Modified Glucose-Insulin-Potassium Regimen Provides Cardioprotection With Improved Tissue Perfusion in Patients Undergoing Cardiopulmonary Bypass Surgery.
Modified Glucose-Insulin-Potassium Regimen Provides Cardioprotection With Improved Tissue Perfusion in Patients Undergoing Cardiopulmonary Bypass Surgery.
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改良的葡萄糖-胰岛素-钾方案为接受心肺搭桥手术的患者提供改善组织灌注的心脏保护作用
DOI：
10.1161/jaha.119.012376
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发表时间：
2020
影响因子：
5.4
通讯作者：
Gao Feng
中科院分区：
文献类型：
--
作者：
Zhao Kun;Zhang Yue;Li Jia;Cui Qin;Zhao Rong;Chen Wensheng;Liu Jincheng;Zhao Bijun;Wan Yi;Ma Xin-Liang;Yu Shiqiang;Yi Dinghua;Gao Feng
背景实验室研究表明，葡萄糖-胰岛素-钾（GIK）作为一种有效的心脏保护干预措施，但临床试验产生了混合的结果，可能是因为不同的公式和GIK治疗的时间和不同的临床环境。本研究旨在评估围手术期胰岛素-葡萄糖比例为1：3的改良GIK方案对心肺转流术患者的影响。Methods and ResultsIn this prospective，randomized，double-blinded trial with 930 patients referred to for cardiopulmonary bypass，GIK（200 g/L葡萄糖，66.7 U/L胰岛素和80 mmol/L KCl）或安慰剂治疗在麻醉前10分钟以1 mL/kg/h静脉给药，持续12.5 h。主要结局是院内主要不良心脏事件的发生率，包括全因死亡、低心输出量综合征、急性心肌梗死、成功复苏的心脏骤停、充血性心力衰竭和心律失常。与对照组相比，GIK治疗降低了主要不良心脏事件的发生率，促进了心功能恢复，且未增加围术期血糖。从机制上讲，该治疗导致GIK治疗患者心脏中葡萄糖摄取增加和乳酸排泄减少（根据动脉窦和冠状窦之间的差异计算），以及胰岛素受体底物-1和蛋白激酶B磷酸化增加。全身血乳酸也减少了GIK治疗的患者在心肺转流surgery.ConclusionsA修改GIK方案围手术期管理降低了发生率在医院的主要不良心脏事件的患者接受心肺转流surgery.这些益处可能是通过GIK激活胰岛素信号增强全身组织灌注和改善心肌代谢的结果。临床试验注册URL：clinicaltrials. gov。标识符：NCT 01516138。
BackgroundLaboratory studies demonstrate glucose‐insulin‐potassium (GIK) as a potent cardioprotective intervention, but clinical trials have yielded mixed results, likely because of varying formulas and timing of GIK treatment and different clinical settings. This study sought to evaluate the effects of modified GIK regimen given perioperatively with an insulin‐glucose ratio of 1:3 in patients undergoing cardiopulmonary bypass surgery.Methods and ResultsIn this prospective, randomized, double‐blinded trial with 930 patients referred for cardiac surgery with cardiopulmonary bypass, GIK (200 g/L glucose, 66.7 U/L insulin, and 80 mmol/L KCl) or placebo treatment was administered intravenously at 1 mL/kg per hour 10 minutes before anesthesia and continuously for 12.5 hours. The primary outcome was the incidence of in‐hospital major adverse cardiac events including all‐cause death, low cardiac output syndrome, acute myocardial infarction, cardiac arrest with successful resuscitation, congestive heart failure, and arrhythmia. GIK therapy reduced the incidence of major adverse cardiac events and enhanced cardiac function recovery without increasing perioperative blood glucose compared with the control group. Mechanistically, this treatment resulted in increased glucose uptake and less lactate excretion calculated by the differences between arterial and coronary sinus, and increased phosphorylation of insulin receptor substrate‐1 and protein kinase B in the hearts of GIK‐treated patients. Systemic blood lactate was also reduced in GIK‐treated patients during cardiopulmonary bypass surgery.ConclusionsA modified GIK regimen administered perioperatively reduces the incidence of in‐hospital major adverse cardiac events in patients undergoing cardiopulmonary bypass surgery. These benefits are likely a result of enhanced systemic tissue perfusion and improved myocardial metabolism via activation of insulin signaling by GIK.Clinical Trial RegistrationURL: clinicaltrials.gov. Identifier: NCT01516138.