体外循環下開心術時の糖代謝の検討 : 糖尿病症例と正常耐糖能症例の比較を中心にして

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The effects of glucose-insulin-potassium (GIK) administration on carbohydrate metabolism were investigated in 28 adult non-diabetic patients, 7 adult diabetic patients and 10 adult borderline diabetic patients subjected to open heart surgery. Non-diabetic patients were divided into three groups on the basis of composition of their potassium supplementary fluid during cardiopulmonary bypass (CPB) ; group 1 : GIK (glucose 1g : insulin 1 units : potassium 4mEq),group 2 : GIK (glucose 2g : insulin 1 units : potassium 4mEq). Diabetic patients were classified as group 4 and borderline diabetic patients were classified as group 5 and both of these 2 group were given same solution as group 1. During CPB,all groups were administrated GIK solution continuously at the speed of 1 mEq of potassium per Kg of bodyweight per hour. Among these groups,following items were compared : serum potassium,blood suger,immuno-reactive insulin (IRI), C-peptide immuno-reactivity (CPR), nonesterified fatty acid (NEFA) and plasma osmolality (POsm). During CBP, blood suger amd IRI levels were gradually elevated due to GIK administration though serum potassium levers were remained within normal range in all groups. At 120min of CPB,blood suger level reached 631±32.4mg/dl in group 3 and 186±11.3mg/dl in group 2, respectively. IRI levels increased rapidly up to 155.2±33.4μU/ml in group 1, 322.6±11.3μU/ml in group 2 and 464.8±56.0μU/ml in group 3, in proportion to their blood suger levels at 120min of CPB. CPR levels gradually decreased until 60min of CPB in these three groups but at 120min of CPB increased except for group 1. POsm levels showed high levels over 300mOsm/lin group 2 and group 3 but it was within normal range in group 1 during CBP. NEFA levels were similar during CBP in these three groups. As indicated by these results, continuous administration of GIK (1 : 1 : 4) during CPB kept balabced state of the carbohydrate metabolism in non-deabetic patients during open heart surgery and, therefore we administrated GIK (1 : 1 : 4) during CBP in diabetic (group 4) and borderline diabetic patients (group 5). In group 4 and group 5,blood suger, IRI, CPR and Posm levels showed similar change as group 1. These results indicated that continuous administration of GIK (1 : 1 : 4) during CPB with Ringer's lactate priming is recommendable for management of carbohydrate metabolism during open heart surgery both in diabetic and non-diabetic patients.
神戸大学の論文

体外循環下開心術時の糖代謝の検討 : 糖尿病症例と正常耐糖能症例の比較を中心にして

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