心瓣膜替换术应用GIK溶液的若干效应

Some Benefical Effects of GIK Solution in Patients of Cardiac Valvular Replacement

本文观察２０例心脏瓣膜置换术病人，在阻断主动脉前输入２５％葡萄糖２５０ｍｌ加入胰岛素６５°和氯化钾３ｇ（ＧＩＫ）及开放主动脉后血糖、血浆胰岛素明显升高（Ｐ＜０．０１），血清钾改变不明显。同时监测血液流变学指标，其结果表明输入４ｍｌ／ｋｇ及开放主动脉后１０ｍｉｎ，全血绝对粘度（ηＨηＬ）及血浆粘度（ηＰ）等明显低于给药前（Ｐ＜０．０５）。经ＧＩＫ治疗的病人心脏自动复跳率高于对照组，而维持正常ＭＡＰ和尿量所需的正性肌力药和利尿药则低于对照组，提示ＧＩＫ溶液可以改善心瓣膜替换病人的心肌功能和血液流变学指标。

n 20 patieuts of cardiac valvular replacement,GIK solution(glucose1g/kg,insulin 1u/kg, KCl 0.64 mEg/kg)was administeved IV before aorfic crossclamp(begining of cardiopulmonavy bypass).The blood concentrationsof glucose,insulin, KCI and changes of hemorrheology were examined at intevvals before and after GIK administra-tiOn, The results show that the blood levels of glucose and insulin were obviously elevated(P<0.01)soon after GIKinfusion till 10min after aorfic declamping,while those of k+ were not significantly changed(P>0.05).The viscos卜ty of whole blood and plasma was lower from the end of GIK infusion till aortic declamping than previously(P<0.05).In GIK group,The rate of spontaneous cardic defibrillation was higher and the dosage of inotropies and di-uretics required for maintaining adeguate MAP and urine volune was lowcr,as compared with that of the control.Itsuggests thar GIK solution is benificial for preserving the myocardial function and improving the hemorrheology inpatients of cardiac valvular replacemeut。