Postoperative N-terminal Pro-Brain Natriuretic Peptide Level in Coronary Artery Bypass Surgery With Ventricular Dysfunction After Perioperative Glucose-Insulin-Potassium Treatment

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• 作者：Mahnoosh Foroughi ; Hossein Rahimian ; Ali Dabbagh ; Masood Majidi ; Manoucher Hekmat ; Mahmood Beheshti ; Mehran Shahzamani
• 关键词：B-type natriuretic peptide ; coronary artery bypass graft surgery ; glucose-insulin-potassium ; left ventricular ejection fraction
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2012
• 出版时间：August, 2012
• 年：2012
• 卷：26
• 期：4
• 页码：631-636
• 全文大小：348 K

文摘

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Objective

The aim of this study was to clarify the efficacy of perioperative glucose-insulin-potassium (GIK) infusion on preoperative and postoperative N-terminal (NT)-pro-brain natriuretic peptide (BNP) concentrations in patients with a low ejection fraction undergoing isolated on-pump coronary artery bypass graft (CABG) surgery.

Design

A double-blind, randomized, controlled study.

Setting

Modarres Hospital, Tehran, Islamic Republic of Iran.

Patients

Sixty-six patients with a low ejection fraction who required coronary artery surgery were selected.

Intervention

Patients were allocated to a GIK (n = 36) or a control (n = 30) group. The GIK group received GIK solution (500 mL of dextrose in water (DW) 10 % + 40 U of regular insulin + 40 mEq of KCl, and 2 g of MgSO₄) at a rate of 1 mL/kg/h for 10 hours preoperatively and until the removal of the aortic cross-clamp. The control group received half saline solution as placebo with an equivalent infusion rate during the same interval.

Measurements and Main Results

Serum NT-proBNP levels were measured before starting the GIK, at the time of anesthesia induction, and 24 hours after surgery. The primary outcome measures were preoperative and postoperative NT-proBNP level. The amount of elevation in postoperative NT-proBNP concentrations was less prominent in the GIK group than in the control group (2,601 ¡À 1,799 pg/mL v 4,732 ¡À 4,127 pg/mL; p = 0.02). The patients in the GIK group were extubated sooner (495 ¡À 92 minutes) than the control group (774 ¡À 224 minutes; p = 0.002). The overall extubation time was 606 ¡À 177 minutes. Delayed requirement for mechanical ventilation was significantly more in the controls compared with the GIK group (45.8 % v 13.9 % , p = 0.004).

Conclusions

GIK is of value in the reduction of post-cardiac surgery NT-proBNP elevation. Thus, its infusion should have a protective effect in patients with low ejection fraction undergoing CABG surgery. Further studies may prove GIK infusion benefits in high-risk CABG surgery patients optimize outcome.