| Background and ObjectivesCoronary atherosclerotic heart disease is called coronary disease, is the common disease to severely impair people health, is the primary cause being to bring about death in the western country. Although coronary disease sends lowly in our country, in the recent 20 years, along with people's livelihood gradual to raise and other influence of factors of level, the morbility of coronary heart disease has the tendency to obviously rise. Patients demanding to accept coronary bypass surgery have more and more too.Extracorporeal circulation lay coronary bypass surgery already mature surgery way at being clinical, as cardiovascular outside scientific and technological method and Cardiopulmonary bypass technology were improved constantly, though the mortality of operation on heart has already been reduced greatly, but during circulating the operation outside the body, the irritability that various stimuli often cause the organism to be strong reacts, produce blood system, alexinic system that the high blood glucose of irritability can activate the organism, etc. This lead to the fact the release of a large number of inflammatory mediums causes inflammation all over and reflects syndrome SIRS(Systemic Inflammatory Response Syndrome) and bleeds with the typical myocardial ischemia and reperfusion injury. SIRS is a body out of control self-destruction and self-sustained amplification of inflammatory response, acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS) can be induced if the balance is destructed.They are the important reasons of causing death. Large clinical data show that insulin therapy intensified not only can effectively control blood sugar can decrease postoperative inflammation, thereby reducing the release of postoperative complications associated with clinical and mortality rate and improve the prognosis of patients with speed recovery rate. This article is for the purpose of discussing the strengthened insulin treatment for adult extracorporeal circulation under a coronary bypass operation (CABG) of inflammation medium's influence and to reduce the whole body inflammation medium response mechanism after the adult external circulation, can reduce the reaction after the release of inflammation,postoperative complications and accelerate the patient recover provides a new way.MethodsThe 20 cases of adult patients who presented for elective coronary artery bypass were randomly divided into two groups, the conventional treatment group (A)and the intensive therapy group(B), with 10 patients in each group .In group A, The blood glucose concentration were maintained less than 180 mg/dl (10mmol/L); in group B,intraoperative high-dose insulin infusion (4mu/kg/min) with 20% glucose with the control of blood glucose between 70 and 110 mg/dl (4-6mmol/L), and less than 150 mg/dl(8.3 mmol/L) after surgery in both group. Blood samples were collected at six time points (Preoperative,30 minutes after the initiation of cardiopulmonary bypass (CPB), and after CPB 0 hours,4 hours,12 hours,24 hours). to determine the levels of interleukin 6 (IL-6), interleukin 8 (IL-8), interleukin 10 (IL-10), tumor necrosis factorα(TNF-α).ResultTwo groups have the same preoperative characteristics. In both two groups,IL-6 and IL-10 levels started to rise after 30 minutes of the initiation of CPB, the levels of IL-6 reached the peaked at the end of CPB while the levels of IL-10 reached the peaked at 4 hours after CPB, then decreased. IL-8, TNF-αbegan to increase at the end of CPB, reached the peak 4h after the termination of CPB and then began to decrease. The levels of IL-6, IL-8 and TNF-αat different time points after the termination of CPB were lower in B group than in A group while the the levels of IL-10 were higher. (P<0.05).ConclusionIntensive insulin therapy through the reduction of IL-6, IL-8 and TNF-α, increase the release of IL-10 to weakened the early postoperative surge in inflammatory response of CPB.
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