Department of Anaesthesiology, Resuscitation and Intensive Care, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
Department of Diabetes, Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Diabetes Obes Metab. 2017 Dec;19(12):1818-1822. doi: 10.1111/dom.13029. Epub 2017 Jul 31.
We performed a randomized controlled trial with the glucagon-like peptide-1 (GLP-1) receptor agonist exenatide as add-on to standard peri-operative insulin therapy in patients undergoing elective cardiac surgery. The aims of the study were to intensify peri-operative glucose control while minimizing the risk of hypoglycaemia and to evaluate the suggested cardioprotective effects of GLP-1-based treatments. A total of 38 patients with decreased left ventricular systolic function (ejection fraction ≤50%) scheduled for elective coronary artery bypass grafting (CABG) were randomized to receive either exenatide or placebo in a continuous 72-hour intravenous (i.v.) infusion on top of standard peri-operative insulin therapy. While no significant difference in postoperative echocardiographic variables was found between the groups, participants receiving exenatide showed improved peri-operative glucose control as compared with the placebo group (average glycaemia 6.4 ± 0.5 vs 7.3 ± 0.8 mmol/L; P < .001; percentage of time in target range of 4.5-6.5 mmol/L 54.8% ± 14.5% vs 38.6% ± 14.4%; P = .001; percentage of time above target range 39.7% ± 13.9% vs 52.8% ± 15.2%; P = .009) without an increased risk of hypoglycaemia (glycaemia <3.3 mmol/L: 0.10 ± 0.32 vs 0.21 ± 0.42 episodes per participant; P = .586). Continuous administration of i.v. exenatide in patients undergoing elective CABG could provide a safe option for intensifying the peri-operative glucose management of such patients.
我们进行了一项随机对照试验，将胰高血糖素样肽-1（GLP-1）受体激动剂艾塞那肽作为标准围手术期胰岛素治疗的附加治疗，用于接受择期心脏手术的患者。该研究的目的是在最大限度降低低血糖风险的同时加强围手术期血糖控制，并评估基于 GLP-1 的治疗方法的建议的心脏保护作用。共有 38 名左心室收缩功能下降（射血分数≤50%）的患者接受择期冠状动脉旁路移植术（CABG），他们被随机分为接受艾塞那肽或安慰剂的组，在标准围手术期胰岛素治疗的基础上，连续 72 小时静脉（i.v.）输注。尽管两组患者术后超声心动图变量无显著差异，但与安慰剂组相比，接受艾塞那肽的患者围手术期血糖控制得到改善（平均血糖 6.4 ± 0.5 与 7.3 ± 0.8 mmol/L；P <.001；目标范围内时间百分比 4.5-6.5 mmol/L 54.8% ± 14.5% 与 38.6% ± 14.4%；P =.001；目标范围以上时间百分比 39.7% ± 13.9% 与 52.8% ± 15.2%；P =.009），且低血糖风险无增加（血糖<3.3 mmol/L：0.10 ± 0.32 与 0.21 ± 0.42 例/患者；P =.586）。在接受择期 CABG 的患者中连续静脉输注艾塞那肽可能是加强此类患者围手术期血糖管理的安全选择。
