胰岛素耐药性,乳酸性酸症的解决,以及在使用长效胰岛素glargine的患者心脏移植后的机械支持需求的减少
Ribal Darwish1, Eva Chen2, Steven Minear2
1Anesthesiology Institute, Surgical Critical Care Division, Cleveland Clinic Florida, Weston, USA. darwisr@ccf.org.
Journal of cardiothoracic surgery
|February 16, 2024
概括
在常规胰岛素输注中添加长效胰岛素类似物有效治疗心脏移植患者的乳酸和胰岛素耐药性. 这种方法减少了对机械循环支持的需求,并缩短了通风的持续时间.
科学领域:
- 心脏病学 心脏病学
- 内分泌学 在内分泌学.
- 密集护理医学 密集护理医学
背景情况:
- 严重的乳酸和胰岛素耐药性是心脏移植后的关键并发症.
- 管理这些情况需要仔细的血糖控制和代谢支持.
研究的目的:
- 为了评估长效胰岛素模拟剂与常规胰岛素输注相结合的疗效.
- 评估对心脏移植后患者的血糖控制和乳酸性酸性溶解的影响.
主要方法:
- 两组患者的回顾性研究:一组接受长效胰岛素类似物加常规胰岛素治疗,另一组仅接受常规胰岛素治疗.
- 患者患有严重的乳酸性化 (动脉乳酸盐> 10 mmol/L) 和胰岛素耐药性 (常规胰岛素> 20 单位/小时而未达到目标葡萄糖120-180 mg/dL).
- 关键的结果包括乳酸性化纠正的时间,机械通风的持续时间,机械循环支持的需要和28天的死亡率.
主要成果:
- 两个组的28天死亡率为零.
- 在接受长效胰岛素类比组中,机械循环支持的需求显著减少 (RR=0.224,p=0.042).
- 长效胰岛素组中乳酸性酸的解决速度更快 (19.7小时 vs 29.3小时,p=0.043) 和机械通风持续时间更短 (29小时 vs 55.1小时,p=0.05).
结论:
- 低剂量长效胰岛素glargine与常规胰岛素一起,有效地解决了乳酸和胰岛素耐药性.
- 这种治疗策略减少了对压力/无热体支和机械循环支的需求.
- 这些发现表明,长效胰岛素类似物在治疗复杂的移植后代谢障碍方面起着有益的作用.
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