Svedjeholm R, Håkanson E, Vanhanen I
Department of Cardiothoracic Surgery, Linköping Heart Center, University Hospital, Sweden.
Ann Thorac Surg. 1995 Feb;59(2 Suppl):S15-22. doi: 10.1016/0003-4975(94)00917-v.
Myocardial metabolism and the current state of metabolic intervention under conditions relevant to cardiac surgery are reviewed. The rationale for metabolic support differs considerably in various settings of cardiac surgery. Although preventive measures are theoretically attractive, their use in the preoperative setting remains to be clarified. Amino acid enrichment of blood cardioplegia seems to be justified by an abundance of animal experimental data. In the postoperative setting of cardiac surgery, metabolic abnormalities may explain reversible myocardial dysfunction. Further, the combined effects of ischemia and the systemic neuroendocrine response to surgical trauma may adversely affect recovery. Amino acids, particularly glutamate, seem vital for metabolic recovery in this setting. Treating the relative shortage of glutamate occurring during this period by the administration of exogenous glutamate and counteracting the effects of the systemic neuroendocrine stress response by high-dose glucose-insulin-potassium are measures that have been shown to improve the metabolic state of the heart and subsequently myocardial performance.
本文综述了与心脏手术相关条件下的心肌代谢及代谢干预的现状。在心脏手术的不同场景中，代谢支持的基本原理差异很大。尽管预防性措施在理论上具有吸引力，但它们在术前环境中的应用仍有待阐明。大量动物实验数据似乎证明了血液心脏停搏液中氨基酸富集的合理性。在心脏手术的术后环境中，代谢异常可能解释可逆性心肌功能障碍。此外，缺血与手术创伤引起的全身神经内分泌反应的联合作用可能对恢复产生不利影响。在这种情况下，氨基酸，尤其是谷氨酸，似乎对代谢恢复至关重要。通过给予外源性谷氨酸来治疗这一时期出现的谷氨酸相对短缺，并通过高剂量葡萄糖 - 胰岛素 - 钾来抵消全身神经内分泌应激反应的影响，这些措施已被证明可改善心脏的代谢状态，进而改善心肌性能。
