葡萄糖-胰岛素-钾可改善主动脉瓣置换术后左心室功能：一项随机对照试验的二次分析。
Glucose-insulin-potassium improves left ventricular performances after aortic valve replacement: a secondary analysis of a randomized controlled trial.
机构信息
Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, CH-1211, Geneva, Switzerland.
Faculty of Medicine, University of Geneva, CH-1211, Geneva, Switzerland.
出版信息
BMC Anesthesiol. 2019 Sep 6;19(1):175. doi: 10.1186/s12871-019-0845-0.
BACKGROUND
Patients with left ventricular (LV) hypertrophy may suffer ischemia-reperfusion injuries at the time of cardiac surgery with impairment in left ventricular function. Using transesophageal echocardiography (TEE), we evaluated the impact of glucose-insulin potassium (GIK) on LV performances in patients undergoing valve replacement for aortic stenosis.
METHODS
In this secondary analysis of a double-blind randomized trial, moderate-to-high risk patients were assigned to receive GIK (20 IU insulin with 10 mEq KCL in 50 ml glucose 40%) or saline over 60 min upon anesthetic induction. The primary outcomes were the early changes in 2-and 3-dimensional left ventricular ejection fraction (2D and 3D-LVEF), peak global longitudinal strain (PGLS) and transmitral flow propagation velocity (Vp).
RESULTS
At the end of GIK infusion, LV-FAC and 2D- and 3D-LVEF were unchanged whereas Vp (mean difference [MD + 7.9%, 95% confidence interval [CI] 3.2 to 12.5%; P < 0.001) increased compared with baseline values. After Placebo infusion, there was a decrease in LV-FAC (MD -2.9%, 95%CI - 4.8 to - 1.0%), 2D-LVEF (MD -2.0%, 95%CI - 2.8 to - 1.3%, 3D-LVEF (MD -3.0%, 95%CI - 4.0 to - 2.0%) and Vp (MD - 4.5 cm/s, 95%CI - 5.6 to - 3.3 cm/s). After cardiopulmonary bypass, GIK pretreatment was associated with preserved 2D and 3D-LVEF (+ 0.4%, 95% 95%CI - 0.8 to 1.7% and + 0.4%, 95%CI - 1.3 to 2.0%), and PGLS (- 0.9, 95%CI - 1.6 to - 0.2) as well as higher Vp (+ 5.1 cm/s, 95%CI 2.9 to 7.3), compared with baseline. In contrast, in the Placebo group, 2D-LVEF (- 2.2%, 95%CI - 3.4 to - 1.0), 3D-LVEF (- 6.0%, 95%CI - 7.8 to - 4.2), and Vp (- 7.6 cm/s, 95%CI - 9.4 to - 5.9), all decreased after bypass.
CONCLUSIONS
Administration of GIK before aortic cross-clamping resulted in better preservation of systolic and diastolic ventricular function in patients with LV hypertrophy undergoing aortic valve replacement.
TRIAL REGISTRATION
ClinicalTrials.gov: NCT00788242 , registered on November 10, 2008.
背景
接受心脏手术的左心室（LV）肥厚患者可能会在缺血再灌注损伤时出现左心室功能障碍。通过经食管超声心动图（TEE），我们评估了葡萄糖-胰岛素-钾（GIK）对接受主动脉瓣置换术治疗主动脉瓣狭窄的患者 LV 功能的影响。
方法
在这项双盲随机试验的二次分析中，中高危患者被分配接受 GIK（麻醉诱导时给予 20IU 胰岛素和 10mEq KCL 在 50ml 40%葡萄糖中）或生理盐水输注 60 分钟。主要结局是 2 维和 3 维左心室射血分数（2D 和 3D-LVEF）、峰值整体纵向应变（PGLS）和经二尖瓣血流传播速度（Vp）的早期变化。
结果
在 GIK 输注结束时，LV-FAC 和 2D 和 3D-LVEF 没有变化，而 Vp（平均差异 [MD] +7.9%，95%置信区间 [CI] 3.2 至 12.5%；P<0.001）与基线值相比增加。在安慰剂输注后，LV-FAC（MD -2.9%，95%CI -4.8 至 -1.0%）、2D-LVEF（MD -2.0%，95%CI -2.8 至 -1.3%）、3D-LVEF（MD -3.0%，95%CI -4.0 至 -2.0%）和 Vp（MD -4.5cm/s，95%CI -5.6 至 -3.3cm/s）下降。在体外循环后，GIK 预处理与 2D 和 3D-LVEF 的保存有关（+0.4%，95%CI -0.8 至 1.7%和+0.4%，95%CI -1.3 至 2.0%）和 PGLS（-0.9，95%CI -1.6 至 -0.2）以及更高的 Vp（+5.1cm/s，95%CI 2.9 至 7.3），与基线相比。相比之下，在安慰剂组中，2D-LVEF（MD -2.2%，95%CI -3.4 至 -1.0%）、3D-LVEF（MD -6.0%，95%CI -7.8 至 -4.2%）和 Vp（MD -7.6cm/s，95%CI -9.4 至 -5.9）在体外循环后均下降。
结论
在主动脉瓣夹闭前给予 GIK 可改善 LV 肥厚患者主动脉瓣置换术后的收缩和舒张心室功能。
试验注册
ClinicalTrials.gov：NCT00788242，于 2008 年 11 月 10 日注册。
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