| 王新利1 陈文生1 金振晓1 刘金成1 俞世强1 赵荣1 陈敏2 金艳1
李红玲3 杨剑1 段维勋1 赵堃1 崔勤1△.改良极化液治疗对体外循环患者多脏器功能的作用及机制[J].现代生物医学进展英文版,2012,12(8):1466-1470. |
| 改良极化液治疗对体外循环患者多脏器功能的作用及机制 |
| The Effect of Glucose - Insulin - Potassium on Multiple Organs Functionin Patients Undergoing Cardiopulmonary Bypass |
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| DOI： |
| 中文关键词: 体外循环 GIK 液 二尖瓣置换 脏器功能保护 |
| 英文关键词: Cardiopulmonary bypass GIK Mitral valve replacement Organ function protection |
| 基金项目:国家自然科学基金资助项目（30972865） |
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| 中文摘要: |
| 目的：探讨改良极化液治疗对体外循环（CPB）患者多脏器功能的作用及机制。方法：将40 例心脏二尖瓣置换病人随机分为
对照（CONTROL）组（19 例）和改良极化液（GIK）治疗组（21 例）。GIK 组于麻醉诱导前经中心静脉给予改良极化液500ml，CONTROL
组给予相同量的平衡盐。分别于术前、术后12h、后24h 测定心肌酶谱、肝功能、肾功能，并于术前、麻醉后、CPB15min、开放
升主5min、CPB 结束前、术后30min、6h、12h、24h 采集血样，测定CRP、IL-1、IL-10、TNF-α、肾上腺素、糖皮质激素。结果：GIK 组
患者AST、CK、LDH、CK-MB、ALT、TBA、BUN、CR 术后12、24h 均低于CONTROL 组；GIK 组患者CRP、IL-1、TNF-α 水平CPB
期及术后均低于CONTROL 组，IL-10 水平高于CONTROL 组；GIK 组患者糖皮质激素水平在CPB 结束及术后24h 低于CONTROL
组，GIK 组患者肾上腺素水平高于CONTROL 组。结论：围CPB 期给予葡萄糖- 胰岛素- 氯化钾液（GIK）治疗可以提高患
者早期多脏器功能，其机制可能与减轻了炎症反应及降低应激状态有关。 |
| 英文摘要: |
| Objective: To investigate the effect of glucose - insulin - potassium (GIK) on multiple organs function and its mechanism
in patients undergoing cardiopulmonary bypass (CPB). Methods:Forty hundred patients undergoing mitral valve replacement were
randomly divided into GIK group (n=21) and control group (n=19). The GIK group received a central GIK infusion consisting of 500ml
of 20% glucose, 33IU insulin，30mmol of potassium chloride (KCl)) run at 60ml.h-1 starting before induction of anesthesia and finishing
six hours following release of the AXC. The control group received equivalent 0.9% Sodium chloride. In the preoperative, postoperative
12h and 24h, determination of myocardial enzymes, hepatic function and renal function were collected. Arterial blood samples were
obtained respectively from patients of the two groups before the operation, after anesthetic, CPB15min, 5min following release of AXC,
the end of CPB, 30min，6h,12h,24h following the end of operation. The levels of CRP, IL-1, IL-10 TNF-α, glucocorticoids and
epinephrine were measured. Results: AST, CK, LDH, CK-MB, ALT, TBA, BUN, CR of the patients in GIK group at post-operative 12,
24h were lower than those of control group. The level of CRP, IL-1, and TNF-α of GIK group were lower than that of control group at
the period of CPB and postoperation, and the level of IL-10 of GIK group was higher than that of control group at the same time. The
level of blood glucocorticoid of GIK group was lower than that of control group after the end of CPB, but the level of blood epinephrine
of GIK group was higher than that of control at the same time. Conclusion: GIK therapy during the CPB period can significantly improve
the multiple organs function, and the mechanism may be related to reducing the inflammatory response and the stress state. |
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