Li Qi, Yang Jun, Zhang Jing, Yang Chaojun, Fan Zhixin, Yang Ying, Zheng Tao, Yang Jian
Department of Cardiology, The First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei, China.
Institute of Evidence-Based and Translational Medicine, China Three Gorges University, Yichang, Hubei, China.
Heart Surg Forum. 2020 Feb 25;23(1):E063-E069. doi: 10.1532/hsf.2735.
The role of glucose-insulin-potassium (GIK) infusion during cardiac surgery has held interest for so many years without a clear answer. The aim of this meta-analysis was to evaluate the effect of GIK therapy on outcomes in patients undergoing on-pump cardiac surgery.
A comprehensive online review was performed in The Web of Science, Embase, Medline, PubMed, and The Cochrane Library databases from 2000 to 2019. Eligible studies included randomized controlled trials (RCTs) that compared GIK treatment with placebo or standard care during on-pump cardiac surgery. Risk ratios (RR) were used for binary outcomes and mean difference (MD) was used for continuous variables; both with their 95% confidence intervals (CI).
A total of 18 RCTs involving 2,131 patients met the inclusion criteria. Compared with the control group, the GIK treatment significantly reduced in-hospital mortality (RR = 0.56, 95% CI: 0.32-0.97; P = .04), postoperative myocardial infarctions (MI) (RR = 0.71, 95% CI: 0.56-0.91; P = .006), the use of inotropic support (RR = 0.53, 95% CI: 0.45-0.63; P < .00001), and length of stay in the intensive care unit (ICU) (MD = -0.33, 95% CI: -0.52--0.14; P = .0007). Moreover, GIK treatment seemed to be associated with fewer postoperative atrial fibrillation (AF) (RR = 0.81, 95% CI: 0.64-1.03; P = .09).
In patients undergoing on-pump cardiac surgery, GIK infusion has a beneficial role in mortality during hospital stay and demonstrates superior efficacy versus standard care for reduction in postoperative MI, AF, ICU length of stay as well as inotropic agent requirements.
多年来，心脏手术期间葡萄糖 - 胰岛素 - 钾（GIK）输注的作用一直备受关注，但尚无明确答案。本荟萃分析的目的是评估GIK治疗对接受体外循环心脏手术患者预后的影响。
2000年至2019年期间，在科学网、Embase、Medline、PubMed和Cochrane图书馆数据库中进行了全面的在线检索。符合条件的研究包括随机对照试验（RCT），这些试验比较了体外循环心脏手术期间GIK治疗与安慰剂或标准治疗。二分类结局采用风险比（RR），连续变量采用均值差（MD）；两者均带有95%置信区间（CI）。
共有18项涉及2131例患者的RCT符合纳入标准。与对照组相比，GIK治疗显著降低了住院死亡率（RR = 0.56，95% CI：0.32 - 0.97；P = 0.04）、术后心肌梗死（MI）（RR = 0.71，95% CI：0.56 - 0.91；P = 0.006）、血管活性药物支持的使用（RR = 0.53，95% CI：0.45 - 0.63；P < 0.00001）以及重症监护病房（ICU）住院时间（MD = -0.33，95% CI：-0.52 - -0.14；P = 0.0007）。此外，GIK治疗似乎与较少的术后房颤（AF）相关（RR = 0.81，95% CI：0.64 - 1.03；P = 0.09）。
在接受体外循环心脏手术的患者中，GIK输注对住院期间死亡率具有有益作用，并且在降低术后MI、AF、ICU住院时间以及血管活性药物需求方面，与标准治疗相比显示出卓越的疗效。
