Kjellman U W, Björk K, Dahlin A, Ekroth R, Kirnö K, Svensson G, Wernerman J
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
Scand Cardiovasc J. 2000 Jun;34(3):321-30. doi: 10.1080/713783123.
The aim of this study was to test the hypothesis that abnormalities of myocardial substrate metabolism during blood cardioplegic aortic cross-clamping and early reperfusion are attenuated further by insulin(GIK) than by alpha-ketoglutarate enrichment of blood cardioplegia alone. Twenty-eight males (47 to 78 years) undergoing coronary artery bypass grafting (CABG) participated in a prospective, controlled, randomized study. All patients had alpha-ketoglutarate-enriched blood cardioplegia. Insulin(GIK) was infused in 13 patients during aortic cross-clamping. Insulin(GIK) prevented lactate release during cardioplegia (1.5+/-15 vs -44+/-14 micromol/min, p = 0.04), and a significant extraction of lactate was induced shortly after declamping the aorta (15+/-3 vs 2+/-1%, p = 0.001). Free fatty acid uptake was reduced after cardioplegic cross-clamping (5.7+/-1.6 vs 16.0+/-3.8 micromol/min, p = 0.02). More positive/less negative levels of alanine, aspartate, glutamine, glycine, ornithine, taurine and tyrosine were found in all the insulin-treated patients. We conclude that insulin(GIK) attenuates abnormalities of myocardial substrate metabolism during blood cardioplegic aortic cross-clamping and early reperfusion further than is obtained with alpha-ketoglutarate enrichment of blood cardioplegia alone.
本研究的目的是检验这样一个假设，即在血液停搏液主动脉阻断和早期再灌注期间，胰岛素（葡萄糖 - 胰岛素 - 钾溶液，GIK）比单纯在血液停搏液中添加α - 酮戊二酸更能进一步减轻心肌底物代谢异常。28名接受冠状动脉旁路移植术（CABG）的男性患者（47至78岁）参与了一项前瞻性、对照、随机研究。所有患者均使用富含α - 酮戊二酸的血液停搏液。13例患者在主动脉阻断期间输注胰岛素（GIK）。胰岛素（GIK）可防止停搏液期间乳酸释放（1.5±15与 - 44±14微摩尔/分钟，p = 0.04），并且在松开主动脉夹后不久诱导了显著的乳酸摄取（15±3与2±1%，p = 0.001）。停搏液阻断后游离脂肪酸摄取减少（5.7±1.6与16.0±3.8微摩尔/分钟，p = 0.02）。在所有接受胰岛素治疗的患者中，发现丙氨酸、天冬氨酸、谷氨酰胺、甘氨酸、鸟氨酸、牛磺酸和酪氨酸的水平更呈正值/负值更小。我们得出结论，在血液停搏液主动脉阻断和早期再灌注期间，胰岛素（GIK）比单纯在血液停搏液中添加α - 酮戊二酸更能进一步减轻心肌底物代谢异常。
