McDaniel H G, Papapietro S E, Rogers W J, Mantle J A, Smith L R, Russell R O, Rackley C E
Am Heart J. 1981 Jul;102(1):10-5. doi: 10.1016/0002-8703(81)90406-3.
Total and individual plasma free fatty acids (FFA) were measured on admission and over the next 4 days in 24 patients admitted to the hospital with chest pain and suspected acute myocardial infarction (AMI). In a prospective randomized fashion, the patients were either given an infusion of 300 gm of glucose, 50 units of insulin, and 80 mEq of KCl per liter at a rate of 1.5 ml/kg/hr over the initial 48 hours of hospitalization, or they served as controls receiving conventional therapy. Eleven patients were in the control group and 13 were in the glucose-insulin-potassium (G-I-K) group. Twenty-one of the patients had an AMI by CK-MB rise and ECG changes (in the G-I-K group three did not evolve AMI). The total plasma FFA were 840 +/- 134 microM/L in the controls and 933 +/- 160 microM/L in the G-I-K group initially (prestudy). Total FFA rapidly fell in the G-I-K group and then rebounded when G-I-K was stopped. In contrast, total FFA values fell gradually in the control group over the 4-day period. The individual FFA had similar percentages initially in the two groups. In the control group the percent of individual plasma FFA was unchanged over the period studied, although there was some mild random day-to-day fluctuation. In contrast in the G-I-K group linoleic acid fell both during and after the infusion was stopped (26.8% to 19.1% P less than 0.001). Arachidonic acid doubled in percentage of the total FFA value during G-I-K infusion (3.1% to 6.5%, P less than 0.002) and returned to the control value when it was stopped. Thus G-I-K infusion during AMI reduces the total level of plasma FFA while increasing the percent of arachidonic and decreasing the percent of linoleic acid, observations proposed to reflect improved membrane stability of the ischemic myocardium.
对24例因胸痛入院且疑似急性心肌梗死（AMI）的患者在入院时及随后4天测定了血浆总游离脂肪酸（FFA）和个体游离脂肪酸水平。采用前瞻性随机方式，患者在住院的最初48小时内，要么以1.5 ml/kg/hr的速率输注每升含300克葡萄糖、50单位胰岛素和80毫当量氯化钾的溶液，要么作为接受传统治疗的对照组。11例患者在对照组，13例在葡萄糖 - 胰岛素 - 钾（G - I - K）组。21例患者通过肌酸激酶同工酶（CK - MB）升高和心电图改变确诊为AMI（在G - I - K组中有3例未发展为AMI）。对照组血浆总FFA最初（研究前）为840±134微摩尔/升，G - I - K组为933±160微摩尔/升。G - I - K组总FFA迅速下降，在停止G - I - K输注后又反弹。相比之下，对照组总FFA值在4天期间逐渐下降。两组个体FFA最初的百分比相似。在对照组，个体血浆FFA的百分比在研究期间没有变化，尽管每天有一些轻微的随机波动。相比之下，在G - I - K组，亚油酸在输注期间及停止后均下降（从26.8%降至19.1%，P＜0.001）。花生四烯酸在G - I - K输注期间占总FFA值的百分比翻倍（从3.1%升至6.5%，P＜0.002），停止输注后恢复到对照值。因此，AMI期间输注G - I - K可降低血浆FFA的总水平，同时增加花生四烯酸的百分比并降低亚油酸的百分比，这些观察结果提示反映了缺血心肌膜稳定性的改善。
