Department of Anesthesiology, Experimental Laboratory for VItal Signs, VU University Medical Center, De Boelelaan 1117, Amsterdam, the Netherlands.
Cardiovasc Diabetol. 2013 Mar 4;12:42. doi: 10.1186/1475-2840-12-42.
Volatile anaesthetics exert protective effects on the heart against perioperative ischaemic injury. However, there is growing evidence that these cardioprotective properties are reduced in case of type 2 diabetes mellitus. A strong predictor of postoperative cardiac function is myocardial substrate metabolism. In the type 2 diabetic heart, substrate metabolism is shifted from glucose utilisation to fatty acid oxidation, resulting in metabolic inflexibility and cardiac dysfunction. The ischaemic heart also loses its metabolic flexibility and can switch to glucose or fatty acid oxidation as its preferential state, which may deteriorate cardiac function even further in case of type 2 diabetes mellitus.Recent experimental studies suggest that the cardioprotective properties of volatile anaesthetics partly rely on changing myocardial substrate metabolism. Interventions that target at restoration of metabolic derangements, like lifestyle and pharmacological interventions, may therefore be an interesting candidate to reduce perioperative complications. This review will focus on the current knowledge regarding myocardial substrate metabolism during volatile anaesthesia in the obese and type 2 diabetic heart during perioperative ischaemia.
挥发性麻醉剂对心脏具有保护作用，可防止围手术期发生缺血性损伤。然而，越来越多的证据表明，在 2 型糖尿病患者中，这些心脏保护特性会降低。术后心功能的一个强有力的预测指标是心肌底物代谢。在 2 型糖尿病患者的心脏中，底物代谢从葡萄糖利用转变为脂肪酸氧化，导致代谢灵活性降低和心脏功能障碍。缺血性心脏也失去了代谢灵活性，它可以切换到葡萄糖或脂肪酸氧化作为其首选状态，这可能会使 2 型糖尿病患者的心脏功能进一步恶化。最近的实验研究表明，挥发性麻醉剂的心脏保护特性部分依赖于改变心肌底物代谢。因此，针对代谢紊乱的干预措施，如生活方式和药物干预，可能是减少围手术期并发症的一个有趣的候选方法。这篇综述将重点介绍肥胖和围手术期缺血时 2 型糖尿病患者的挥发性麻醉期间心肌底物代谢的最新知识。
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