محلول "گلوکز- انسولین‌ـ پتاسیم" در سکته‌ مغزی ایسکمیک: کارآزمایی بالینی

Background: Hyperglycemia after acute stroke is a common finding that has been associated with an increased risk of death. For the last several years, it was believed that post-stroke hyperglycemia may worsen brain infarction in animal models. According to previous studies, the anti-inflammatory effect of insulin has a protective role on ischemic tissues. Glucose-insulin-potassium (GIK) infusions can be safely administered to acute stroke patients with mild to moderate hyperglycemia producing a physiological but attenuated glucose response to acute stroke, the effectiveness of which remains to be elucidated. In this study, we compared the effects of GIK infusion vs. placebo in ischemic stroke patients. Methods: In this double blind randomized controlled trial, the intervention group consisted of 48 patients who received GIK infusion for 24 hours and the control group included 50 patients who received normal saline infusion for 24 hours. All patients had been admitted to Shariati Hospital during the first 24 hours after the onset of ischemic stroke. At one and three months after the treatment, patients were examined for morbidity and mortality using the Bethel and Modified- Rankin-Scale (MRS) questionnaires. Results: GIK infusions significantly reduced plasma glucose concentrations. Statistically significant differences between the two groups were observed for disability and mortality. However, in spite of the protective effects of insulin and adverse effect of hyperglycemia in ischemic tissues, we observed no significant therapeutic effect from the GIK solution on patient outcome. Conclusions: Although hyperglycemia following acute stroke has been associated with subsequent mortality and impaired neurological recovery, the maintenance of euglycemia in the acute phase has not been shown to improve prognosis. According to this study, GIK infusion has no significant clinical benefit on the outcome of stroke patients. Thus, we cannot recommend routine use of GIK infusion in post-stroke hyperglycemia as an adjuvant treatment for ischemic stroke.