Visser L, Zuurbier C J, Hoek F J, Opmeer B C, de Jonge E, de Mol B A J M, van Wezel H B
Department of Anaesthesia, Academic Medical Center, University of Amsterdam, The Netherlands.
Br J Anaesth. 2005 Oct;95(4):448-57. doi: 10.1093/bja/aei220. Epub 2005 Aug 12.
The clinical benefits of glucose-insulin-potassium (GIK) and tight glycaemic control in patients undergoing coronary artery bypass grafting (CABG) may be partly explained by an anti-inflammatory effect. We applied GIK as a hyperinsulinaemic normoglycaemic clamp for >25 h and quantified its effect on systemic inflammation in patients undergoing CABG.
Data obtained in 21 non-diabetic patients with normal left ventricular function scheduled for elective coronary artery surgery, who were randomly allocated to a control or GIK group, were analysed. In GIK patients, regular insulin was infused at a fixed rate of 0.1 IU kg(-1) h(-1). The infusion rate of glucose (30%) was adjusted to maintain blood glucose levels within a target range of 4.0-5.5 mmol litre(-1). Plasma concentrations of interleukins 6, 8 and 10, C-reactive protein (CRP) and serum amyloid A (SAA) were measured on the day of surgery and on the first and second postoperative days (POD1 and POD2).
In the GIK group hypoglycaemia (glucose <2.2 mmol litre(-1)) did not occur, whereas hyperglycemia (glucose >6.1 mmol litre(-1)) developed in 15% of all measurements. In control patients, hyperglycaemia developed in >80% of all measurements in the presence of low endogenous insulin levels. CRP and SAA levels increased in both groups, with maximum levels measured on POD2. GIK treatment significantly reduced CRP and SAA levels. Interleukin levels increased significantly in both groups following cardiopulmonary bypass, but no differences were found between the groups.
Hyperinsulinaemic normoglycaemic clamp is an effective method of maintaining tight glycaemic control in patients undergoing CABG and it attenuates the systemic inflammatory response in these patients. This effect may partly contribute to the reported beneficial effect of glycaemic control in patients undergoing CABG.
葡萄糖 - 胰岛素 - 钾（GIK）及严格血糖控制在冠状动脉旁路移植术（CABG）患者中的临床益处，可能部分归因于其抗炎作用。我们应用GIK进行超过25小时的高胰岛素正常血糖钳夹，并量化其对CABG患者全身炎症的影响。
分析了21例计划接受择期冠状动脉手术、左心室功能正常的非糖尿病患者的数据，这些患者被随机分配至对照组或GIK组。GIK组患者以0.1 IU kg⁻¹ h⁻¹的固定速率输注常规胰岛素。调整葡萄糖（30%）的输注速率，以将血糖水平维持在4.0 - 5.5 mmol L⁻¹的目标范围内。在手术当天以及术后第1天和第2天（POD1和POD2）测量白细胞介素6、8和10、C反应蛋白（CRP）及血清淀粉样蛋白A（SAA）的血浆浓度。
GIK组未发生低血糖（血糖<2.2 mmol L⁻¹），而在所有测量中有15%出现了高血糖（血糖>6.1 mmol L⁻¹）。在对照组患者中，由于内源性胰岛素水平较低，超过80%的测量出现了高血糖。两组的CRP和SAA水平均升高，在POD2时达到最高水平。GIK治疗显著降低了CRP和SAA水平。体外循环后两组的白细胞介素水平均显著升高，但两组之间未发现差异。
高胰岛素正常血糖钳夹是在CABG患者中维持严格血糖控制的有效方法，并且它减轻了这些患者的全身炎症反应。这种作用可能部分促成了报道中血糖控制对CABG患者的有益效果。
