Wistbacka J O, Lepojärvi M V, Karlqvist K E, Koistinen J, Kaukoranta P K, Nissinen J, Peltola T, Rainio P, Ruokonen A, Nuutinen L S
Anestesiaklinikka, Keskuslaboratorio, Oulun Yliopistollinen Keskussairaala, Suomi/Finland.
Infusionsther Transfusionsmed. 1995 Apr;22(2):82-90. doi: 10.1159/000223104.
The goal of this study was to assess the effects of a combination of glucose-insulin-potassium (GIK) and the amino acids aspartate and glutamate upon perioperative hemodynamics in coronary surgery patients with unstable angina and/or compromised left ventricular function.
Prospective, randomized, and double-blind clinical study.
Operating theatre and intensive care unit (ICU) of a university hospital.
44 coronary artery bypass graft (CABG) patients with unstable angina and/or compromised left ventricular function.
22 patients (group A) were given 1l of an infusion with 250g glucose, 100 I.U. fast-acting human insulin, 72 mmol potassium, 32 mmol magnesium, 20 mmol phosphate, 65 mmol aspartate, and 65 mmol glutamate, while another 22 patients (group C) were given 1l of an infusion with 50 g glucose, 72 mmol potassium, 32 mmol magnesium, and 8 mmol phosphate. The infusion rate was 1.2 ml/kg/h from the anesthesia induction onward to the commencement of cardiopulmonary bypass, when it was reduced to 0.8 ml/kg/h. When 11 had been infused, but not later than 4 a.m., the infusion was continued by giving 10% glucose at the same rate to both groups. Additional insulin (median: 14.2 I.U., range: 0-41.5) or saline was given during bypass to the A and C patients, respectively. A blood cardioplegia technique containing aspartate and glutamate was used in both groups.
At aortic cannulation, the cardiac index (CI) had increased from the pre-anesthetic level by 15.3% (mean) (SD: 31.7%) in group A and decreased by 7.7% (15.1%) in C patients, p = 0.0069. Also the changes in stroke index (SI; p = 0.022), left (LVSWI; p = 0.0037) and right ventricular stroke work index (RVSWI; p = 0.0097) were more favorable in group A. Despite longer aortic cross-clamp, p = 0.031, and perfusion times, p = 0.042, in A patients, the change in cardiac index was also better in this group after bypass: At decannulation, the difference between mean values was 31.8%, p = 0.0001, and at arrival in the ICU it was 16.1%, p = 0.028. The same was also seen 8 h postoperatively and on the 1st and 2nd postoperative mornings; p = 0.034, 0.040, and 0.037, respectively (Wilcoxon test). Favorable changes were seen for the A patients also regarding SI at decannulation (p = 0.0002) and after 8 h (p = 0.017); LVSWI at decannulation (p = 0.0002), at arrival in the ICU (p = 0.0023), and after 8 h (p = 0.0011); and RVSWI at decannulation (p = 0.0027), at the ICU (p = 0.021), after 8 h (p = 0.014), and on the 1st postoperative morning (p = 0.039). However, the response to a hemodynamic loading test (6% hydroxyethyl starch 5 ml/kg) was similar in the 2 groups, and there was no difference in the need for inotropic support.
Amino acid-enriched GIK infusion improves hemodynamic function in CABG patients with unstable angina and/or compromised left ventricular function.
本研究旨在评估葡萄糖 - 胰岛素 - 钾（GIK）与氨基酸天冬氨酸和谷氨酸联合应用对不稳定型心绞痛和/或左心室功能受损的冠状动脉手术患者围手术期血流动力学的影响。
前瞻性、随机、双盲临床研究。
大学医院的手术室和重症监护病房（ICU）。
44例患有不稳定型心绞痛和/或左心室功能受损的冠状动脉搭桥术（CABG）患者。
22例患者（A组）接受1升含有250克葡萄糖、100国际单位速效人胰岛素、72毫摩尔钾、32毫摩尔镁、20毫摩尔磷酸盐、65毫摩尔天冬氨酸和65毫摩尔谷氨酸的输注，而另外22例患者（C组）接受1升含有50克葡萄糖、72毫摩尔钾、32毫摩尔镁和8毫摩尔磷酸盐的输注。输注速率从麻醉诱导开始至体外循环开始时为1.2毫升/千克/小时，体外循环开始后降至0.8毫升/千克/小时。当输注1升后，但不迟于凌晨4点，两组均以相同速率继续输注10%葡萄糖。在体外循环期间，A组和C组患者分别额外给予胰岛素（中位数：14.2国际单位，范围：0 - 41.5）或生理盐水。两组均采用含天冬氨酸和谷氨酸的血液心脏停搏技术。
在主动脉插管时，A组心脏指数（CI）较麻醉前水平平均增加15.3%（标准差：31.7%），C组患者心脏指数下降7.7%（15.1%），p = 0.0069。A组的每搏输出指数（SI；p = 0.022）、左心室每搏功指数（LVSWI；p = 0.0037）和右心室每搏功指数（RVSWI；p = 0.0097）的变化也更有利。尽管A组患者的主动脉阻断时间更长（p = 0.031）和灌注时间更长（p = 0.042），但该组在体外循环后心脏指数的变化也更好：在拔除主动脉插管时，平均值之间的差异为31.8%，p = 0.0001，到达ICU时为16.1%，p = 0.028。术后8小时以及术后第1天和第2天早晨也观察到同样情况；p分别为0.034、0.040和0.037（Wilcoxon检验）。A组患者在拔除主动脉插管时（p = 0.0002）和8小时后（p = 0.017）的SI；拔除主动脉插管时（p = 0.0002）、到达ICU时（p = 0.0023）和8小时后（p = 0.0011）的LVSWI；以及拔除主动脉插管时（p = 0.0027）、在ICU时（p = 0.021）、8小时后（p = 0.014）和术后第1天早晨（p = 0.039）的RVSWI也有有利变化。然而，两组对血流动力学负荷试验（6%羟乙基淀粉5毫升/千克）的反应相似，在使用血管活性药物支持方面没有差异。
富含氨基酸的GIK输注可改善不稳定型心绞痛和/或左心室功能受损的CABG患者的血流动力学功能。
