中国体外循环杂志2012，Vol.10Issue(1)：20-24,5.
改良极化液对体外循环二尖瓣置换患者心脏功能的作用及其机制
Effect of modified glucose - insulin - potassium solution on cardiac function in patients undergoing mitral valve replacement with extracorporeal circulation
摘要
Abstract
Objective To investigate the effect of modified glucose - insulin - potassium ( GIK ) solution on cardiac function and its mechanism in patients undergoing mitral valve replacement ( MVR ) with extracorporeal circulation ( ECC ). Methods Forty consecutive patients undergoing MVR were randomized into control group ( n = 19 ) and GIK group ( n =21 ). The GIK group received GIK solution 500 ml ( glucose 20% , insulin 33 IU, 10% potassium chloride 30 ml) via central venous catheter at 60 ml per hour before induction of anesthesia and ended about six hours after aortic cross clamp ( AXC ) removal. The control group received e-quivalent 0. 9% Sodium chloride in the same fashion. Peri - operative hemodynamic data and left ventricular ejection fraction ( LVEF ), serum concentrations of glucose, insulin, glucocorticoids, epinephrine and lactic acid were measured, and the insulin resistance index ( HOMA - IRI ) was calculated at different time points. Results The cardiac index ( CI ) at postoperative 24 and 48 hours of GIK group increased significantly compared with control group; the LVEF of GIK group was higher than that of control group. The systemic vascular resistance ( SVR ) and pulmonary circulation resistance ( PVR ) at postoperative 24 and 48 hours in GIK group decreased significantly compared with control group. The levels of blood glucose and insulin of GIK group were higher during the period of ECC but were lower postoperatively than that of control group. The HOMA - IRI of GIK group was lower than that of control group at postoperative 12 and 24 hours. The level of blood glucocorticoid of GIK group was lower and the level of blood epinephrine of GIK group was higher than that of control group at the end of ECC. Meanwhile, the peri - operative level of serum lactic acid was decreased in GIK group compared with control group. Conclusion GIK therapy during the peri - ECC period can significantly improve the cardiac function and hemodynamic status of MVR patients, and the mechanism may be related to its ability of stress reduction and metabolism stabilization.关键词
体外循环/GIK液/二尖瓣置换Key words
Extracorporeal circulation/ Glucose - insulin - potassium solution/ Mitral valve replacement分类
医药卫生引用本文复制引用
王新利,杨剑,段维勋,赵堃,崔勤,陈文生,金振晓,刘金成,俞世强,赵荣,陈敏,金艳,李红玲..改良极化液对体外循环二尖瓣置换患者心脏功能的作用及其机制[J].中国体外循环杂志,2012,10(1):20-24,5.基金项目
国家自然科学基金资助项目(30972865) （30972865）
