改良极化液对心内直视手术心肌保护的初步研究  

Primary study of modified glucose-insulin-potassium solution on perioperative cardiac surgery patients

作　　者：张盈 赵堃 张明[2] 赵荣 金振晓 陈敏 李红玲 金艳 吕珊珊 贺清 陈文生 崔勤 

机构地区：[1]第四军医大学第一附属医院心血管外科,西安710032 [2]第四军医大学基础部神经生物学教研室,西安710032 [3]第四军医大学第一附属医院麻醉科,西安710032 [4]第四军医大学第一附属医院超声科,西安710032

出　　处：《中国体外循环杂志》2014年第1期16-20,共5页Chinese Journal of Extracorporeal Circulation

基　　金：国家自然科学基金资助项目(30972865)

摘　　要：目的研究改良极化液(GIK)对心内直视手术的心肌保护效果。方法 760例患者随机分为GIK组(n=379)和对照组(n=381),观察患者术后并发症发生率和死亡率,测定围术期血糖、乳酸及心肌酶学指标的变化。结果体外循环(CPB)后两组血糖水平均显著上升,在术后6 h达到峰值,但GIK组在术后6 h显著低于对照组(P<0.05);两组乳酸水平在CPB后均显著上升,GIK组在术后1 h﹑6 h和12 h显著低于对照组(P<0.05);两组血清钾离子浓度在各观察点均保持正常水平;两组术后谷草转氨酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌钙蛋白I(cTnI)均显著升高(P<0.05),GIK组患者AST、CK、LDH在术后24 h、48 h均低于对照组(P<0.05),cTnI在术后24 h低于对照组(P<0.05);术后一周左室射血分数明显高于对照组(P<0.01);术后突发休克、新发房颤比率显著低于对照组。结论 GIK对心内直视手术患者有明显的心肌保护作用。Objective To investigate the effect of modified glucose-insulin-potassium solution（GIK） on the myocardial protec- tion of the cardiac surgery patients. Methods 760 cases with the heart disease were divided randomly into two groups ： modified GIK group （379 cases） and control group （381 cases）. The early mortality and rate of complications were observed. The blood glucose, lactic acid and indexes of myocardial enzymes were measured in the perioperative period. Results The blood glucose after cardiopulmonary bypass （CPB） increased significantly in 2 groups, and reached to the peak at T5. But the level of blood glucose in GIK group was much lower than that in control group at T5 （ P 〈0.05）. The lactic acid level rised dramatically after CPB, and it was markedly lower in GIK groupthan control group （ P 〈0.05） at I＂4, T5 and T6. There were not significant differences of serum potassium ion in each ob- servation point. Glutamic oxalacetic transaminase （AST）, lactate dehydrogenase （LDH）, creatine kinase （CK） and troponin I （CT- nI） increased observably （ P 〈0.05）. But in the GIK group, the AST, CK and LDH were much lower than those in the control group at T6 and T7 （ P 〈0.05） ; the CTnI much less than control group at T7 （ P 〈0.05）. The left ventricular ejection fraction of GIK group was much higher at 7th day after operation （ P 〈0.01） ; Rates of postoperative sudden shock and atrial fibrillation （AF） of GIK group were much lower. Conclusion Modified GIK has the good myocardial protecting functions of myocardium during the open-heart surgery.

关 键 词：极化液 体外循环 心肌保护 心内直视手术 

分 类 号：R654.2[医药卫生—外科学]