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Глюкозоинсулиновая смесь как кардиопротектор в кардиологии и кардиохирургии (обзор)

https://doi.org/10.15360/1813-9779-2017-1-57-72

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Аннотация

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 механизмы
действия 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, и
др.). 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 отмечается
возрат интереса к лечебно-профилактическому использованию  глюкозо-инсулиновой смеси как в экстренной кардиологии, так и в кардиохирургии

Об авторах

И. А. Козлов
Московский областной научно%исследовательский клинический институт им. М. Ф. Владимирского, НИИ Общей реаниматологии им. В. А. Неговского, Федеральный научно-клинический центр реаниматологии и реабилитологии
Россия


Т. В. Клыпа
Федеральный научно%клинический центр Федерального медико-биологического агентства России
Россия


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Для цитирования:


Козлов И.А., Клыпа Т.В. Глюкозоинсулиновая смесь как кардиопротектор в кардиологии и кардиохирургии (обзор). Общая реаниматология. 2017;13(1):57-72. https://doi.org/10.15360/1813-9779-2017-1-57-72

For citation:


Kozlov I.A., Klypa T.V. Glucoseinsulin Mixture as a Cardioprotective Agent in Cardiology and Cardiac Surgery (Review). General Reanimatology. 2017;13(1):57-72. (In Russ.) https://doi.org/10.15360/1813-9779-2017-1-57-72

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