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

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,CON-TROL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CONT-ROL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。

The Effect of Glucose - Insulin - Potassium on Multiple Organs Function in Patients Undergoing Cardiopulmonary Bypass

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.