The mechanism of polarized fluid therapy
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The mechanism of polarized fluid therapy
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The mechanism of polarized fluid therapy.
Insulin can promote sugar into cells to provide energy, while bringing potassium into cells to restore cell membrane potential, thereby preventing arrhythmia from occurring.
Polarized fluid therapy, dating back to 1962, was proposed by Dr. Sodi-Pallare and was first used in the treatment of patients with acute myocardial infarction (AMI).
He believed that it was beneficial as an auxiliary treatment for certain cardiovascular diseases. Including its role in reducing myocardial infarction, improving heart function, and promoting heart recovery after surgery.
The mechanism of polarized fluid therapy
1. Due to potassium overflow in ischemic myocardial cells and insufficient energy, polarizing fluid provides energy and K+ to the ischemic myocardium, promotes the uptake and utilization of glucose by myocardial cells, inhibits the release of fatty acids from adipose tissue, and reduces fat dripping. Accumulation in the ischemic myocardium significantly increases the synthesis of myocardial protein and promotes the functional recovery of the ischemic myocardium.
2. Insulin in the polarizing fluid can activate Akt (also known as protein kinase B, PKB) in myocardial cells, further activate eNOS (endothelial nitric oxide synthase), increase myocardial NO production, and thereby inhibit ischemia/regeneration Perfusion cardiomyocyte apoptosis, exert cardiovascular protective effect.
3 Activate the Na + -K + -ATP enzyme of the myocardial cell membrane, increase the intracellular potassium ion concentration, restore the cell polarization state, improve the electrophysiology of ischemic myocardium, and reduce the occurrence of arrhythmia.
The polarizing fluid can restore the polarization state of the cell membrane to the diseased cardiomyocytes, protect the ischemic-damaged myocardium, improve the sinus and atrioventricular conduction, and prevent arrhythmia. It is now widely used in cardiology and cardiology surgery, severe infections, trauma and perioperative patients.
Classification and function of polarized liquid
1. Conventional Polarizing Liquid (GIK)
1) Composition: 10U ordinary insulin, 10% potassium chloride 10ml, 10% glucose solution 500ml,
2) Usage: intravenous drip, 1 time/day, 7-14 days as a course of treatment.
3) Function: Insulin can promote sugar to enter cells to provide energy, and at the same time bring potassium into cells, restore cell membrane potential, thereby preventing the occurrence of arrhythmia.
4) Principle:
①Insulin can reduce the content of K+, fatty acids and amino acids in the blood;
②The potassium in the myocardial fibers of ischemic injury escapes, and the energy is insufficient, and the polarizing liquid provides sugar and potassium chloride while supplying insulin, so that extracellular potassium can be transferred back into the myocardial cells and improve the metabolism of the ischemic myocardium. ；
③Promote glucose to enter into myocardial cells, inhibit the release of fatty acids from adipose tissue, thereby reducing the accumulation of neutral fat droplets in the ischemic myocardium;
④Insulin can significantly increase the synthesis of myocardial protein, so the polarizing fluid can restore the polarization state of the cell membrane to the diseased cardiomyocytes, protect the ischemic damaged myocardium, improve the sinoatrial and atrioventricular conduction, and prevent arrhythmia. .
2. Magnesium polarized liquid (GIKM)
1) Composition: insulin 10U, 10% potassium chloride 10ml, 10% magnesium sulfate 10-20ml, 10% glucose solution 500ml.
2) Usage: intravenous drip, 1 time/day, 7-14 days as a course of treatment.
3) Function: Nourish myocardium.
4) Principle:
① Magnesium has a wide range of effects on myocardial electrical activity;
② Magnesium can activate myocardial adenosine cyclase, maintain the integrity of mitochondria and promote its oxidative phosphorylation process;
③Prevent the outflow of potassium in the cell;
④ Make extracellular potassium enter the cell, reduce the blood K+ concentration, so that the ischemic-injured cardiomyocytes can restore the polarization state, inhibit reentry, and reduce the occurrence of arrhythmia;
⑤Provide energy and strengthen myocardial contractility.
3. Enhanced polarizing liquid
1) Composition: 10U insulin, 10% potassium chloride 10ml, L-magnesium potassium aspartate (L-PMA) 20ml, 5%-10% glucose solution 300-500ml.
