Barcellos Christiano da Silveira de, Wender Orlando C B, Azambuja Paulo Cerati de
Hospital São Vicente de Paulo - Hospital Escola da Faculdade de Medicina da Universidade de Passo Fundo, Passo Fundo, RS.
Rev Bras Cir Cardiovasc. 2007 Jul-Sep;22(3):275-84. doi: 10.1590/s0102-76382007000300002.
This study was undertaken to determine whether GIK infusion improves hemodynamic performance by reducing the use of inotropic agents, as well as the morbidity of diabetic patients submitted to CABG.
Patients with type 2 DM referred for CABG were randomized to receive GIK or subcutaneous insulin from anesthetic induction up to 12 hours postoperatively. The primary clinical outcome was the cardiac index (CI) and the secondary clinical outcomes were the remaining hemodynamic parameters; the use of inotropics and vasodilators, the glycemic control (maintenance of plasma glucose levels), and the postoperative morbidity. Hemodynamic and laboratory measurements were performed in the first 24 hours postoperatively, and the patients were followed up for 30 days to detect any surgery-related complications.
Twenty-four patients were randomly included in the study. IC did not show significant difference (mean cardiac index at 24 hours in both GIK group 3.49+/-0.94 and Control group 3.38+/-0.75; p=0.74). The GIK group revealed lower blood glucose levels in the infusion period (glucose at 12 hours GIK group 195.6+/-68.25 versus Control group 269.6+/-78.48; p=0.02), with a lower incidence of hyperglycemia in the GIK group, two (16%) against eight (64%) in the control group (RR 0.25; 95% CI 0.07-0.94; p=0.03). Postoperative infectious complications were less frequent in the GIK group than in Control group, three (25%) against 10 (80%), respectively (RR 0.30; 95% CI 0.11-0.83; p=0.01).
Studies have proven that GIK improves hemodynamic performance of both patients with or without DM submitted to CABG, what was not confirmed in this study. The use of GIK neither improved the CI improvement nor reduced the use of inotropic drugs, but it provided better glucose control. Secondary clinical outcome, including postoperative infections, was more frequent in the control group.
本研究旨在确定极化液（GIK）输注是否通过减少血管活性药物的使用来改善血流动力学表现，以及接受冠状动脉旁路移植术（CABG）的糖尿病患者的发病率。
因CABG而就诊的2型糖尿病患者被随机分组，从麻醉诱导期至术后12小时接受GIK或皮下胰岛素治疗。主要临床结局是心脏指数（CI），次要临床结局是其余血流动力学参数、血管活性药物和血管扩张剂的使用、血糖控制（血浆葡萄糖水平的维持）以及术后发病率。在术后24小时内进行血流动力学和实验室测量，并对患者进行30天随访以检测任何与手术相关的并发症。
24例患者被随机纳入研究。CI未显示出显著差异（GIK组术后24小时平均心脏指数为3.49±0.94，对照组为3.38±0.75；p = 0.74）。GIK组在输注期血糖水平较低（GIK组12小时血糖为195.6±68.25，对照组为269.6±78.48；p = 0.02），GIK组高血糖发生率较低，分别为2例（16%）和对照组8例（64%）（相对危险度0.25；95%可信区间0.07 - 0.94；p = 0.03）。GIK组术后感染并发症比对照组少，分别为3例（25%）和10例（80%）（相对危险度0.30；95%可信区间0.11 - 0.83；p = 0.01）。
研究已证明GIK可改善接受CABG的糖尿病或非糖尿病患者的血流动力学表现，但本研究未证实这一点。GIK的使用既未改善CI，也未减少血管活性药物的使用，但它提供了更好的血糖控制。包括术后感染在内的次要临床结局在对照组中更常见。
