改良GIK液对心脏外科患者体外循环术后心血管事件的影响  

Effects of Modified GIK Solution on Cardiovascular Events after Cardiopulmonary Bypass

作　　者：易莎 苏兰 齐新凤 YI Sha;SU Lan;QI Xinfeng(Operating Room,Chengdu Shangjin Nanfu Hospital,Chengdu 611730,China)

机构地区：[1]成都上锦南府医院麻醉手术中心,成都611730 [2]成都医学院第二附属医院.核工业四一六医院胸外科

出　　处：《解放军预防医学杂志》2018年第5期574-577,共4页Journal of Preventive Medicine of Chinese People's Liberation Army

基　　金：四川省卫生和计划生育委员会课题(No.120058)

摘　　要：目的观察心脏外科行体外循环手术治疗患者应用改良极化(GIK)液对术后心血管事件的影响。方法将2014年12月-2017年12月于我院心脏外科行体外循环手术治疗的204例患者随机分为观察组(n=102)与对照组(n=102),观察组在麻醉诱导前输注改良GIK液,对照组输注平衡盐溶液,比较两组主要不良心血管事件(MACE)发生率、30 d死亡率、180 d死亡率、住院时间、ICU滞留时间、机械通气时间、二次手术、脑卒中、术后正性肌力药应用率、败血症/感染、肾脏并发症发生率及左心室射血分数(LVEF)、心肌酶学指标、肝肾功能指标、血糖、胰岛素、乳酸水平变化。结果观察组MACE发生率15.69%(16/102)显著低于对照组36.27%(37/102),ICU滞留时间、术后正性肌力药应用率及肾脏并发症发生率显著低于对照组(P<0.05);术后观察组LVEF指标已恢复至术前水平,而对照组LVEF指标仍低于术前及观察组术后水平(P<0.05);观察组术后心肌酶学指标、肝肾功能指标及血糖、胰岛素、乳酸水平均显著提高,且低于对照组(P<0.05)。结论心脏外科行体外循环手术治疗患者应用改良GIK液可显著降低术后MACE发生率,减轻心肌损伤及肝肾功能损伤,提高组织细胞葡萄糖氧化功能及全身氧供能力,改善组织低灌注状态及机体能量代谢,保护患者心脏功能。Objective To explore the effects of a modified glucose-insulin-potassium （ GIK） solution on cardiovascular events among recipients of cardiac surgery after cardiopulmonary bypass. Methods Two hundred and four cases of patients who had undergone cardiopulmonary bypass surgery in our hospital between December 2014 and December 2017 were randomly divid-ed into the observation group （n=102） and control group （n=102）. The observation group was treated with infusion of a modi-fied GIK solution before anesthesia induction, while the control group was infused with a balanced salt solution. The incidence of major adverse cardiovascular events （MACE）, the 30d mortality, 180d mortality, length of hospital stay and ICU stay, mechani-cal ventilation time, second surgery, stroke, the usage of positive inotropic drugs after operation, sepsis/infection, renal compli-cations, levels of left ventricular ejection fraction （LVEF）, myocardial enzymology indexes, indexes of hepatorenal function, blood glucose, insulin and lactate were compared between the two groups. Results The incidence of MACE in the observation group was significantly lower than that in the control group〔15. 69％ （16/102） vs 36. 27％ （37/102）〕, the ICU stay was sig-nificantly shorter than that in the control group, and usage of positive inotropic drugs after operation and the incidence of renal complications were significantly lower than those in the control group （P〈0. 05）. The postoperative LVEF index in the observa-tion group returned to the preoperative level, and the LVEF index in the control group decreased and became lower than that in the observation group after operation （P〈0. 05）. The postoperative levels of myocardial enzymology indexes, hepatorenal function indexes, and blood glucose, insulin and lactate were significantly increased in the observation group, but were lower than those in the control group （P〈0. 05）. Conclusion The modified GIK solution for recipients of cardiopulmonary bypass can signi

关 键 词：改良GIK液 心脏外科 体外循环 心血管事件 

分 类 号：R654.2[医药卫生—外科学]