葡萄糖与极化液对经皮冠状动脉介入治疗术后心肌损伤的随机对照研究

Protective effect of glucose-insulin-potassium solutions on myocardial injury after percutaneous coronary intervention: a randomized controlled trail

摘要:

目的 比较葡萄糖与极化液对减少经皮冠状动脉介入治疗（PCI）术后心肌损伤的不同作用。方法 选择接受PCI治疗的冠心病患者100例，随机分为试验组和对照组，各50例。试验组在常规治疗的基础上于PCI术前2～4h给予10%葡萄糖溶液500ml，对照组则给予极化液（10%葡萄糖溶液500ml+10%氯化钾溶液10ml+胰岛素12U）。所有患者术前及术后次日检测磷酸激酶同工酶（CK-MB）和肌钙蛋白I（cTnI）浓度。结果 试验组和对照组基线临床资料差异无统计学意义（P＞0.05）。试验组PCI术前快速血糖水平显著高于对照组[（11.9±3.6） vs （5.3±3.7）mmol/L，P＜0.001]；试验组PCI术后快速血糖水平亦显著高于对照组[（8.8±4.2） vs （5.1±3.9）mmol/L，P＜0.001]。试验组患者PCI术前快速血糖水平无1例≤5.0mmol/L，而对照组患者有7例（14.0%）出现快速血糖水平≤5.0mmol/L。两组患者PCI术后CK-MB和cTnI均显著升高，且对照组CK-MB和cTnI升高幅度更显著，对照组CK-MB和cTnI升高1～3倍者及＞3倍者的比例更高（均P＜0.05）。结论 冠心病患者PCI术前应用葡萄糖较极化液可显著减少PCI术后心肌损伤。

Abstract:

Objective To compare the different effects of glucose solution and glucose-insulin-potassium (GIK) solutions on myocardial injury after percutaneous coronary intervention (PCI). Methods A total of 100 patients with identified coronary heart disease undergoing PCI in our hospital from October to November 2012 were prospectively enrolled in this study. They were randomly divided into two matched groups, with 50 in each group. They were all given conventional treatment as guideline recommended. Patients in control group received intravenous injection of 500ml 10% glucose solution at 2 to 4h before PCI, while those in experimental group had GIK solutions (containing 500ml 10% glucose, 10ml 10% potassium chloride and 12 U insulin) instead of glucose solution. Serum contents of creatine phosphokinase isoenzyme MB (CK-MB) and cardiac troponin I (cTnI) were measured before and one day after PCI. Results There was no significant difference in all baseline clinical data between the two groups. The experimental group had very significant higher blood glucose than control [(11.9±3.6) vs (5.3±3.7)mmol/L, P＜0.001] before PCI, and the value was also higher after PCI [(8.8±4.2) vs (5.1±3.9)mmol/L, P＜0.001]. There was no case from the experimental group with blood glucose ≤5.0mmol/L, but there were 7 (14.0%) found in control group. Both groups had obvious increased CK-MB and cTnI levels after PCI, but control group had more significant increases, with patients had more increased CK-MB by 1- to 3-folds and cTnI by over 3-folds (both P＜0.05). Conclusion Glucose solution applied preoperatively protect patients more significantly against myocardial injury when compared with GIK solutions.