The Initial Study Of Intensive Insulin Therapy In Cardiovascular Surgery Perioperation

【background and Aims】Stress hyperglycemia and insulin resistance are common in severe illness patients with or without diabetes. Stress hyperglycemia was found to be an independently risk factor of increasing mortality , and it had been paid more and more attention by the clinicians in recent years. In order to find a suitable intensive insulin therapy project for Chinese cardiac surgery and study the relationship between intensive insulin therapy and patient's prognosis , our ICU of cardiovascular surgery used the modified Portland project as guideline, and organized an intensive insulin therapy team. Then part of the patients undergoing heart surgery during December,2005 and November,2007 were accepted the intensive insulin therapy. Compared with the patients accepted conventional insulin treatment in the same time, we began this retrospective study.【Contents】1. Establishment of IIT project for Chinese cardiac surgery patients and study of it's feasibility, necessity. 2. Relationship between IIT and postoperative infection in the patients undergoing CPB cardiac surgery without diabetes.3. Relationship between IIT and prognosis in the patients undergoing valve replacement under CPB without diabetes.4. Relationship between IIT and prognosis in the patients undergoing coronary artery bypass grafting.5. Relationship between IIT and prognosis in the children undergoing congenital heart disease operating.【Results】1. In the patients undergoing heart surgery without blood glucose control, the trend was comparable between change of blood glucose and clinical symptom in the same time. And blood glucose level increased significantly in most of the dead cases.2. In the patients undergoing heart surgery, compared with the CT group, we can find that IT group had increased the IIT rate and the insulin dosage. The 3-BG average level was decreased(P<0.05). And hypoglycemic rate between the two groups has no statistically differences(P>0.05).3. In the patients undergoing CPB cardiac surgery without diabetes, compared with the CT group, we can find that blood infection, respiratory infection and wound infection rate were decreased in the IT group(P<0.05).4. In the patients undergoing valve replacement under CPB without diabetes, compared with the CT group, we can find that the rates hepatic insufficiency and kidney failure were decreased, the time on ventilator and length of stay in ICU were shortened , in-hospital infection rate and mortality were decreased in the IT group(P<0.05).5. In the patients undergoing coronary artery bypass grafting with diabetes, compared with the CT group, we can find that in-hospital infection rate was decreased, the length of postoperative hospital stay was shortened in the IT group(P<0.05).6. In the patients undergoing coronary artery bypass grafting without diabetes, compared with the CT group, we can find that in-hospital infection , rates of hepatic insufficiency and kidney failure were decreased, the length on ventilator and postoperative hospital stay were shortened in the IT group(P<0.05).7. In the children undergoing simple congenital heart disease operating, compared with the CT group, we can find that the length on ventilator was shortened in the IT group(P<0.05). On the contrary, the differences of the other items between the two groups had no statistically differences. (P>0.05)8. In the children undergoing complex congenital heart disease operating, compared with the CT group, we can find that in-hospital infection rate was decreased, the length of postoperative hospital stay was shortened in the IT group(P<0.05). On the contrary, the differences of the other items between the two groups had no statistically differences.(P>0.05)【Conclusions】1. Using modified Portland protocol to control the blood glucose level in 70-150mg/dL was necessary,safe and effective. It was worthy to popularize in Chinese cardiac surgery patients.2. IIT in non-diabetic CPB cardiac surgery patients could decrease the rate of postoperative nosocomial infection.3. IIT in nondiabetic patients undergoing heart valve replacement could reduce the injury of vital organs such as hepar and kidney, and it could improve the prognosis.4. IIT in CABG patients, despite of diabetic or non-diabetic patients, could decrease the postoperative blood glucose level, in-hospital infection rate and the time on ventilator , improve the function of vital organs. Finally, it can improve the prognosis.5. IIT in the children undergoing complex congenital heart disease operating, could improve all prognostic indicators in different degree by control the blood glucose level. In the children undergoing simple congenital heart disease operating, routine therapy of blood glucose was more economic.6. With more understanding of blood glucose control, we have constructed the IIT project and it had been a routine treatment in our ICU of cardiac surgery.