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目的确定先天性心脏病术后患儿理想的血糖控制范围和方法。方法住院行先心病矫治术后、年龄≤6个月的小婴儿82例。将82例患儿按随机数字表法分成两大组:胰岛素控制血糖组(A组)及非胰岛素控制血糖组(B组),每组随机分成三小组(A1、A2、A3和B1、B2、B3)。A组患儿进行胰岛素控制血糖策略,B组患儿采用非胰岛素控制血糖策略,使每组达目标血糖值。术后72小时抽股静脉血查白细胞(WBC)、C反应蛋白(CRP)、乳酸、丙氨酸氨基转移酶(ALT)、肌酐(Cr),并统计术后重症监护室(ICU)停留时间、肺部感染发生率、低血糖发生率和病死率。结果 A2组和B2组患儿的股静脉血WBC、CRP、乳酸、ALT、Cr水平均低于同大组内其他两小组,A2组与A3组、B2组与B3组间比较差异均有统计学意义(P<0.05)。A2组各项血液检测指标与B2组比较更低,差异有统计学意义(P<0.05)。A2组与A1、A3组,B2组与B1、B3组比较,ICU停留时间更短,各并发症发生率更低,其中,A2组ICU停留时间与A3组和B2组比较,差异有统计学意义(P<0.05)。结论术后过高的血糖可增加肺部感染率,但过于积极的控制血糖并不能改善患者的疗效,反而增加低血糖的发生率。
Objective To determine the ideal range and method of glycemic control in children with congenital heart disease. Methods Eighty-two infants younger than 6 months after operation were treated with CHD. 82 children were divided into two groups according to random number table: insulin-controlled blood glucose (group A) and non-insulin controlled blood glucose (group B), and each group was randomly divided into three groups (A1, A2, A3 and B1, B2 , B3). A group of children with insulin control blood sugar strategy, B group children with non-insulin control blood sugar strategy, so that each group reached the target blood glucose. Venous blood was collected for venous thrombolysis at 72 hours after operation to collect white blood cells (WBC), C reactive protein (CRP), lactate, alanine aminotransferase (ALT) and creatinine (Cr) Incidence of pulmonary infection, incidence of hypoglycemia and mortality. Results The levels of WBC, CRP, lactate, ALT and Cr in the femoral vein of children in group A2 and group B2 were lower than those in other two groups in group A2, group A3, group B2 and group B3 Significance (P <0.05). A2 group of blood test indicators and B2 group was lower, the difference was statistically significant (P <0.05). A2 group and A1, A3 group, B2 group and B1, B3 group, ICU shorter residence time, the incidence of complications is lower, which, A2 group ICU residence time compared with A3 and B2 group, the difference was statistically significant Significance (P <0.05). Conclusions Postoperative high blood sugar can increase the rate of lung infection, but too much positive control of blood sugar does not improve the efficacy of patients, but increase the incidence of hypoglycemia.