Glucoseinsulin Mixture as a Cardioprotective Agent in Cardiology and Cardiac Surgery (Review)
General Reanimatology
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| Title |
Glucoseinsulin Mixture as a Cardioprotective Agent in Cardiology and Cardiac Surgery (Review)
Глюкозоинсулиновая смесь как кардиопротектор в кардиологии и кардиохирургии (обзор) |
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I. Kozlov A.; M. F. Vladimirsky Moscow Regional Research Clinical Institute, V. A. Negovsky Research Institute of General Reanimatology, Federal Scientific and Clinical Center of Reanimatology and Rehabilitology
T. Klypa V.; Federal Scientific and Clinical Center, Federal Medico%Biological Agency of the Russia И. Козлов А.; Московский областной научно%исследовательский клинический институт им. М. Ф. Владимирского, НИИ Общей реаниматологии им. В. А. Неговского, Федеральный научно-клинический центр реаниматологии и реабилитологии Т. Клыпа В.; Федеральный научно%клинический центр Федерального медико-биологического агентства России |
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| Subject |
glucose-insulin-potassium mixture; adjuvant cardioprotection; insulin; glucose; carbohydrate metabolism in acute myocardial infarction; hyperglycemia in cardiac surgery
глюкозо-инсулин-калиевая смесь; адъювантная кардиопотекция; инсулин; глюкоза; углеводный метаболизма при остром инфаркте миокарда; гипергликемия в кардиохирургии |
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| Description |
The literature review presents an analysis of publications describing the use of a glucose%insulin mixture as a cardioprotective agent in acute myocardial infarction and in cardiac surgeries with extracorporeal circulation (ECC). It summarizes historical aspects of implementation of the glucose%insulin therapy in cardiology and car%diac surgery. Possible mechanisms of action of the glucose-insulin-potassium mixture in acute ischemia and myocardial infarction were analyzed (normalization of electrical processes on the cardiomyocyte membrane, replenishment of metabolic substrates and increased production rate of adenosine triphosphoric acid due to glycolysis, decreased intensity of non%esterified fatty acid oxidation, decreased apoptosis, etc.). It discusses results of clinical studies evaluating prescription of the mixture for acute myocardial infarction, including data from metaanalyses. It demonstrated that the role and the clinical efficacy of the preventive and therapeutic measure under consideration in acute myocardial infarction are still the subject of discussion and require further research. It also analyzed modern concepts explaining the cardioprotective effects of insulin and glucose during surgeries with ECC (decreased insulin resistance, activation of anaplerosis, stimulation of intracellular signaling pathways maintaining the viability of cells, reduction of the severity of systemic inflammatory response, immunomodulatingeffect, etc.). Review discusses results of clinical studies including data from randomized clinical trials and metaanalyses performed over the last 5 years that demonstrated the absence of the effect of the glucose%insulin therapy on the hospital mortality. Various studies demonstrated its positive effects including decreased incidence of peri%operative myocardial infarctions and intensity of inotropic support, increased values of postoperative cardiac index, decreased duration of postoperative mechanical ventilation and ICU stay, etc. Review concludes that the interest to the therapeutic and preventive use of the glucose%-nsulin mixture in both emergency cardiology and cardiac surgery has been revived recently.
В обзоре литературы представлен анализ публикаций, посвященных использованию инсулино-глюкозной смеси в качестве кардиопротектора при остром инфаркте миокарда и при кардиохирургических операциях с искусственным кровообращением (ИК). Кратко изложены исторические аспекты внедрения инсулино%глюкозной терапии в кардиологии и кардиохирургии. Проанализированы возможные механизмыдействия глюкозо-инсулин-алиевой смеси при острой ишемии и инфаркте миокарда (нормализация электрических процессов на мембране кардиомиоцитов, пополнение метаболический субстратов и увеличение гликолитической продукции аденозинтрифосфорной кислоты, снижение интенсивности окисления неэстерефицированных жирных кислот, уменьшение апоптоза и др.). Рассмотрены результаты клинических исследований по назначению смеси при остром инфаркте миокарда, включая данные мета-анализов. Продемонстрировано, что роль и клиническая эффективность рассматриваемой лечебно-профилактической меры при остром инфаркте миокарда остаются предметом дискуссии и требует дальнейших исследований. Также проанализированы современные концепции, объясняющие кардиопротекторные эффекты глюкозы и инсулина при операциях с ИК (уменьшение инсулинорезистентности, активизация анаплерозиса, стимуляция внутриклеточных сигнальных путей, обеспечивающих сохранение жизнеспособности клеток, снижение выраженности системной воспалительной реакции, иммуномодулирующее действие, идр.). Представлены результаты клинических исследований, включая данные рандомизированных клинических исследований и мета%анализов, выполненных за последние 5 лет и продемонстрировавших оттсутствие влияния глюкозо%инсулиновой терапии на госпитальную летальность. Вместе с тем, в ряде работ выявлены и обсуждаются ее положительные эффекты: снижение частоты периоперационных инфарктов миокарда, уменьшение интенсивности инотропной поддержки, лучшие значения послеоперационного сердечного индекса и укорочение длительности послеоперационной искусствкнной вентиляции легких, пребывания в отделении интенсивной терапии и др. Сделано заключение, что в последние годы отмечаетсявозрат интереса к лечебно-профилактическому использованию глюкозо-инсулиновой смеси как в экстренной кардиологии, так и в кардиохирургии |
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FSBI "SRIGR" RAMS
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2017-03-03
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info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion Рецензированная статья |
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application/pdf
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http://www.reanimatology.com/rmt/article/view/1574
10.15360/1813-9779-2017-1-57-72 |
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General Reanimatology; Том 13, № 1 (2017); 57-72
Общая реаниматология; Том 13, № 1 (2017); 57-72 2411-7110 1813-9779 10.15360/1813-9779-2017-1 |
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rus
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http://www.reanimatology.com/rmt/article/view/1574/1080
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