Haider W, Eckersberger F, Losert U, Wolner E
Anaesthesist. 1982 Mar;31(3):124-8.
In this study we investigated, whether in addition to cooling and cardioplegia, preventive administration of massive doses of insulin with glucose exerts a protective effect on the myocardium by increasing myocardial glycogen stores and shifting myocardial metabolism towards (primarily anaerobic) glycolysis. Experiments were done on two groups of 5 dogs each (average 27 kg) undergoing experimental extracorporeal circulation (ECC) with 90 min aortic clamping, under cooling and cardioplegia. Cardiac output (CO), systolic ventricular blood pressure (Pventr), heart rate (HR) and mean central venous pressure (CVP) were recorded at LA-levels of 5, 10, 15 and 20 mm Hg before onset of ECC (preop. value), after termination of ECC, and after 2 periods of a 10 min. reperfusion. While the 1st group served as control, the 2nd group received a massive i.v. insulin supply (total 20 U/kg) every 10 min, as well as glucose to keep blood sugar level stable within 60 min. prior to the onset of ECC. It was shown that in the control group after termination of ECC and after 1st reperfusion Pventr and CO were significantly below the preop. values, and only after the 2nd reperfusion within the preop. range. In the insulin group, however, Pventr and CO were already within the preop. range at termination of the ECC. After the 1st and after the 2nd reperfusion CO was in part significantly above the preoperative value. HR and total peripheral resistance (TPR) were not significantly changed. It is concluded that preventive insulin application produces a more vital myocardial cell function immediately after termination of ECC, indicating increased myocardial protection and improved ischaemic tolerance.
在本研究中，我们探究了除降温与心脏停搏液外，预防性给予大剂量胰岛素加葡萄糖是否通过增加心肌糖原储备并使心肌代谢转向（主要是无氧）糖酵解从而对心肌发挥保护作用。实验在两组犬身上进行，每组5只（平均体重27千克），均在降温与心脏停搏液作用下接受90分钟主动脉阻断的体外循环（ECC）实验。在ECC开始前（术前值）、ECC结束后以及两段10分钟再灌注期后，于左心房压力为5、10、15和20毫米汞柱时记录心输出量（CO）、心室收缩压（Pventr）、心率（HR）和平均中心静脉压（CVP）。第一组作为对照组，第二组在ECC开始前每10分钟静脉内大量输注胰岛素（总量20单位/千克）以及葡萄糖以维持血糖水平在60分钟内稳定。结果显示，在对照组中，ECC结束后及首次再灌注后，Pventr和CO显著低于术前值，仅在第二次再灌注后才处于术前范围内。然而，在胰岛素组中，ECC结束时Pventr和CO已处于术前范围内。在第一次和第二次再灌注后，CO部分显著高于术前值。HR和总外周阻力（TPR）无显著变化。结论是预防性应用胰岛素在ECC结束后立即产生更具活力的心肌细胞功能，表明心肌保护增强且缺血耐受性改善。