2) Usage: intravenous drip, 1 time/day, 7-14 days as a course of treatment.
3) Function: It can restore the polarized state of the myocardial cells damaged by ischemia and strengthen the original polarizing fluid.
4) Principle:
①Increase the concentration of potassium in the cell to play the role of potassium and magnesium ions;
②Involved in the tricarboxylic acid cycle in the cell.
4. High-concentration polarizing liquid
1) Composition: insulin 20U, 10% potassium chloride 15ml, 10% glucose solution 500ml, 50% glucose 60ml.
2) Usage: intravenous drip, 1 time/day, 7-14 days as a course of treatment.
3) Function: Provide energy and potassium ions that cannot be provided by conventional polarizing fluids for some severely ischemic-damaged cardiomyocytes to restore their resting state.
4) Principle: Increasing the concentration of conventional polarizing fluid and maintaining a higher concentration of K+ ion balance can restore the polarization state of cardiomyocytes.
5. Simplify polarizing liquid
1) Composition: 20ml potassium magnesium L-aspartate and 500ml 10% glucose solution.
2) Usage: intravenous drip, 1 time/day, 7-14 days as a course of treatment.
3) Function: It can effectively promote potassium ions to enter the cardiomyocytes, restore the polarization state of the cardiomyocytes, avoid hypoglycemia and inhibit the cardiac conduction system.
4) Principle: When the concentration of potassium and magnesium aspartate is less than 10% (that is, the concentration of L-PMA in 100ml glucose solution does not exceed 10ml), it does not affect the concentration of K+ and magnesium in the blood.
6. Dynamically adjust the polarizing liquid
1) Composition: glucose, regular insulin, potassium chloride, magnesium sulfate.
2) Usage: Start pumping slowly by infusion pump, uninterrupted for 72 hours, and measure blood glucose every 2 hours. Unstable blood glucose is monitored at any time.
According to the blood glucose level, the compatibility ratio of glucose and insulin is dynamically adjusted.
The amount of insulin input into the body is basically fixed at 2U/h, which can be increased or decreased according to body weight. On this basis, the glucose dose is adjusted.
The ratio of glucose to insulin is about 2~5g:1IU.
When blood sugar is greater than 14mmol/L, temporarily give 50ml sodium chloride injection + 10IU insulin pump at a rate of 25ml/h.
The blood sugar drops below 11mmol/L, immediately switch to polarizing fluid.
For example, the blood sugar is 8-11mmol/L, the ratio of glucose and insulin is 3g:1IU, that is, 250ml of 10% glucose injection + 8IU of insulin, the speed is 60ml/h, to ensure that the amount of insulin entering the body every hour is 2IU.
If the blood sugar drops to 5-8mmol/L, increase the ratio of glucose to insulin to 4g:1IU, add 20ml of 50% glucose injection to the polarizing liquid of the previous group, and the amount of insulin will not change.
According to this method, it will decrease when the blood sugar rises.
Glucose ratio, increase the glucose ratio when the blood sugar decreases, the dosage needs to be individualized, and the blood sugar is monitored frequently, and the dosage is adjusted at any time.
3) Function: The dynamic adjustment of the polarized solution program can well control the occurrence of hypoglycemia and help the patient to pass the dangerous period smoothly.
4) Principle: The dynamic adjustment of the polarizing solution program can improve the metabolism of ischemic myocardium, promote glucose into myocardial cells, and inhibit the release of fatty acids from adipose tissue, thereby reducing the accumulation of neutral fat droplets in the ischemic myocardium and reducing oxidative stress It can restore the polarization state of the cell membrane to the diseased cardiomyocytes, and has a certain effect on protecting the ischemic-damaged myocardium, improving the sinus node and atrioventricular conduction, and preventing arrhythmia.
In short, the polarizing fluid can promote myocardial uptake and metabolism of glucose; make K+ enter the cell, restore the polarization state of the cell membrane, ensure the normal contraction of the myocardium, and reduce the occurrence of arrhythmia; mainly used in chronic stable coronary heart disease and acute myocardial infarction , Cardiomyopathy and other heart diseases.
The mechanism of polarized fluid therapy
(source:internet, reference only)
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