Castro Pablo F, Larrain Germán, Baeza Ricardo, Corbalán Ramón, Nazzal Carolina, Greig Douglas P, Miranda Fernando P, Pérez Osvaldo, Acevedo Mónica, Marchant Eugenio, Olea Enrique, Gonzalez Rolando
Department of Cardiovascular Diseases, Hospital Clínico de la Pontificia Universidad Católica de Chile, Santiago, Chile.
Crit Care Med. 2003 Aug;31(8):2152-5. doi: 10.1097/01.CCM.0000079604.46997.7B.
To evaluate the effects of glucose-insulin-potassium (GIK) therapy on infarct size and left ventricular function when used as an adjuvant therapy to primary angioplasty.
Prospective, randomized, double-blind, placebo-controlled study.
Cardiac intensive care unit at a university hospital.
Thirty-seven patients with acute myocardial infarction for whom primary angioplasty was indicated.
Eligible patients were randomized by a blinded pharmacist to GIK solution (30% glucose in water with insulin 50 U/L, and KCl 40 mM/L) vs. placebo at 1.5 mL/kg/hr for 24 hrs.
Tc 99m sestamibi myocardial scintigraphy was performed at admission and at 3 months. Primary end points were the changes in left ventricular ejection fraction (LVEF) and the size of salvaged myocardium. Baseline clinical characteristics were similar in both groups. At the 3-month follow-up, a significant overall decrease in infarct size (37 +/- 16% vs. 12 +/- 10%, p <.005) and an increase in LVEF (34 +/- 13% vs. 49 +/- 9%, p =.005) were observed. Patients randomized to GIK solution experienced a significant increase in their LVEF at 3 months (39 +/- 12 to 51 +/- 13, p =.002). Patients who received placebo had no significant differences between baseline and 3-month measurements (44 +/- 13 vs. 49 +/- 14, p = NS). There was a trend toward an increase in myocardial salvage in the GIK group, which did not reach statistical significance. When patients from both groups were compared directly, differences in LVEF improvement were no longer significant.
GIK solution did not improve LVEF or decrease the infarct size among patients undergoing primary angioplasty.
评估葡萄糖-胰岛素-钾（GIK）疗法作为直接经皮冠状动脉腔内血管成形术（primary angioplasty）辅助治疗时对梗死面积和左心室功能的影响。
前瞻性、随机、双盲、安慰剂对照研究。
一所大学医院的心脏重症监护病房。
37例有直接经皮冠状动脉腔内血管成形术指征的急性心肌梗死患者。
符合条件的患者由一位盲法药剂师随机分配接受GIK溶液（水中30%葡萄糖加胰岛素50 U/L和氯化钾40 mM/L）或安慰剂，以1.5 mL/kg/小时的速度输注24小时。
入院时及3个月时进行锝99m甲氧基异丁基异腈（Tc 99m sestamibi）心肌闪烁显像。主要终点是左心室射血分数（LVEF）的变化和存活心肌的大小。两组的基线临床特征相似。在3个月随访时，观察到梗死面积显著总体减小（37±16%对12±10%，p<.005）以及LVEF增加（34±13%对49±9%，p=.005）。随机接受GIK溶液的患者在3个月时LVEF显著增加（39±12至51±13，p=.002）。接受安慰剂的患者在基线和3个月测量值之间无显著差异（44±13对49±14，p=无统计学意义）。GIK组有存活心肌增加的趋势，但未达到统计学意义。当直接比较两组患者时，LVEF改善的差异不再显著。
GIK溶液在接受直接经皮冠状动脉腔内血管成形术的患者中未改善LVEF或减小梗死面积。
