Intraoperative glycaemic control and the effectiveness of myocardial reperfusion – initial reports

Abstract

Introduction: The proper reperfusion after CABG relies on many factors. Intraoperative hyperglycaemia is a state associated with a negative prognosis. The ischemic markers -creatine kinase (CK-MB) and troponin I (T hs ) -are the molecular indicators of the aorto-coronary by-pass procedure effectiveness. Aim of the study: The purpose of the study was to assess the influence of intraoperative insulin infusion on the myocardial reperfusion, without concerning the preoperative metabolic condition. Materials and methods: The study included 42 randomly chosen patients, operated on in the Cardiosurgical Clinic in Lodz in 2010-2011. There were patients with diabetes (19), non-diabetic patients (20) and those with impaired glucose tolerance (3). During the operation4-5 glycaemic measurements were conducted. The glycaemic level of 135 mg/dl (7.5 mmol/l) was the aim. After the surgery CK-MB and Ths were assessed. The analysis included glycaemia from the operative day, and ischaemic marker measurements from the operative day and the first postoperative day. It also involved the blood pressure, the kind and amount of used liquids and medicaments. Results: 52.38% (22) patients were grouped as normoglycaemic (glicaemia ≤ 135 mg/dl in all measurements or except one). In 23.81% (10) patients there was intraoperative insulin infusion applied. The comparison of the operative measurements of glycaemia and CK-MB from the operative and first postoperative day showed positive correlation. The highest levels were noted in the group with insulin infusion (mean 46.4 U/l). In all groups the glycaemic measurements were further increasing on the intensive care unit (ICU). In the case of troponin measurements there were also higher levels noted in the hyperglycaemic patients than in the normoglycaemic. FORUM MŁODYCH 490Adres do korespondencji: Anna Marcinkiewicz, Klinika Kardiochirurgii, Katedra Kardiologii i Kardiochirurgii, Uniwersytet Medyczny w Łodzi, ul. S. Sterlinga 1/3, 91-425 Łódź, tel./faks +48 633 15 58, e-mail annamar87@o2.pl StreszczenieWstęp: Prawidłowa reperfuzja mięśnia sercowego po zabiegu pomostowania aortalno-wieńcowego (ang. coronary artery bypass graft -CABG) zależy od wielu czynników. Śródoperacyjna hiperglikemia jest stanem o udowodnionym negatywnym znaczeniu rokowniczym. Wskaźnikiem efektywności zabiegu CABG na poziomie molekularnym są markery uszkodzenia miokardium: izoenzym MB kinazy kreatynowej (CK-MB) i troponina I (T hs ). Cel pracy: Ocena wpływu śródoperacyjnej kontroli glikemii bez uwzględnienia przedoperacyjnego statusu metabolicznego na reperfuzję mięśnia sercowego. Materiały i metody: Badanie uwzględniało 42 losowo wybranych pacjentów operowanych w Klinice Kardiochirurgii w latach 2010-2011. Byli to pacjenci chorzy na cukrzycę (n = 19), bez cukrzycy (n = 20) oraz z nietolerancją glukozy (n = 3). Śródoperacyjnie dokonywano 4-5 pomiarów glikemii. Starano się osiągnąć stężenie 135 mg/dl (7,5 mmol/l). Po zabiegu wykonywano pomiary CK-MB i T hs . Analiza uwzględniała glikemię z doby operacyjnej, pomiary ma...