葡萄糖-胰岛素-钾极化液对风湿性心脏病围术期心脏功能的作用

目的研究葡萄糖-胰岛素-钾极化液（GIK）（强心药）对风湿性心脏病围术期心脏功能的改善作用。方法将98例风湿性心脏病瓣膜置换术病人随机分为对照组（52例）和治疗组（46例）。人院后8h内，治疗组开始GIK静滴至手术，平均用药时间为（7．44±2．52）天；术后继续给予7天。对照组未用GIK。比较2组心脏自动复跳率、术后恶性心律失常发生率、低心排综合征发生率、围术期心力衰竭发生率及死亡率。结果治疗组与对照组心脏自动复跳率、恶性心律失常发生率以及围术期心衰发生率有显著性差异（P〈0．05）；低心排综合征发生率有非常显著性差异（P〈0．01）；治疗组无围术期死亡，对照组有1例死亡（1．92％）。结论在术前、术后给予GIK可降低心瓣膜病合并巨大左室术后恶性室性心律失常、低心排综合征、心力衰竭的发生率以及围术期死亡率，从而提高手术成功率。

Effect of glucose -insulin -potassium solution on the cardiac function in patients with rheumatic valvular disease during perioperation period

Objective To study the effects of glucose-insulin-pota-ssium (GIK) on the cardiac function in patients with rheumatic valvular disease during perioperation period. MethodsNinety-eight patients randomly assigned to control and trial group, 52 patients untreated with GIK (control group) and 46 patients received GIK intravenously (trial group). Regular insulin 10 IU with 10% potassium chloride 10 mL and 10% glucose 250 mL, and 50% glucose 50 mL administered after patients hospitalized until operation and continuously used for 7 days postoperatively.ResultsAutomatical recovery heart beat rate after openning aortic clamp, incidence of arrhythmia rate, and perioperative heart failure rate in trial group was significantly reduced compared with the control group(P<0.05). Incidence of low output syndrome rate was significantly reduced in trial group compared with the control group (P<0.01).There was 1 patient dead postoperative day 3 caused by fatal cardiac arrhythmia, concomitantly caused by low output syndrome rate in control group;less need for inotropic support in trial group than that in control group intro and postoperation.Conclusion GIK considerably improve peri- and post-operative recovery of contractile function and reduce the incidences of arrhythmia, low output syndrome, perioperative heart failure, postoperative mortality, and less need for inotropic support after valve replacement with enlarged left ventricle of rheumatic valvular disease.