Insulin (GIK) improves myocardial metabolism in patients during blood cardioplegia

被引:19
作者
Kjellman, UW
Björk, K
Dahlin, A
Ekroth, R [1 ]
Kirnö, K
Svensson, G
Wernerman, J
机构
[1] Sahlgrens Univ Hosp, Dept Cardiothorac Surg, SE-41345 Gothenburg, Sweden
[2] Sahlgrens Univ Hosp, Dept Anesthesia, SE-41345 Gothenburg, Sweden
[3] Sahlgrens Univ Hosp, Dept Intens Care, SE-41345 Gothenburg, Sweden
[4] Huddinge Univ Hosp, Dept Anesthesia, S-14186 Huddinge, Sweden
关键词
insulin; heart surgery; lactate; GIK;
D O I
10.1080/713783123
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The aim of this study was to test the hypothesis that abnormalities of myocardial substrate metabolism during blood cardioplegic aortic cross-clamping and early reperfusion are attenuated further by insulin(GIK) than by alpha-ketoglutarate enrichment of blood cardioplegia alone. Twenty-eight males (47 to 78 years) undergoing coronary artery bypass grafting (CABG) participated in a prospective, controlled, randomized study. All patients had cc-ketoglutarate-enriched blood cardioplegia. Insulin(GIK) was infused in 13 patients during aortic cross-clamping. Insulin(GIK) prevented lactate release during cardioplegia (1.5 +/- 15 vs -44 +/- 14 mu mol/min, p = 0.04), and a significant extraction of lactate was induced shortly after declamping the aorta (15 +/- 3 vs 2 +/- 1%, p = 0.001). Free fatty acid uptake was reduced after cardioplegic cross-clamping (5.7 +/- 1.6 vs 16.0 +/- 3.8 mu mol/min, p = 0.02). More positive/less negative levels of alanine, aspartate, glutamine, glycine, ornithine, taurine and tyrosine were found in all the insulin-treated patients. We conclude that insulin(GIK) attenuates abnormalities of myocardial substrate metabolism during blood cardioplegic aortic cross-clamping and early reperfusion further than is obtained with alpha-ketoglutarate enrichment of blood cardioplegia alone.
引用
收藏
页码:321 / 330
页数:10
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