使用葡萄糖 - 胰岛素 - 钾溶液限制缺血性心肌损伤。

Limiting ischemic myocardial damage using glucose-insulin-potassium solutions.

作者信息

Lazar H L, Zhang X, Rivers S, Bernard S, Shemin R J

机构信息

Department of Cardiothoracic Surgery, Boston University Hospital, MA 02118, USA.

出版信息

Ann Thorac Surg. 1995 Aug;60(2):411-6. doi: 10.1016/0003-4975(95)00402-7.

DOI:10.1016/0003-4975(95)00402-7

PMID:7646105

Abstract

BACKGROUND

This experimental study sought to determine whether the infusion of glucose-insulin-potassium (GIK) solutions to ischemic myocardium during revascularization would decrease myocardial damage.

METHODS

In 40 pigs, the second and third diagonal vessels were occluded with snares for 90 minutes followed by 30 minutes of cardioplegic arrest and 180 minutes of reperfusion. During the periods of coronary occlusion and reperfusion, 10 pigs received GIK (glucose = 300 g/L, insulin = 50 U/L, K+ = 80 mEq/L) through the jugular vein at 1 mL.kg-1.h-1 (GIK-IV group); 10 pigs received GIK through the coronary sinus (GIK-CS group); 5 pigs received GIK through the jugular vein during reperfusion only (GIK-R group); 5 pigs received GIK through the jugular vein 2 hours prior to coronary occlusion and then during the periods of coronary occlusion and reperfusion (GIK-Pre group); and 10 pigs received no GIK (Unmodified group). Ischemic damage was assessed by wall motion scores using two-dimensional echocardiography, changes in myocardial tissue pH, and the area of necrosis in the area of risk.

RESULTS

Hearts treated with GIK had significantly less tissue acidosis, higher wall motion scores, and the least tissue necrosis (14% +/- 2% GIK-Pre versus 12% +/- 2% GIK-CS versus 16% +/- 2% GIK-IV versus 25% +/- 2% GIK-R versus 73% +/- 4% Unmodified; all, p < 0.05 versus Unmodified).

CONCLUSIONS

We conclude that a glucose-insulin-potassium solution reduces ischemic myocardial damage during coronary revascularization.

摘要

背景

本实验研究旨在确定在血管重建过程中向缺血心肌输注葡萄糖 - 胰岛素 - 钾（GIK）溶液是否会减少心肌损伤。

方法

在40头猪中，用圈套器阻断第二和第三对角支血管90分钟，随后进行30分钟心脏停搏和180分钟再灌注。在冠状动脉闭塞和再灌注期间，10头猪通过颈静脉以1 mL·kg⁻¹·h⁻¹的速度接受GIK（葡萄糖 = 300 g/L，胰岛素 = 50 U/L，K⁺ = 80 mEq/L）（GIK - IV组）；10头猪通过冠状窦接受GIK（GIK - CS组）；5头猪仅在再灌注期间通过颈静脉接受GIK（GIK - R组）；5头猪在冠状动脉闭塞前2小时通过颈静脉接受GIK，然后在冠状动脉闭塞和再灌注期间接受GIK（GIK - Pre组）；10头猪未接受GIK（未改良组）。使用二维超声心动图通过壁运动评分、心肌组织pH值变化以及危险区域的坏死面积评估缺血损伤。