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葡萄糖-胰岛素-治疗ST段升高心肌梗塞患者
Rafael Díaz1, Abhinav Goyal, Shamir R Mehta
1Etudios Cardiologica Latin America, Rosario, Argentina.
JAMA
|November 29, 2007
概括
葡萄糖-胰岛素- (GIK) 输注对ST段升高心肌梗塞 (STEMI) 患者没有益处,可能会增加早期的危害. 由于高血糖,高胆固醇和液体过载的潜在风险,不建议使用GIK治疗.
科学领域:
- 心脏病学 心脏病学
- 关键护理医学 关键护理医学
- 代谢研究研究 代谢研究
背景情况:
- 葡萄糖-胰岛素- (GIK) 输注在ST段升高心肌梗塞 (STEMI) 的临床效用仍然不确定,之前的研究结果相矛盾.
- 虽然一些较小的试验表明了潜在的益处,但一项大型试验 (CREATE-ECLA) 在超过20,000名STEMI患者中没有发现对30天死亡率的影响.
研究的目的:
- 调查GIK输液治疗与STEMI后30天和6个月的患者结局之间的关联.
- 分析来自多项大型随机对照试验的综合数据,以提供STEMI中GIK治疗的综合评估.
主要方法:
- 对OASIS-6 GIK随机对照试验 (2748名患者) 的初级分析和结合OASIS-6和CREATE-ECLA (22,943名患者) 数据的预规定的分析.
- 小组分析检查了GIK启动时间对结果的影响.
- 后期分析探讨了与GIK相关的潜在早期危害,重点关注葡萄糖水平,水平和净流体增加.
主要成果:
- 在OASIS-6试验的6个月后,与对照组相比,GIK输液在死亡率,心力衰竭或死亡或心力衰竭的复合性方面没有显著差异.
- 对OASIS-6和CREATE-ECLA的综合分析显示,GIK输注后3天死亡率的统计学上显著增加 (HR,1.13;P = .03),在30天后消失了.
- GIK治疗增加了葡萄糖,和净流体增加,所有这些都与死亡率增加有关;调整这些因素消除了GIK观察到的早期死亡率益处.
结论:
- 对STEMI患者来说,GIK输液治疗没有临床益处,可能与早期的危害有关.
- 未来对STEMI代谢调节的研究应该考虑避免或仔细管理输液相关的高血糖症,高胆固醇症和净流体增加.
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