Stanley A W, Moraski R E, Russell R O, Rogers W J, Mantle J A, Kreisberg R A, McDaniel H G, Rackley C E
Am J Cardiol. 1975 Dec;36(7):929-37. doi: 10.1016/0002-9149(75)90085-5.
To assess the metabolic effects of myocardial substrate alteration in patients with coronary artery disease, glucose-insulin-potassium solution was administered intravenously for 30 minutes to 14 men with stable angiographically documented coronary artery disease. The glucose-insulin-potassium solution (300 g of glucose, 50 units of regular insulin and 80 mEq of potassium chloride per liter of water) was infused at a constant rate in each patient, but individual infusion rates ranged from 0.013 to 0.032 ml/kg per min (4 to 10 mg glucose/kg per min) in the 14 patients. Simultaneous arterial and coronary sinus samples were obtained at 15 minute intervals during a stable 30 minute control period and again at 15 minute intervals during the infusion; samples were assayed for glucose, lactate, free fatty acid and oxygen content. In all 14 patients, during the glucose-insulin-potassium infusion, arterial glucose and lactate increased and arterial free fatty acid levels fell; the magnitude of the changes in arterial lactate and free fatty acids was related to the rate of infusion. Arterial-coronary sinus differences (A-Cs) for glucose, lactate and free fatty acid levels correlated with the arterial concentrations of these substrates (r = 0.66, 0.87 and 0.79, respectively). Regression analyses demonstrated myocardial thresholds for the uptake of these substrates as follows: glucose 79 mg/100 ml; lactate 300 mu mole/liter; and free fatty acids 100 to 200 mu Eq/liter. Finally and most importantly, the reduction in A-Cs oxygen values after glucose-insulin-potassium infusion correlated with the reduction in A-Cs free fatty acid levels (r = 0.64, P less than 0.0001). This observation suggests that, in patients with coronary artery disease, glucose-insulin-potassium infusion may significantly diminish myocardial oxygen requirements by reduction of myocardial free fatty acid utilization and simultaneous enhancement of myocardial carbohydrate utilization. Myocardial substrate availability may be an important determinant of myocardial oxygen demand in patients with coronary artery disease. Infusion of glucose-insulin-potassium solution has the potential to alter myocardial substrate availability, thus improving the balance between myocardial oxygen demand and supply.
为评估冠状动脉疾病患者心肌底物改变的代谢效应，对14例经血管造影证实患有稳定型冠状动脉疾病的男性患者静脉输注葡萄糖 - 胰岛素 - 钾溶液30分钟。葡萄糖 - 胰岛素 - 钾溶液（每升水中含300克葡萄糖、50单位正规胰岛素和80毫当量氯化钾）以恒定速率输注到每位患者体内，但14例患者的个体输注速率范围为每分钟0.013至0.032毫升/千克（每分钟4至10毫克葡萄糖/千克）。在稳定的30分钟对照期内，每隔15分钟同时采集动脉和冠状窦样本，在输注期间同样每隔15分钟采集一次；对样本进行葡萄糖、乳酸、游离脂肪酸和氧含量的检测。在所有14例患者中，在输注葡萄糖 - 胰岛素 - 钾期间，动脉葡萄糖和乳酸增加，动脉游离脂肪酸水平下降；动脉乳酸和游离脂肪酸变化的幅度与输注速率有关。葡萄糖、乳酸和游离脂肪酸水平的动脉 - 冠状窦差值（A - Cs）与这些底物的动脉浓度相关（分别为r = 0.66、0.87和0.79）。回归分析显示这些底物摄取的心肌阈值如下：葡萄糖79毫克/100毫升；乳酸300微摩尔/升；游离脂肪酸100至200微当量/升。最后且最重要的是，葡萄糖 - 胰岛素 - 钾输注后A - Cs氧值的降低与A - Cs游离脂肪酸水平的降低相关（r = 0.64，P < 0.0001）。这一观察结果表明，在冠状动脉疾病患者中，输注葡萄糖 - 胰岛素 - 钾可能通过减少心肌游离脂肪酸利用并同时增强心肌碳水化合物利用，从而显著降低心肌氧需求。心肌底物可用性可能是冠状动脉疾病患者心肌氧需求的重要决定因素。输注葡萄糖 - 胰岛素 - 钾溶液有可能改变心肌底物可用性，从而改善心肌氧供需平衡。
