of pulmonary infection, the length of intensive care unit (ICU) stay, incidence of hypoglycemia and mortality were compared at 72 hours after operation among three groups.
RESULTS: WBC [×10(9)/L], CRP (mg/L) and incidence of pulmonary infection in group C were significantly higher than those in group A and group B (WBC: 18.2 ± 8.7 vs. 13.2 ± 5.1, 14.5 ± 5.7; CRP: 32.9 ± 10.9 vs. 20.8 ± 9.8, 18.6 ± 8.5; incidence of pulmonary infection: 27.6% vs. 8.6%, 10.5%, all P < 0.05), but there were no statistical differences between group A and group B. ALT (U/L) in group B was significantly lower than that in group A and group C (49.0 ± 17.8 vs. 68.4 ± 16.9, 69.9 ± 13.8, both P < 0.05), but there was no statistical difference between group A and group C. Incidence of hypoglycemia in group A was significantly higher than that in group B and group C (20.0% vs. 2.6%, 3.4%, both P < 0.05), but there was no statistical difference between group B and group C. There were no statistical differences in lactic acid (mmol/L), Cr (μmol/L) and the length of ICU stay (days) among group A, B, and C (lactic acid: 2.1 ± 0.8, 2.3 ± 0.5, 2.2 ± 0.7; Cr: 55.1 ± 13.4, 49.4 ± 15.7, 57.3 ± 11.6; the length of ICU stay: 3.5 ± 1.8, 3.2 ± 1.1, 3.6 ± 1.6, all P>0.05). There was no infant death in three groups.
CONCLUSIONS: Severe hyperglycemia after open heart operation was associated with increasing WBC count, CRP level and incidence of pulmonary infection during the post operative period. However, it also demonstrated that intensive blood glucose control be link to increase risks of hypoglycemia and liver dysfunction.
METHODS: One hundred and two infants ≤1 year old undergoing open-heart surgery were randomly divided into three groups: intensive blood glucose control group (group A, n = 35), active blood glucose control group (group B, n = 38), and common glucose control group (group C, n = 29). Insulin injection would be intravenously administrated when blood glucose levels up to 8.3, 15.0, and 18.0 mmol/L in group A, B, and C, respectively. Blood white blood count (WBC), C-reactive protein (CRP), lactic acid, alanine aminotransferase (ALT), creatinine (Cr), incidence of pulmonary infection, the length of intensive care unit (ICU) stay, incidence of hypoglycemia and mortality were compared at 72 hours after operation among three groups.
RESULTS: WBC [×10(9)/L], CRP (mg/L) and incidence of pulmonary infection in group C were significantly higher than those in group A and group B (WBC: 18.2 ± 8.7 vs. 13.2 ± 5.1, 14.5 ± 5.7; CRP: 32.9 ± 10.9 vs. 20.8 ± 9.8, 18.6 ± 8.5; incidence of pulmonary infection: 27.6% vs. 8.6%, 10.5%, all P < 0.05), but there were no statistical differences between group A and group B. ALT (U/L) in group B was significantly lower than that in group A and group C (49.0 ± 17.8 vs. 68.4 ± 16.9, 69.9 ± 13.8, both P < 0.05), but there was no statistical difference between group A and group C. Incidence of hypoglycemia in group A was significantly higher than that in group B and group C (20.0% vs. 2.6%, 3.4%, both P < 0.05), but there was no statistical difference between group B and group C. There were no statistical differences in lactic acid (mmol/L), Cr (μmol/L) and the length of ICU stay (days) among group A, B, and C (lactic acid: 2.1 ± 0.8, 2.3 ± 0.5, 2.2 ± 0.7; Cr: 55.1 ± 13.4, 49.4 ± 15.7, 57.3 ± 11.6; the length of ICU stay: 3.5 ± 1.8, 3.2 ± 1.1, 3.6 ± 1.6, all P>0.05). There was no infant death in three groups.
CONCLUSIONS: Severe hyperglycemia after open heart operation was associated with increasing WBC count, CRP level and incidence of pulmonary infection during the post operative period. However, it also demonstrated that intensive blood glucose control be link to increase risks of hypoglycemia and liver dysfunction.