Глюкозоинсулиновая смесь как кардиопротектор в кардиологии и кардиохирургии (обзор)
https://doi.org/10.15360/1813-9779-2017-1-57-72
Аннотация
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. КозловРоссия
Т. В. Клыпа
Россия
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Рецензия
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. https://doi.org/10.15360/1813-9779-2017-1-57-72