Dilek YAZICI, Hasan SUNAR, Serpil TAŞ, Hicran EMİR

Koroner Arter Bypass Cerrahisi Geçirenİnsülin Tedavilerinin Karşılaştırılması Hastalarda 3 lüKarışım ve 4 lü Yoğun

Amaç: Kalp cerrahisi sonrasında insülin tedavisi verilmesinin uzun dönemdemortalite üzerinde olumlu etkileri gösterilmiştir. Bu çalışmanın amacıkardiyak cerrahi geçirecek diyabetik hastalarda taburculuk sırasındadüzenlenen 3 lü karışım insülin ve 4 lü bazal-bolus insülin tedavilerininetkinliklerinin karşılaştırılmasıdır.Hastalar ve Yöntem: Çalışmaya Kartal Koşuyolu Yüksek İhtisas Eğitim veAraştırma Hastanesi nde koroner arter bypass cerrahisi geçiren 34 diyabetikhasta dahil edilmiştir. Bu hastaların preoperatif dönemde açlık kan şekeri(AKŞ), tokluk kan şekeri (TKŞ), hemoglobin A1c (HbA1c) değerleri vehemogramları belirlenmiştir. Postoperative1. haftada (taburculukta) aynı kantetkikleri tekrarlanmış ve hastalara randomize olarak 3 lü veya 4 lü yoğuninsülin tedavisi başlanmıştır. Üç aylık takip süresinin sonunda başlangıçtayapılan ölçümler tekrarlanmıştır. Bulgular: Çalışmaya alınan 17 kişi (61,5±8,5 yıl; K/E:9/8) 3 lü kola (1. Grup), 17kişi (57,4±9,2; K/E:10/7) ise 4 lü kola (2. Grup) randomize olmuştur. İki grupta da3. ayın sonundaki AKŞ, TKŞ ve HbA1c değerleri (%7,6±0,8 ile %6,7±0,5 1. gruptave %7,3±0,7 ile %7,3±1,0 2. grupta) randomizasyon sırasındaki değerlerdenfarklı değildir. Üçüncü ayın sonunda hedef %6,0, %6,5 ve %7,0 HbA1cdeğerlerine ulaşan hasta sayısı BBT grubunda PPT grubuna göre daha fazladır. Sonuç: Koroner arter cerrahisi geçiren hastalarda BBT 3. ayın sonunda hedef HbA1c değerlerine ulaşan hasta yüzdesi açısından PPT tedavisinden daha etkilidir. (Marmara Üniversitesi Tıp Fakültesi Dergisi 2012;25:16-9)

A Comparison of Preprandial Mixed Insulin Given Three Times Daily and Basal-Bolus Insulin Therapy Started Postoperatively on Patients Having Coronary Artery Bypass Graft Surgery

Objective: Insulin therapy initiated after coronary artery bypass graft (CABG)surgery has decreased long-term mortality. The aim was to compare theeffectiveness of prandial premixed therapy (PPT) using insulin thrice daily andbasal-bolus therapy (BBT) on patients having CABG surgery.Patients and Methods: Thirty-four patients having CABG surgery were included.Fasting blood glucose (FBG), postprandial blood glucose (PPBG), hemoglobinA1c (HbA1c) and hemoglobin levels were determined preoperatively and at thefirst week postoperatively when the patients were randomized to either PPT orBBT. Initial measurements were repeated at the end of three months.Results: Seventeen patients (F/M:9/8; 61.5±8.5 years) were assigned on arandom basis to the mixed insulin arm and 17 patients (F/M:10/7; 57.4±9.2years) to the basal-bolus arm. FBG, PPBG and HbA1c levels of both groups(7.6±0.8 % vs 6.7±0.5 % in the BBT and 7.3±0.7 % vs 7.3±1.0 % in the PPTgroup) at the end of the 3 months were not different than at the time of randomization. The percentage of patients reaching HbA1c levels below 6.0%,6.5% and 7.0% were higher in the BBT group compared to the PPT group.Conclusion: For patients who had undergone CABG surgery, BBT providedmore patients with HbA1c levels below the target than did PPT. (MarmaraMedical Journal 2012;25:16-9

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