Coleman G M, Gradinac S, Taegtmeyer H, Sweeney M, Frazier O H
University of Texas Medical School, Division of Cardiology, Houston 77030.
Circulation. 1989 Sep;80(3 Pt 1):I91-6.
Refractory pump failure after cardiopulmonary bypass carries a high mortality. To assess the effectiveness of metabolic support for the heart in patients with refractory heart failure after hypothermic ischemic arrest for aortocoronary bypass surgery, we randomly assigned 22 patients to receive either intravenous glucose (50%), insulin (80 units/I), and potassium (100 meq/l) (GIK) infused at a rate of 1 ml/kg/hr for up to 48 hours or glucose (5%) and NaCl (0.225%) infused at the same rate (control). All patients required inotropic drug support, received intra-aortic balloon pump assistance, and had an initial mean cardiac index (CI) of 2.5 l/min/m2. At 12 and 24 hours, CI had risen significantly in the GIK but not in the control group (3.6 and 3.4 l/min/m2 vs. 2.5 and 2.7 l/min/m2, p less than 0.005). Time on the intra-aortic balloon pump (39 vs. 61 hours) and requirements for inotropic drug support were also significantly less in the GIK compared with the control group. Although the number of patients was relatively small, the GIK group also showed a trend for improved long-term survival: at 60 days after surgery, there were 10 of 11 survivors in the GIK-treated group compared with seven of 11 survivors in the control group. Although the exact mechanism for the beneficial effects of GIK on myocardial contractility remains to be elucidated, we conclude that GIK is safe and effective in the treatment of refractory left ventricular failure after aortocoronary bypass surgery.
体外循环后难治性泵衰竭的死亡率很高。为了评估代谢支持对接受主动脉冠状动脉搭桥手术的低温缺血停搏后难治性心力衰竭患者心脏的有效性，我们随机分配了22名患者，一组接受静脉输注葡萄糖（50%）、胰岛素（80单位/升）和钾（100毫当量/升）（GIK），输注速率为1毫升/千克/小时，持续48小时；另一组接受相同速率输注葡萄糖（5%）和氯化钠（0.225%）（对照组）。所有患者均需要使用正性肌力药物支持，接受主动脉内球囊泵辅助，初始平均心脏指数（CI）为2.5升/分钟/平方米。在12小时和24小时时，GIK组的CI显著升高，而对照组未升高（分别为3.6和3.4升/分钟/平方米，对比2.5和2.7升/分钟/平方米，p<0.005）。与对照组相比，GIK组使用主动脉内球囊泵的时间（39小时对比61小时）和正性肌力药物支持的需求也显著减少。尽管患者数量相对较少，但GIK组在长期生存方面也显示出改善趋势：术后60天时，GIK治疗组的11名幸存者中有10名存活，而对照组的11名幸存者中有7名存活。虽然GIK对心肌收缩力产生有益作用的确切机制仍有待阐明，但我们得出结论，GIK在治疗主动脉冠状动脉搭桥手术后的难治性左心室衰竭方面是安全有效的。
