Hagerman Andres, Schorer Raoul, Putzu Alessandro, Keli-Barcelos Gleicy, Licker Marc
Dept. of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland.
University of Geneva, Faculty of Medicine, Geneva, Switzerland.
Semin Thorac Cardiovasc Surg. 2024 Summer;36(2):167-181. doi: 10.1053/j.semtcvs.2022.11.002. Epub 2022 Nov 8.
The infusion of glucose-insulin-potassium (GIK) has yielded conflicting results in terms of cardioprotective effects. We conducted a meta-analysis to examine the impact of perioperative GIK infusion in early outcome after cardiac surgery. Randomized controlled trials (RCTs) were eligible if they examined the efficacy of GIK infusion in adults undergoing cardiac surgery. The main study endpoint was postoperative myocardial infarction (MI) and secondary outcomes were hemodynamics, any complications and hospital resources utilization. Subgroup analyses explored the impact of the type of surgery, GIK composition and timing of administration. Odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) were calculated with a random-effects model. Fifty-three studies (n=6129) met the inclusion criteria. Perioperative GIK infusion was effective in reducing MI (k=32 OR 0.66[0.48, 0.89] P=0.0069), acute kidney injury (k=7 OR 0.57[0.4, 0.82] P=0.0023) and hospital length of stay (k=19 MD -0.89[-1.63, -0.16] days P=0.0175). Postoperatively, the GIK-treated group presented higher cardiac index (k=14 MD 0.43[0.29, 0.57] L/min P<0.0001) and lesser hyperglycemia (k=20 MD -30[-47, -13] mg/dL P=0.0005) than in the usual care group. The GIK-associated protection for MI was effective when insulin infusion rate exceeded 2 mUI/kg/min and after coronary artery bypass surgery. Certainty of evidence was low given imprecision of the effect estimate, heterogeneity in outcome definition and risk of bias. Perioperative GIK infusion is associated with improved early outcome and reduced hospital resource utilization after cardiac surgery. Supporting evidence is heterogenous and further research is needed to standardize the optimal timing and composition of GIK solutions.
葡萄糖 - 胰岛素 - 钾（GIK）输注在心脏保护作用方面产生了相互矛盾的结果。我们进行了一项荟萃分析，以研究围手术期GIK输注对心脏手术后早期结局的影响。如果随机对照试验（RCT）研究了GIK输注对接受心脏手术的成年人的疗效，则该试验符合纳入标准。主要研究终点是术后心肌梗死（MI），次要结局是血流动力学、任何并发症和医院资源利用情况。亚组分析探讨了手术类型、GIK成分和给药时间的影响。采用随机效应模型计算比值比（OR）或平均差（MD）以及95%置信区间（CI）。53项研究（n = 6129）符合纳入标准。围手术期GIK输注可有效降低心肌梗死发生率（k = 32，OR 0.66[0.48, 0.89]，P = 0.0069）、急性肾损伤发生率（k = 7，OR 0.57[0.4, 0.82]，P = 0.0023）以及缩短住院时间（k = 19，MD -0.89[-1.63, -0.16]天，P = 0.0175）。术后，GIK治疗组的心脏指数高于常规治疗组（k = 14，MD 0.43[0.29, 0.57]L/min，P < 0.0001），高血糖发生率低于常规治疗组（k = 20，MD -30[-47, -13]mg/dL，P = 0.0005）。当胰岛素输注速率超过2 mUI/kg/min时以及在冠状动脉旁路移植术后，GIK对心肌梗死的保护作用有效。鉴于效应估计的不精确性、结局定义的异质性和偏倚风险，证据的确定性较低。围手术期GIK输注与心脏手术后早期结局改善和医院资源利用减少相关。支持证据存在异质性，需要进一步研究以规范GIK溶液的最佳给药时间和成分。
