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目的评价高浓度极化液(GIK)对急性心肌梗死(AMI)患者血液动力学的影响。方法本研究采用前瞻性、随机、对照设计,用Swanganz导管评价了GIK对21例AMI患者血液动力学的影响。所有入选患者随机分为GIK组和对照组,GIK组患者给予高浓度极化液[25%葡萄糖,80mmolLKCI,50IUL普通胰岛素,1.5ml(kg·min)]输注24h;对照组给予常规治疗,分别于输注前、输注后6h、12h、18h、24h记录血液动力学参数(RAP、PAP、PAWP、SBP、DBP、MAP、SV、CI、SVRI、PVRI、LVSWI和RVSWI)。两组患者不同时间血液动力学参数的变化比较采用重复测量方差分析。结果两组的一般临床资料相似,其中20例患者接受再灌流治疗,基线时两组患者血液动力学参数均衡。心率、SBP、DBP、MAP、RAP、LVSWI和RVSWI在不同时间无明显变化,GIK输注对这些参数也无明显影响;PAWP在开始的12h逐渐上升,然后缓慢下降(F=3.75,P=0.02),两组的变化趋势相似;在开始的12h,GIK组SVRI和PVRI呈下降趋势,而对照组呈上升趋势,两组的变化趋势不同(F=4.71,P=0.02);GIK输注可提高SV(F=4.11,P=0.03)和CI(F=4.40,P=0.02)。结论高浓度GIK对AMI患者血液动力学参数无不良影响,在AMI早期,可以改善心脏功能,降低外周血管阻力可能是其机制之一。
Objective To evaluate the effect of GIK on hemodynamics in patients with acute myocardial infarction (AMI). Methods In this prospective, randomized, controlled design, we evaluated the hemodynamic effects of GIK on 21 patients with AMI using a Swanganz catheter. All selected patients were randomly divided into GIK group and control group. Patients in GIK group were given high concentration of polarized solution [25% glucose, 80mmolLKCI, 50IUL normal insulin, 1.5ml (kg · min)] infusion 24h; control group were given routine treatment, Hemodynamic parameters (RAP, PAP, PAWP, SBP, DBP, MAP, SV, CI, SVRI, PVRI, LVSWI and RVSWI) were recorded before and after infusion at 6h, 12h, 18h and 24h respectively. Two groups of patients at different times changes in hemodynamic parameters were compared using repeated measures analysis of variance. Results The general clinical data of both groups were similar, with 20 patients receiving reperfusion therapy and hemodynamic parameters balanced at baseline. The changes of heart rate, SBP, DBP, MAP, RAP, LVSWI and RVSWI did not change significantly at different time points, and GIK infusion had no significant effect on these parameters. PAWP increased gradually at the first 12h and then slowly decreased (F = 3.75, P = 0.02) ). The trend of change in the two groups was similar. In the first 12 hours, the SVRI and PVRI in the GIK group showed a decreasing trend while the control group showed an upward trend with different trends in the two groups (F = 4.71, P = 0.02) Increased SV (F = 4.11, P = 0.03) and CI (F = 4.40, P = 0.02). Conclusions High-concentration GIK has no adverse effect on the hemodynamic parameters in patients with AMI. Early in AMI, it may improve cardiac function and reduce peripheral vascular resistance, which may be one of its mechanisms.