GIK液在围体外循环期机体高胰岛素伴高血糖状态中的应用(PDF)
《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]
- 期数:
- 2007年第1期
- 页码:
- 76-78
- 栏目:
- 临床研究
- 出版日期:
- 2007-01-01
文章信息/Info
- Title:
- Effect of GIK treatment in patients with high insulin and blood glucose during cardiopulmonary bypass
- Author(s):
- ZHENG Qijun1; CHENG Xiaodong2; YU Shiqiang1; CHEN Wensheng1; CUI Qin1; JIN Zhenxiao1; GAO Feng3
- 1.Department of Cardiovascular Surgery, 2.Department of Clinical Laboratory, Xijing Hospital, 3.Department of Physiology,Faculty of Preclinical Medicine,Fourth Military Medical University, Xi′an 710032, Shaanxi, China
- 分类号:
- R654.2
- DOI:
- -
- 文献标识码:
- A
- 摘要:
- 目的 研究极化液（GIK）对体外循环后高胰岛素伴高血糖状态引起的内分泌和代谢紊乱的防治作用。方法 选取32例单个瓣膜置换术患者，分别在麻醉前、体外循环前、体外循环30 min、开放升主动脉10 min和停体外循环后30 min抽取血样，测定血糖、胰岛素、C肽、生长激素和皮质醇等，进行动态对比分析。实验分GIK治疗组和空白对照组。 结果 体外循环期间血糖、胰岛素、C肽、生长激素和皮质醇等与麻醉前比较均有不同程度增高（P<0.05）；同时，GIK组血糖、生长激素和皮质醇浓度显著低于对照组（P<0.05），而胰岛素、C肽浓度显著高于对照组（P<0.05）。 结论 体外循环可导致机体胰岛素和血糖升高，GIK治疗可以有效防治体外循环后高胰岛素伴高血糖状态引起的内分泌和代谢紊乱。
- Abstract:
- AIM To investigate the preventive and therapeutic effects of GIK solution on high state of insulin and blood glucose, hormones and metabolic disorder in patients during cardiopulmonary bypass (CPB). METHODS Thirtytwo patients to be treated with singlevalve replacement operations were divided into 2 groups: GIK group (n=16) and control group (n=16). GIK solution containing insulin (G/I=1∶1) was infused continuously at a rate of 16.67 nkat/(kg h) into the patients in GIK group, and GIK withiut insulin was infused to the patients in control group from induction of anesthesia to clamping of aortic flow. Blood samples were obtained respectively from patients of the two groups before anesthesia, before CPB, 30 min after CPB and 10 min after declamping of aortic. Insulin, cpeptide, cortisol, growth hormone as well as blood glucose were also measured. RESULTS During the period of cardiopulmonary bypass, glucose, insulin, Cpeptide, glucagons, cortisol and growth hormone all significantly increased （P<0.05）. In comparison with those of control group, the levels of blood glucose, cortisol and growth hormone were significantly reduced（P<0.05）and the levels of cpeptide and insulin increased（P<0.05）in GIK group. CONCLUSION Cardiopulmonary bypass leads to a typical peripheral high state of insulin and blood glucose. GIK Solution can increase the insulin sensitivity and improve hormones and metabolic disorder in patients with high insulin and blood glucose.
参考文献/References
［1］Ruige JB, Assendelft WJ, Dekker JM, et al. Insulin and risk of cardiovascular disease［J］. Circulation,1998,97(10):996-1001.
［2］Wallin M, Barr G, Owall A, et al. The influence of glucoseinsulinpotsssium (GIK) on the GH/IGF1/IGFBP1 axis during elective coronary artery bypass surgery［J］. J Cardiothorac Vasc Anesth, 2003,17(4):470-477.
［3］Woods AA, Taegtmeyer H. Reversal of glucoseinsulinpotassiuminduced hyperglycemia by aggressive insulin treatment in postoperative heart failure. An observational study［J］. Cardiology, 2004,102(2):82-88.
［4］Ramanathan T, Shirota K, Morita S, et al. Glucoseinsulinpotassium solution improves left ventricular mechanics in diabetes［J］. Ann Thorac Surg, 2002,73(2):582-587.
［5］Guo F,Gao E,Yue TL,et al. Nitric oxide mediates the antiapoptotic effect of insulin in myocardial ischemiareperfusion:the roles of PI3kinase,Akt,and endothelial nitric oxide synthase phosphorylation［J］. Circulation,2002,105(12):1497-1502.
［6］Miles PD, Li S, Hart M, et al. Mechanisms of insulin resistance in experimental hyperinsulinemic dogs［J］. J Clin Invest, 1998,101（1）:202-211.
［7］Szabo Z, Hakanson E, Maros T, et al. Highdose glucoseinsulinpotassium after cardiac surgery: a retrospective analysis of clinical safety issues［J］. Acta Anaesthesiol Scand, 2003,47(4):383-390.
备注/Memo
- 备注/Memo:
- 收稿日期：2005-09-20. 基金项目：国家自然科学基金项目资助（No.30471923）作者简介：郑奇军,主治医师,博士Email：qj_zheng2003@yahoo.com.cn
常用功能
统计/Statistics
- 摘要浏览/Viewed1244
- 全文下载/Downloads806
- 评论/Comments
