静脉输注高剂量葡萄糖-胰岛素-钾对ST段抬高的急性心肌梗死的作用  

Effect of high dose glucose-insulin-potassium infusion in patients with acute ST-segment elevation myocardial infarction.analysis of 7510 patients in China as part of CREATE-ECLA study

作　　者：杨艳敏[1] 朱俊[1] 谭慧琼[1] 梁岩[1] 章晏[1] 丽英[1] 李建冬[1] 刘力生[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院急症抢救中心,北京100037

出　　处：《中华医学杂志》2008年第26期1806-1810,共5页National Medical Journal of China

摘　　要：目的进一步评价中国人群应用高剂量葡萄糖-胰岛素-钾（GIK）输注对ST段抬高的AMI患者病死率的影响。方法将参加国际多中心评价低分子肝素和代谢调节剂（GIK）治疗急性心肌梗死（AMI）的临床研究中的中国人群进行亚组分析，采用随机开放对照研究，全部入选患者来自中国地区274家医院，入选为出现症状12h内的ST段抬高的AMI。伴有Ⅰ型糖尿病、已知的肾功能损害或高钾血症的患者被排除。患者随机分配至接受24hGIK输注加常规治疗以及单纯常规治疗（对照组）。随访30d，观察GIK对总病死率，心脏骤停，心源性休克以及随机30d内再次心肌梗死的影响。结果中国地区共人选7510例患者，平均年龄（62±12）岁，从症状出现到随机的均值时间为（5．8±3．4）h。64．0％患者接受再灌注治疗。药物治疗与欧美国家注册登记研究相似。对照组与GIK组30d时病死率分别为10．4％与11．2％[风险比（HR）为1．05，95％可信区间0．916—1．207，P=0．476]。以下各种事件发生率对照组与GIK组，心脏骤停（1．0％、0．8％），心源性休克（6．4％、6．8％），再次心肌梗死（1．9％、2．0％），两组间差异均无统计学意义。死亡与非致死性心脏骤停、死亡与心源性休克、死亡与再次心肌梗死联合终点发生率两组间差异均无统计学意义。结论中国人群应用GIK输注对现代治疗下ST段抬高的AMI患者的病死率、心脏骤停或心源性休克无影响。Objective To investigate the effect of high-dose glucose-insulin-potassium （GIK） infusion on the outcomes of ST-elevation myocardial infarction （STEMI） in China. Methods As part of the international multicentre CREATE-ECLA study, 7510 patients with STEMI, aged （62 ± 12 ）, presenting their symptoms within 12 hours of onset who were hospitalized in 274 centers throughout China from July 2001 through July 2004 were randomized to receive GIK intravenous infusion for 24 hours plus routine treatment （3739） or control group （n = 3771 ） receiving routine treatment alone. The patients were flowed up in the out-patient department 30 days after the randomization to assess the rates of mortality, cardiac arrest, cardiogenic shock and re-infarction. Results The median time from symptom onset to randomization was 5.8 hours. The mortality of the control group was 10.4%, not significantly different from that of the GIK group （ 11.2 %, hazard ratio = 1.05, 95 % CI： 0.916-1. 207, P = 0. 476 ）. There rates of cardiac arrest, cardiogenic shock, and re-infarction of the GIK group were 0.8%, 6.8%, and 2.0% respectively, all not significantly different from those of the control group （ 1.0%, 6.4%, and 1.9% respectively, all P 〉0. 05）. At the Day 7 the heart failure rate of the GIK group was 19.7%, not significantly different from that of the control group （18.3%, P=0. 102）. The symptomatic hypotension rate of the GIK group was 3.7%, significantly higher than that of the control group （ 1.2%, P 〈 0.01 ）. The phlebitis rate of the GIK group was 2.2%, significantly higher than that f the control group （0. 1%, P 〈0.01 ）. The net increased fluid volume of the control group wasl3 584 ml. more than that of the GIK group （ 1036 ml）. Conclusions High dose GIK infusion has neutral effect on mortality, cardiac attest or cardiogenic shock in patients with acute STEMI in China.

关 键 词：心肌梗死 葡萄糖-胰岛素-钾输注 静脉输注 临床分析 

分 类 号：R686[医药卫生—骨科学]