葡萄糖-胰岛素-氯化钾对体外循环内分泌、代谢紊乱及胰岛素抵抗的防治作用  

Effects of glucose-insulin-potassium on stress hormones and insulin resistance during cardiopulmonary bypass

作　　者：黑飞龙[1] 龙村[1] 房秀生 

机构地区：[1]中国医学科学院阜外心血管病医院麻醉和体外循环实验室,北京100037

出　　处：《中华实验外科杂志》2000年第6期499-500,共2页Chinese Journal of Experimental Surgery

摘　　要：目的　探讨葡萄糖 胰岛素 氯化钾 (GIK)液对体外循环 (CPB)期间胰岛素抵抗和内分泌代谢紊乱的防治作用。方法　将 2 0例心脏瓣膜置换术患者分为两组 ,GIK组和对照组各 10例。GIK组于麻醉诱导后 ,GIK液按胰岛素每小时 1U/kg体重持续静脉滴注 ,至主动脉阻断前滴完。在麻醉前、CPB前、CPB 15min、开放升主动脉后 5min和停机后 2 0min采取血样 ,测定红细胞压积、血糖、胰岛素、C肽、生长激素和皮质醇的浓度。结果　CPB期GIK组血糖浓度分别为 (19.2 6± 1.0 4)mmol/L ,(15 .80± 1.2 4)mmol/L ,(12 .0 7± 1.2 9)mmol/L ,对照组血糖浓度分别为 (15 .5 6± 1.12 )mmol/L ,(11.5 8± 1.37)mmol/L ,(7.79± 1.49)mmol/L ;GIK组皮质醇浓度分别为 (771.44± 83 .2 8)μg/L ,(742 .72± 91.5 5 ) μg/L ,(712 .2 4± 93.2 2 ) μg/L ,对照组皮质醇浓度分别为 (4 80 .73±5 1.10 )μg/L ,(387.6 2± 46 .92 ) μg/L ,(336 .33± 39.81) μg/L。CPB期GIK组血糖和皮质醇浓度显著低于对照组。而与之相反胰岛素、C肽浓度高于对照组。GIK组的生长激素也有降低 ,但两组差异无显著性 (P >0 .0 5 )。结论　GIK液对CPB期内分泌和代谢反应有一定的防治作用 ,也能使胰岛素敏感性增加 ,使胰腺 β细胞分泌功能得到一定的改善。Objective\ To study the preventive effect of glucose insulin potassium (GIK) solution on insulin resistance and metabolic disorder in patients during the period of cardiopulmonary bypass (CPB). Methods\ Twenty patients were divided into two groups: GIK group ( n =10) and control group ( n =10). Insulin, which was contained in GIK solution was infused continuously at a rate of 1 U·kg -1 ·h -1 ) during the period from induction of anesthesia to clamping aorta. Blood samples were obtained respectively at the following intervals: before anesthesia, before CPB, 15 min after CPB, 5 min after unclamping aorta, 20 min after CPB. Insulin, c peptide, cortisol, growth hormone as well as glucose in the samples were measured. Results\ During and after the end of CPB, the levels of plasma glucose were (19.26±1.04) mmol/L, (15.80±1.24) mmol/L, (12.07±1.29) mmol/L in GIK group and (15.56±1.12) mmol/L ,(11.58±1.37) mmol/L, (7.79±1.49) mmol/L in the control group, respectively. The levels of plasma cortisol were (771.44±83.28) μg/L, (742.72±91.55) μg/L and (712.24±93.22) μg/L in GIK group and (480.73±51.10) μg/L,(387.62±46.92) μg/L, (336.33±39.81) μg/L in the control group, respectively. The levels of glucose and cortisol were significantly reduced in GIK group. On the contrary, the concentrations of insulin and C peptide in GIK group were higher than those in the control group. No significant difference in growth hormone levels was found between the two groups. Conclusion Stress hormonal responses, carbohydrate metabolism, the secretion of pancreatic β cells were improved and the degree of stress was reduced by GIK solution.\;

关 键 词：体外循环 胰岛素抵抗 内分泌代谢紊乱 GIK液 

分 类 号：R654.2[医药卫生—外科学]