Hyperinsulinemic glucose control and myocardial function during cardiac surgery

心脏手术期间高胰岛素血糖控制和心肌功能

• 批准号: 8045609
• 负责人: Andra E Duncan
• 金额: $ 15.35万
• 依托单位: CLEVELAND CLINIC LERNER COM-CWRU
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-15 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8045609
• 关键词: 6-Phosphofructokinase; Acetylglucosamine; Advanced Development; Adverse effects; Adverse event; Anabolism; Award; Basic Science; Biochemical; Blood Glucose; Brain natriuretic peptide; Cardiac; Cardiac Myocytes; Cardiac Output; Cardiac Surgery procedures; Caring; Cessation of life; Clinical; Clinical Data; Clinical Research; Clinical Trials; Collaborations; Complex; Critical Illness; Data; Enzymes; Event; FOS gene; Glucose; Glyceraldehyde-3-Phosphate Dehydrogenases; Goals; Grant; Growth; Heart; Heart Atrium; Hexosamines; Hospitalization; Hyperglycemia; Infusion procedures; Injury; Insulin; Investigation; Ischemia; Kidney Failure; Knowledge; Left Ventricular Dysfunction; Left Ventricular Function; Link; Low Cardiac Output; Measures; Mentored Patient-Oriented Research Career Development Award; Mentorship; Metabolic Pathway; Metabolism; Methods; Morbidity - disease rate; Myocardial; Myocardial Ischemia; Myocardial tissue; N-terminal; Operative Surgical Procedures; Outcome; Pathway interactions; Patients; Perioperative Care; Physiologic intraventricular pressure; Postoperative Complications; Postoperative Period; Potassium; Proto-Oncogene Proteins c-jun; Randomized; Reporting; Research; Research Design; Research Personnel; Research Project Grants; Risk; Serum; Serum Markers; Stroke; Techniques; Testing; Therapeutic; Thrombospondin 1; Tissues; Training; Translational Research; Troponin T; United States National Institutes of Health; Ventricular; blood glucose regulation; career; experience; glucose uptake; heart function; hemodynamics; high risk; improved; indexing; innovation; meetings; mortality; multidisciplinary; patient oriented; patient population; public health relevance; pyruvate dehydrogenase; response; skills; standard care; statistics; tool; uptake

DESCRIPTION (provided by applicant): The candidate's ultimate goal is to become an independent, patient-oriented researcher investigating innovative ways to decrease morbidity and mortality in critically ill patients undergoing high-risk cardiac surgical procedures. This Mentored Patient-Oriented Research Career Development Award will provide the knowledge, training, and experience necessary to achieve this goal. Specifically, this Award will provide for: 1) coursework in clinical research, statistics, and study design to provide the background for a successful career in clinical research; 2) an in-depth investigative experience under exceptional mentorship to gain invaluable experience and training in investigation of critically ill cardiac surgical patients; 3) development of advanced echocardiographic skills with important research applications for investigating perioperative care of complex cardiac surgical patients; 4) an investigation in basic science research to elucidate the cellular effects of hyperglycemia and cardioprotection; and 5) an opportunity to acquire preliminary data and apply for an NIH Project Grant (R01), examining the means to improve care of high-risk critically ill cardiac surgical patients. These goals will be met by collaboration with an integrated, multidisciplinary team of expert researchers and clinicians. Clinical Investigation: Hyperglycemia during cardiac surgery is associated with increased risk of morbidity and mortality. Provision of exogenous glucose while treating hyperglycemia has improved morbidity and mortality in surgical patients. The hyperinsulinemic normoglycemic clamp (HNC) provides exogenous glucose while normalizing blood glucose, which is expected to provide beneficial effects by increasing myocardial uptake and utilization of glucose resulting in improved myocardial function. The purpose of this investigation is to determine whether normalization of blood glucose using HNC promotes cardiomyocyte utilization of glucose, provides cellular protection from the adverse effects of hyperglycemia, and improves myocardial global and regional function. Patients will be randomly assigned to either glucose control with HNC versus standard glucose management. To the extent that HNC improves myocardial function, outcomes in high-risk cardiac surgical patients may improve. PUBLIC HEALTH RELEVANCE: The purpose of this study is to determine whether controlling blood glucose during heart surgery using a hyperinsulinemic-normoglycemic clamp improves heart function, increases the use of glucose as fuel for the heart, and protects the heart from the adverse effects of excessive glucose. Patients, who undergo heart surgery, will be randomly assigned to either glucose control with the hyperinsulinemic- normoglycemic clamp or standard glucose management. To the extent that the hyperinsulinemic- normoglycemic clamp improves heart function, the risk associated with having heart surgery may be decreased.

应聘者描述(由申请者提供)：应聘者的最终目标是成为一名独立的、以患者为中心的研究人员，研究降低危重患者接受高风险心脏外科手术的发病率和死亡率的创新方法。这个以患者为导向的导师研究职业发展奖将提供实现这一目标所需的知识、培训和经验。具体地说，该奖项将提供：1)临床研究、统计学和研究设计方面的课程，为临床研究的成功生涯提供背景；2)在杰出导师的指导下获得深入的调查经验，以获得在调查危重心脏手术患者方面的宝贵经验和培训；3)开发先进的超声心动图技能，将重要的研究应用于调查复杂的心脏手术患者的围手术期护理；4)在基础科学研究中进行调查，以阐明高血糖和心脏保护的细胞影响；以及5)有机会获得初步数据并申请NIH项目补助金(R01)，研究改善高危心脏外科危重患者护理的方法。这些目标将通过与由专家研究人员和临床医生组成的综合多学科团队的合作来实现。临床研究：心脏手术期间的高血糖与发病率和死亡率的增加有关。在治疗高血糖的同时提供外源性葡萄糖可以改善外科患者的发病率和死亡率。高胰岛素正常血糖钳夹(HNC)在正常血糖的同时提供外源性葡萄糖，通过增加心肌对葡萄糖的摄取和利用，从而改善心肌功能，有望提供有益的效果。本研究的目的是确定使用HNC的血糖正常化是否促进心肌细胞对葡萄糖的利用，提供细胞保护，免受高血糖的不利影响，并改善心肌的整体和局部功能。患者将被随机分配到HNC血糖控制组和标准血糖控制组。在HNC改善心肌功能的程度上，心脏手术高危患者的预后可能会改善。 公共卫生相关性：这项研究的目的是确定在心脏手术期间使用高胰岛素-正常血糖钳控制血糖是否改善了心功能，增加了作为心脏燃料的葡萄糖的使用，并保护心脏免受过量葡萄糖的不利影响。接受心脏手术的患者将被随机分配到高胰岛素-正常血糖钳夹下的血糖控制组或标准血糖管理组。在一定程度上，高胰岛素-正常血糖钳夹可以改善心脏功能，心脏手术相关的风险可能会降低。