Myocardial metabolism during administration of a metabolic myocardial protection in coronary artery surgery [KORONER CERRAHI OLGULARINDA MIYOKARDIN METABOLIK KORUNMASI SIRASINDA METABOLIZMASI]
Küçük Resim Yok
Tarih
1994
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
Preischemic glucose-insulin-potassium administration in open heart surgery has been implicated in better myocardial protection during cross clamping of the aorta. To assess the metabolic effects of myocardial substrate alteration in patients undergoing coronary artery bypass grafting (CABG), glucose (0.5 g/kg/h) - insulin (1 U/kg/h) - potassium (25 mmol/h) was administered intravenously for 30 minutes to 12 patients (Acute Parenteral Alimentation, APA) before cardiopulmonary bypass was commenced. Another 12 patients to whom 0.9 % NaCl and 25 mmol/h potassium was given with the same infusion rate served as control group. Simultaneous arterial (a) and coronary sinus (cs) samples were obtained before and after a 30 minute infusion period; samples were assayed for sodium, potassium, glucose, lactate and blood gas analysis. The cs potassium level in the APA group decreased from 4.377±0.196 to 3.787±0.146 mmol/L, whereas there was an increase from 4.033±0.062 to 4.650±0.070 mmol/L in the control group. The difference between two groups was significant, p<0.01. Upon infusion of glucose-insulin-potassium, myocardial glucose extraction (a-cs difference) increased from 54.42±6.28 mg/dl to 92.5±12 mg/dl; whereas it was reduced from 50.25±4.58 mg/dl to 37.67±4.43 mg/dl in the control group (p<0.01). While myocardial lactate extraction increased from 0.461±0.103 mmol/L to 0.987±0.114 mmol/L in APA group with the glucose-insulin administration (p<0.01), it remained unchanged in the control group. The enhancement of myocardial carbohydrate utilisation, evidenced with the increase in myocardial glucose and lactate uptake with the action of glucose-potassium-insulin before the initiation of cardiopulmonary bypass, would be particularly important for the patients undergoing myocardial revascularization that, this may further improve ischemic tolerance of the myocardium during cross clamping of the aorta.
Açıklama
Anahtar Kelimeler
Coronary artery surgery, Glucose, Insulin, Myocardial metabolism, Potassium
Kaynak
Turk Anesteziyoloji ve Reanimasyon
WoS Q Değeri
Scopus Q Değeri
N/A
Cilt
22
Sayı
4
