Martinez E E, Telles J S, Martinez T L, Portugal O P, Guimaraes R F, Herrmann J L, Lamounier E N, Caio A A, Auriemo R C, Ambrose J A
Department of Cardiology, Escola Paulista de Medicina, Sao Paulo, Brazil.
Am J Cardiol. 1987 Nov 1;60(13):947-51. doi: 10.1016/0002-9149(87)90330-4.
Infusion of glucose-insulin-potassium during acute myocardial infarction has favorable clinical and hemodynamic effects, presumably as a result of decreased myocardial utilization of free fatty acids. In 14 patients with coronary artery disease, hypertonic glucose (a bolus of 10 g followed by infusion of a 30% glucose solution at a constant rate of 10 mg/kg/min) was infused and arterial and coronary sinus levels of glucose, lactate and free fatty acids were measured before and after 15 and 30 minutes of infusion. Arterial glucose and lactate levels increased significantly after glucose infusion, whereas free fatty acid levels decreased significantly. Modest but significant correlations also existed between glucose arterial levels and the arterial-coronary sinus glucose difference (r = 0.53, p less than 0.001); arterial lactate and the arterial-coronary sinus lactate difference (r = 0.35, p less than 0.01); arterial free fatty acids; and the arterial-coronary sinus free fatty acid difference (r = 0.62, p less than 0.001). These results with a hypertonic glucose infusion are similar to those reported after infusion of glucose-insulin-potassium without the potential for harmful adverse effects from infusions of insulin or potassium. Therefore, infusion of hypertonic glucose may be beneficial in patients with coronary artery disease. Further work is necessary to study its effects in different subgroups of patients with coronary artery disease.
急性心肌梗死期间输注葡萄糖-胰岛素-钾具有良好的临床和血流动力学效应，推测这是心肌游离脂肪酸利用减少的结果。对14例冠心病患者输注高渗葡萄糖（先静脉推注10 g，然后以10 mg/kg/min的恒定速率输注30%葡萄糖溶液），并在输注15分钟和30分钟前后测量动脉和冠状窦的葡萄糖、乳酸和游离脂肪酸水平。输注葡萄糖后动脉葡萄糖和乳酸水平显著升高，而游离脂肪酸水平显著降低。动脉葡萄糖水平与动脉-冠状窦葡萄糖差值之间也存在适度但显著的相关性（r = 0.53，p < 0.001）；动脉乳酸与动脉-冠状窦乳酸差值之间（r = 0.35，p < 0.01）；动脉游离脂肪酸；以及动脉-冠状窦游离脂肪酸差值之间（r = 0.62，p < 0.001）。高渗葡萄糖输注的这些结果与输注葡萄糖-胰岛素-钾后报道的结果相似，且不存在胰岛素或钾输注带来的有害不良反应风险。因此，高渗葡萄糖输注可能对冠心病患者有益。有必要进一步研究其在不同亚组冠心病患者中的作用。
