Wistbacka J O, Nuutinen L S, Lepojärvi M V, Nissinen J, Karlqvist K E, Ruokonen A
Anestesiaklinikka, Oulun Yliopistollinen, Keskussairaala, Finland.
Infusionsther Transfusionsmed. 1994 Jun;21(3):160-6. doi: 10.1159/000222967.
The goal of this study was to examine the metabolic and hemodynamic effects of a glucose-insulin-potassium infusion in elective coronary surgery, when blood cardioplegia was used for cardiac protection.
A prospective, randomized, open, clinical comparison was performed between 2 perioperative infusion regimens in 40 elective nondiabetic coronary artery bypass graft (CABG) surgery patients.
20 patients (glucose-insulin-potassium-GIK-group) received glucose 0.2 g/kg/h, insulin 0.12 U/kg/h, potassium 0.15, magnesium 0.032 and phosphate 0.024 mmol/kg/h from anesthesia induction to the start of bypass, when infusion rate was reduced to 30%, and after bypass increased to 50% of the initial rate. The infusion was continued until the first postoperative morning. Another 20 patients (control-R-group) received glucose 0.05 g/kg/h, potassium 0.075, magnesium 0.016 and phosphate 0.008 mmol/kg/h from the end of bypass to the next morning. Pump prime was glucose-free and a blood cardioplegia technique was used for cardiac protection.
The GIK patients needed less dopamine support in the intensive care unit (ICU) (p < 0.05). No difference was found between the groups with regard to myocardial injury, the MB-fractions of serum creatine kinase (CK-MB) being elevated to a similar degree in both groups. Likewise there were no significant differences in hemodynamic changes or duration of ICU stay. Although the glucose infusion was continued during bypass in the GIK patients, there was a considerable risk of hypoglycemia (due to insulin and hemodilution) after the onset of bypass: in 5 GIK patients (25%; 95% confidence interval 8.7 to 49.1%) blood glucose was less than 2 mmol/l. However, the hypoglycemia was of short duration and no detrimental effects were seen.
Perioperative GIK infusion entailed a slight decrease in the postoperative need for dopamine support, but was connected with a considerable risk of hypoglycemia.
本研究的目的是在采用冷血心脏停搏液进行心脏保护的择期冠状动脉手术中，研究葡萄糖 - 胰岛素 - 钾输注的代谢和血流动力学效应。
对40例择期非糖尿病冠状动脉旁路移植术（CABG）患者的两种围手术期输注方案进行了前瞻性、随机、开放的临床比较。
20例患者（葡萄糖 - 胰岛素 - 钾 - GIK组）从麻醉诱导至体外循环开始时接受葡萄糖0.2 g/（kg·h）、胰岛素0.12 U/（kg·h）、钾0.15、镁0.032和磷酸盐0.024 mmol/（kg·h），体外循环开始后输注速率降至30%，体外循环后增至初始速率的50%。输注持续至术后第一个早晨。另外20例患者（对照组 - R组）从体外循环结束至次日早晨接受葡萄糖0.05 g/（kg·h）、钾0.075、镁0.016和磷酸盐0.008 mmol/（kg·h）。预充液不含葡萄糖，采用冷血心脏停搏液技术进行心脏保护。
GIK组患者在重症监护病房（ICU）所需的多巴胺支持较少（p < 0.05）。两组在心肌损伤方面无差异，两组血清肌酸激酶（CK - MB）的MB分数升高程度相似。同样，血流动力学变化或ICU住院时间也无显著差异。尽管GIK组患者在体外循环期间持续输注葡萄糖，但体外循环开始后仍有相当大的低血糖风险（由于胰岛素和血液稀释）：5例GIK组患者（25%；95%置信区间8.7%至49.1%）血糖低于2 mmol/l。然而，低血糖持续时间较短，未观察到有害影响。
围手术期GIK输注使术后多巴胺支持需求略有减少，但伴有相当大的低血糖风险。
