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极化液(GIK)溶液对心肌代谢的影响

[Effect of GIK solution on the myocardial metabolism].

作者信息

Yamada T, Kaneko H, Imazeki T, Heima S

机构信息

Department of Cardiovascular and Thoraic Surgery, Dokkyo University Koshigaya Hospital.

出版信息

Kyobu Geka. 1991 Feb;44(2):126-31.

PMID:1901117
Abstract

Effect of GIK solution (50% glucose 100 ml + insulin 20IU + KCl 20 mEq) infused in an hour on the myocardial metabolism was studied in the postoperative period following the open-heart surgery. Increase of arterial glucose, pyruvate, K+ and PCO2 and the decrease of pH was significant at the end of infusion. Increase of coronary sinus blood PCO2, myocardial oxygen extraction ratio for glucose and carbohydrate and the decrease of pH was highly significant. Myocardial oxygen extraction ratio for carbohydrate correlated significantly with the increase of coronary sinus blood PCO2 and the decrease of pH. Although the cardiac index correlated poorly with the myocardial oxygen extraction ratio for carbohydrate, a significant correlation was observed between the coronary arterial-sinus blood K+ difference and the coronary sinus blood PCO2, pH and myocardial oxygen extraction ratio for carbohydrate. It is suggested that the infused glucose with insulin and K+ was metabolized and degraded to CO2 and H2O quickly in the TCA cycle producing ATP and the rest was stored as glycogen with the uptake of K+ in the myocardium.

摘要

在心脏直视手术后的恢复期,研究了在一小时内输注GIK溶液(50%葡萄糖100毫升+胰岛素20国际单位+氯化钾20毫当量)对心肌代谢的影响。输注结束时,动脉血葡萄糖、丙酮酸、钾离子和二氧化碳分压升高,pH值降低,差异有统计学意义。冠状窦血二氧化碳分压升高、心肌对葡萄糖和碳水化合物的氧摄取率升高以及pH值降低,差异有高度统计学意义。心肌对碳水化合物的氧摄取率与冠状窦血二氧化碳分压升高和pH值降低显著相关。虽然心脏指数与心肌对碳水化合物的氧摄取率相关性较差,但观察到冠状动脉-窦血钾离子差值与冠状窦血二氧化碳分压、pH值以及心肌对碳水化合物的氧摄取率之间存在显著相关性。提示输注的葡萄糖与胰岛素和钾离子在三羧酸循环中迅速代谢降解为二氧化碳和水,产生三磷酸腺苷,其余部分则以糖原形式储存,并伴有心肌对钾离子的摄取。

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