Nurgül YURTSEVEN, Sevim CANİK, Dilek SAVAŞKAN, Müzeyyen İyigün KUNT, Abdullah Kemal TUYGUN

Myocardial protection: standard versus insulin cardioplegia and glucose-insulin-potassium solutions

Amaç: Bu çalışmada, koroner arter bypass greftleme (KABG) cerrahisinde insülin kardiyoplejisi, glikoz-insülin-potasyum (GİK) solüsyonu ile kombine edilmiş insülin kardiyoplejisi ve yalnız kan kardiyoplejisinin ameliyat sonrası derlenme üzerine olan hemodinamik ve metabolik etkileri belirlendi.Çalışma planı: Diyabet öyküsü olmayan ve sol ventrikül fonksiyonları normal olan 120 hasta randomize olarak üç gruba ayrıldı. Ameliyat sırasında grup 1 (n=40) ve 2’deki (n=40) hastalara 10 IU/L kristalize insülin ilave edilmiş kan kardiyoplejisi ve grup 3’deki (n=40) hastalara standart kan kardiyoplejisi uygulandı. Grup 2’de kros-klemp (KK) açılmadan önce ilave olarak GİK solüsyonu başlandı. Arteryel ve koroner sinüs kan örnekleri, KK uygulamasından önce (T0), KK açılmadan önce (T1) ve KK açıldıktan sonraki 0, 5, 10. ve 15. dakikalarda (T2-T3-T4-T5) alındı. Hemodinamik parametreler anestezi indüksiyonunu takiben 30. dakikada ve ameliyat sonrası 1. ve 24. saatlerde ölçüldü. Ameliyat sırası ve sonrasında, defibrilasyon gereksinimi, inotropik ve intraaortik balon pompası desteği, ameliyat sonrası aritmi insidansı, entübasyon süresi, yoğun bakım ve hastanede kalış süreleri kaydedildi.Bulgular: Arteryel ve koroner sinüs laktat düzeyleri grup 3 ile karşılaştırıldığında grup 2’de 5, 10. ve 15. dakikalarda anlamlı şekilde düşük bulundu. Arteryel ve koroner sinüs kan glikoz seviyeleri grup 3’de anlamlı olarak yüksek bulundu. Ameliyat sonrası aritmi insidansı ve inotropik destek ihtiyacı grup 2’de, grup 1 ve grup 3’den daha düşük bulundu (p

Miyokardiyal koruma: Standarda karşı insülin kardiyopleji ve glikoz-insülin-potasyum solüsyonu

Background: This study determined the hemodynamic and metabolic effects of insulin cardioplegia, glucose-insulin-potassium (GIK) solution combined with insulin cardioplegia, and bloodonly cardioplegia on postoperative recovery in coronary artery bypass grafting (CABG).Methods: One-hundred and twenty patients with normal ventricle function and no history of diabetes mellitus (DM) were randomly divided into three groups. During the operation, 10 IU/L of crystalized insulin-added blood cardioplegia was administered to the patients in group 1 (n=40) and group 2 (n=40), and standard blood cardioplegia was used in group-3 (n=40). In addition, GIK solution was started before the removal of cross-clamp (CC) period in group 2. The blood samples from arterial and coronary sinus were collected before CC application (T0), before CC removal (T1) and 0, 5th, 10th, and 15th minutes (T2-T3-T4-T5) after CC removal. Hemodynamic parameters were measured at the 30th minute after anesthesia induction and 1st and 24th hours following surgery. During the peri- and postoperative course, the need for defibrillation, inotropic and intraaortic balloon pump support, the incidence of postoperative arrythmias, duration of intubation, intensive care unit stay and hospitalization were recorded.Results: The levels of arterial and coronary sinus lactate were significantly lower in group 2 compared to group 3 in the 5th, 10th, and 15th minutes. The blood glucose levels of arterial and coronary sinus were significantly higher in group 3. In group 2, the incidence of postoperative arrythmias and requirement for inotropic support was less than that of group 1 and group 3 (p

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