冠状动脉手术中应用葡萄糖-胰岛素-钾可改善心肌保护:一项随机对照试验  

Improved myocardial protection during coronary artery surgery with glucose-in- sulin-potassium: A randomized controlled trial

作　　者：Quinn D.W Pagano D Bonser R.S. 程敏 

机构地区：[1]Department of Cardiothoracic Surgery, Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Edgbaston, Birmingham, B15 2TH, United Kingdom

出　　处：《世界核心医学期刊文摘（心脏病学分册）》2006年第5期55-56,共2页

摘　　要：Objective: We sought to assess the role of glucose-insulin-potassium in providing myocardial protection in nondiabetic patients undergoing coronary artery surgery with cardiopulmonary bypass. Methods: A prospective, randomized, double-blind, placebo-controlled trial was conducted at a single-center university hospital performing adult cardiac surgery. Two hundred eighty nondiabetic adult patients undergoing first-time elective or urgent isolated multivessel coronary artery bypass grafting were prospectively randomized to receive glucose-insulin-potas- sium infusion or placebo(dextrose 5% )before, during, and for 6 hours after surgical intervention. Anesthetic, cardiopulmonary bypass, myocardial protection, and surgical techniques were standardized. The primary end point was postreperfusion cardiac index. Secondary end points were systemic vascular resistance index, the incidence of low cardiac output episodes, inotrope and vasoconstrictor use, and biochemical-electrocardiographic evidence of myocardial injury. The incidence of dysrhythmias and infections requiring treatment was recorded prospectively. Results: The glucose-insulin-potassium group experienced higher cardiac indices(P< .001) throughout infusion and reduced vascular res istance(P< .001). The incidence of low cardiac output episodes was 15.9% (22/138) in the glucose-insulin-potassium group and 27.5% (39/142) in the placebo group(P=.021). Inotropes were required in 18.8% (26/138) of the glucose-insulin-potassium group and 40.8% (58/142) of the placebo group(P< .001). Fewer patients in the glucose-insulin-potassium group(12.3% [16/133]) versus those in the placebo group(23.4% [32/137]) had significant myocardial injury(P=.017). Noncardiac morbidity was not different. Conclusion: Glucose-insulin-potassium therapy improves early postoperative cardiovascular performance, reduces inotrope requirement, and might reduce myocardial injury. These potential benefits are not at the expense of increased noncardiac morbidity.Objective： We sought to assess the role of glucose-insulin-potassium in providing myocardial protection in nondiabetic patients undergoing coronary artery surgery with cardiopulmonary bypass. Methods： A prospective, randomized, double-blind, placebo-controlled trial was conducted at a single-center university hospital performing adult cardiac surgery. Two hundred eighty nondiabetic adult patients undergoing first-time elective or urgent isolated multivessel coronary artery bypass grafting were prospectively randomized to receive glucose-insulin-potassium infusion or placebo（dextrose 5% ）before, during, and for 6 hours after surgical intervention. Anesthetic, cardiopulmonary bypass, myocardial protection, and surgical techniques were standardized. The primary end point was postreperfusion cardiac index. Secondary end points were systemic vascular resistance index, the incidence of low cardiac output episodes, inotrope and vasoconstrictor use, and biochemical-electrocardiographi c evidence of myocardial injury. The incidence of dysrhythmias and infections requiring treatment was recorded prospectively.

关 键 词：随机对照试验 5%葡萄糖 冠状动脉手术 手术中应用 心肌保护 胰岛素 多支冠状动脉搭桥术 钾 血管阻力指数 体外循环 

分 类 号：R4[医药卫生—临床医学] R961