Bronsveld W, van Lambalgen A A, van den Bos G C, Thijs L G, Koopman P A
Circ Shock. 1984;13(4):325-40.
Glucose-insulin-potassium (GIK) has beneficial effects during endotoxin shock, possibly through improvement of myocardial function, but the mechanism is not clear. We have studied the effects of GIK on left ventricular function, coronary flow, and oxygen consumption in controls and dogs treated with endotoxin (1.5 mg/kg-1). The animals were anaesthetized (etomidate 4 mg/kg-1/hr-1) and ventilated (N2O:O2 = 2:1). We have measured left ventricular pressure, left ventricular end-diastolic pressure (LVEDP) and LVdP/dt, systemic blood pressure, cardiac output (CO; thermodilution), coronary blood flow (CBF; radioactive microspheres), and oxygen content and lactate in arterial and coronary sinus blood. Endotoxin caused a rapid fall of CO and blood pressure with a temporary recovery followed by gradual circulatory collapse. GIK infusion (50% glucose, 2 g/kg-1 bw, 8 mmol KCl, and 3 U insulin/kg-1 bw) increased CO (56%), CBF (61%), blood pressure (21%), LVEDP (77%), and LVdP/dt (28%), and systemic vascular resistance decreased (23%). Stroke work (80%) and tension time index (42%) decreased during shock, but GIK temporarily improved these variables. The ratio of stroke work, respectively tension time index to oxygen consumption, suggests that myocardial efficiency decreased during shock and improved after GIK. Endotoxin decreased the ratio of endo- to epicardial flow. GIK did not change this ratio. However, for the same endo to epi ratio, increased CBF implies increased flow to endocardium.
葡萄糖 - 胰岛素 - 钾（GIK）在内毒素休克期间具有有益作用，可能是通过改善心肌功能，但机制尚不清楚。我们研究了GIK对对照组和接受内毒素（1.5 mg/kg-1）治疗的犬的左心室功能、冠状动脉血流和氧消耗的影响。动物用依托咪酯（4 mg/kg-1/hr-1）麻醉并通气（N2O:O2 = 2:1）。我们测量了左心室压力、左心室舒张末期压力（LVEDP）和LVdP/dt、全身血压、心输出量（CO；热稀释法）、冠状动脉血流量（CBF；放射性微球）以及动脉血和冠状窦血中的氧含量和乳酸。内毒素导致CO和血压迅速下降，随后有短暂恢复，接着是逐渐的循环衰竭。输注GIK（50%葡萄糖，2 g/kg-1体重，8 mmol氯化钾，和3 U胰岛素/kg-1体重）使CO增加（56%）、CBF增加（61%）、血压增加（21%）、LVEDP增加（77%）和LVdP/dt增加（28%），全身血管阻力降低（23%）。休克期间每搏功（80%）和张力 - 时间指数（42%）降低，但GIK使这些变量暂时改善。每搏功以及张力 - 时间指数与氧消耗的比值表明，休克期间心肌效率降低，GIK治疗后有所改善。内毒素降低了心内膜与心外膜血流的比值。GIK未改变该比值。然而，对于相同的心内膜与心外膜比值，CBF增加意味着流向心内膜的血流增加。
