Svedjeholm R, Håkanson E, Szabó Z
Department of Cardiothoracic Surgery, Linköping Heart Center, University Hospital, Sweden.
Wien Klin Wochenschr. 1999 Jul 9;111(13):501-11.
There is increasing evidence that the availability of different metabolic substrates can influence post-ischemic functional recovery of the heart and the damage incurred during episodes of myocardial ischemia. Here we present the rationale for metabolic interventions, describe their mechanisms of action and suggest potential clinical applications. In cardiac surgery, basic research, studies of human myocardial metabolism after cardiac operations, and available experience with metabolic interventions provide a rationale for metabolic support with glutamate and/or high-dose glucose-insulin-potassium (GIK) in postoperative cardiac failure. In the treatment of acute myocardial infarction GIK deserves serious evaluation as recent randomized studies in diabetics with myocardial infarction and in patients undergoing reperfusion strategies demonstrate significant reductions in mortality. However, before large scale prospective randomized studies are undertaken, further studies of myocardial metabolism in acute myocardial infarction and the impact of different GIK regimes may be advisable in order to determine appropriate doses. A brief overview of metabolic modulation with pharmacological measures is given as it eventually may prove that we have to await the introduction of pharmacological agents which enhance full glucose oxidation at the expense of free fatty acids to create the commercial interest necessary to achieve widespread use of metabolic therapies.
越来越多的证据表明，不同代谢底物的可用性会影响心脏缺血后的功能恢复以及心肌缺血发作期间所产生的损伤。在此，我们阐述代谢干预的基本原理，描述其作用机制并提出潜在的临床应用。在心脏手术、基础研究、心脏手术后人体心肌代谢的研究以及代谢干预的现有经验，为在术后心力衰竭中使用谷氨酸和/或高剂量葡萄糖 - 胰岛素 - 钾（GIK）进行代谢支持提供了理论依据。在急性心肌梗死的治疗中，GIK值得认真评估，因为最近针对糖尿病心肌梗死患者和接受再灌注策略患者的随机研究表明死亡率显著降低。然而，在进行大规模前瞻性随机研究之前，对急性心肌梗死中的心肌代谢以及不同GIK方案的影响进行进一步研究可能是明智的，以便确定合适的剂量。本文简要概述了药理学措施的代谢调节，因为最终可能证明我们必须等待能够以游离脂肪酸为代价增强全葡萄糖氧化的药物制剂的推出，以产生实现代谢疗法广泛应用所需的商业利益。
