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目的:观察先天性心脏病外科术后血糖控制对并发症发生率及预后的影响。方法:156例先天性心脏病患儿被随机分为加强控制组(A组),积极控制组(B组),一般控制组(C组)。患儿入ICU后每2 h查静脉血糖,A组、B组、C组分别在血糖超过8.3 mmol/L、10.0 mmol/L、15.0 mmol/L静脉给予胰岛素治疗。比较3组患儿术后72 h血白细胞计数、呼吸道感染发生率、伤口感染发生率、低血糖发生率、手术死亡率、ICU滞留时间、住院时间。结果:A组的低血糖发生率明显高于B组和C组,A组和B组的72 h血白细胞计数、肺部感染发生率、伤口感染发生率、手术死亡率、ICU滞留时间、住院时间均无统计学差异。C组的72 h血白细胞计数、肺部感染发生率明显高于A组和B组。结论:术后过高的血糖能增加患儿的白细胞计数及肺部感染发生率。但过于积极的控制血糖并不能改善患者的疗效,反而会增加低血糖的发生率。
Objective: To observe the effect of postoperative blood glucose control on the complication rate and prognosis of patients with congenital heart disease. Methods: 156 cases of congenital heart disease were randomly divided into intensive control group (A group), active control group (B group) and general control group (C group). Venous blood glucose was measured every 2 hours after admission to ICU. Groups A, B and C were treated with intravenous insulin at concentrations of 8.3 mmol / L, 10.0 mmol / L and 15.0 mmol / L respectively. The blood leucocyte counts, the incidence of respiratory infections, the incidence of wound infection, the incidence of hypoglycemia, operative mortality, ICU stay and hospital stay at 72 h were compared between the three groups. Results: The incidence of hypoglycemia in group A was significantly higher than those in groups B and C. The blood leukocyte counts at 72 h, the incidence of pulmonary infection, the incidence of wound infection, operative mortality, ICU stay, hospital stay There was no significant difference in time. C group of 72 h white blood cell count, the incidence of pulmonary infection was significantly higher than the A and B group. Conclusion: Postoperative hyperglycemia can increase the white blood cell count and the incidence of pulmonary infection in children. However, the positive control of blood glucose does not improve the efficacy of patients, but will increase the incidence of hypoglycemia.