Department of Anaesthesiology and Pain Medicine, Anaesthesia and Pain Research Institute, Yonsei University Health System, 250 Seongsanno, Seodaemun-Gu, Seoul 120-752, Republic of Korea.
Br J Anaesth. 2013 Jan;110(1):47-53. doi: 10.1093/bja/aes324. Epub 2012 Sep 17.
The aim of this randomized and controlled trial was to investigate the effect of a glucose-insulin-potassium (GIK) solution on myocardial protection in acute coronary syndrome (ACS) patients undergoing urgent multivessel off-pump coronary artery bypass (OPCAB) surgery.
Sixty-six patients were randomly allocated either to receive 0.3 ml kg(-1) h(-2) GIK solution (potassium 80 mEq and regular insulin 325 IU in 500 ml of 50% glucose) or equivalent volume of normal saline (control) upon anaesthetic induction until 6 h after reperfusion. The primary endpoints were to compare the concentrations of creatine kinase-MB (CK-MB) and troponin-T between the groups after reperfusion. The secondary endpoints were to compare the incidences of postoperative troponin-T >0.8 ng ml(-1) and myocardial infarction (MI) between the groups.
Highest CK-MB [8.7 (4.4) vs 13.1 (7.9) ng ml(-1), P=0.006] and troponin-T [0.20 (0.13-0.49) vs 0.48 (0.18-0.91) ng ml(-1), P<0.0001] values after reperfusion were significantly lower in the GIK group compared with the control group. The area under the curve of serially measured troponin-T was also significantly smaller in the GIK group compared with the control group [0.83 (0.43-1.81) vs 0.46 (0.31-1.00), P=0.036]. Significantly fewer patients in the GIK group showed troponin-T >0.8 ng ml(-1) after reperfusion compared with the control group (3 vs 11, P=0.033). The incidence of postoperative MI was similar between the groups.
GIK administration in ACS patients undergoing urgent multivessel OPCAB significantly attenuated the degree of ensuing myocardial injury without complications related to glycaemic control. Clinical Trial Registry. URL: http://clinicaltrials.gov/ct2/show/NCT01384656?term=GIK+AND+OPCAB&rank=1. Unique identification number NCT01384656.
本随机对照试验旨在探讨葡萄糖-胰岛素-钾（GIK）溶液对急性冠脉综合征（ACS）患者行急诊非体外循环冠状动脉旁路移植术（OPCAB）时心肌保护的作用。
66 例患者随机分为 GIK 组（诱导麻醉时给予 0.3 ml/kg·h，含 80 mEq 钾和 325 IU 常规胰岛素的 50%葡萄糖 500 ml）或生理盐水组（对照组），至再灌注后 6 h。主要终点是比较两组再灌注后肌酸激酶同工酶-MB（CK-MB）和肌钙蛋白-T 的浓度。次要终点是比较两组术后肌钙蛋白-T >0.8 ng/ml 和心肌梗死（MI）的发生率。
GIK 组再灌注后 CK-MB[8.7（4.4）vs 13.1（7.9）ng/ml，P=0.006]和肌钙蛋白-T[0.20（0.13-0.49）vs 0.48（0.18-0.91）ng/ml，P<0.0001]值明显低于对照组。GIK 组连续测量的肌钙蛋白-T 曲线下面积也明显小于对照组[0.83（0.43-1.81）vs 0.46（0.31-1.00），P=0.036]。GIK 组再灌注后肌钙蛋白-T >0.8 ng/ml 的患者明显少于对照组（3 例 vs 11 例，P=0.033）。两组术后 MI 的发生率无差异。
在 ACS 患者行急诊多支 OPCAB 时，GIK 给药可显著减轻随后发生的心肌损伤程度，且与血糖控制无关。临床试验注册处。网址：http://clinicaltrials.gov/ct2/show/NCT01384656？term=GIK+AND+OPCAB&rank=1. 独特识别号码 NCT01384656。
