Kalp Cerrahisi Yapılan Hastalarda Derin Sternal Yara İnfeksiyonları ile HbA1c Seviyeleri Arasındaki İlişki

Year 2016, Volume: 19 Issue: 1, 7 - 11, 04.04.2016

Utkan Sevük , Abdulkadir Bilgiç Barış Yaylak Nurettin Ay Erkan Baysal Aylin Erkul Vahhaç Alp Ünal Beyazıt Süleyman Akkaya

Abstract

Giriş:
Kalp cerrahisi yapılan hastalarda, diabetes
mellitus (DM)’lu hastalarda olduğu kadar diyabetik olmayan hastalarda da
hiperglisemi ile sık karşılaşılır. Kalp cerrahisi sonrasında intraoperatif ve
postoperatif hipergliseminin derin sternal yara infeksiyonu (DSYİ) için
bağımsız risk faktörü olduğu gösterilmiştir. Ancak, preoperatif kronik glisemik
kontrolün DSYİ ile ilişkisi tartışmalıdır. Hemoglobin A1c (HbA1c) geçmiş 2-3
aylık dönemdeki glukoz düzeyi hakkında bilgi verir. Bu çalışmanın amacı koroner
baypas cerrahisi yapılan DM’li hastalarda, HbA1c seviyeleri ile DSYİ arasındaki
ilişkiyi incelemektir.

Hastalar
ve Yöntem: Kliniğimizde kardiyopulmoner
baypas altında koroner baypas operasyonu yapılmış olan hastaların kayıtları
retrospektif olarak incelendi. DM’si olan ve perioperatif periyodda yeterli
glisemik kontrol sağlanmış 180 hasta çalışmaya dahil edildi. DM’si olmayan
koroner baypas cerrahisi yapılmış ardışık 200 hasta kontrol grubuna dahil
edildi.

Bulgular:
Medyan HbA1c değerleri diyabetik hasta grubunda anlamlı
olarak daha yüksekti [8.16 (7.2-10.4 vs 5.49 (5-6), p< 0.001]. DSYİ sıklığı
bakımdan iki grup arasında istatistiksel olarak anlamlı bir fark saptanmadı [%5
(n= 9) vs %2 (n= 4); p= 0.1]. Yoğun bakımda kalış (p= 0.005) ve hastanede kalış
süreleri (p= 0.01) diyabetik hastalarda anlamlı olarak daha uzundu.

Sonuç: Preoperatif dönemdeki yüksek HbA1c
seviyeleri koroner baypas sonrası DSYİ ile ilişkili bulunmamıştır. Ayrıca
perioperatif periyodda yeterli glisemik kontrol sağlanmış DM’li hastalarda  DSYİ sıklığında artış olmadığı saptanmıştır.

Keywords

Mediastinit, koroner arter baypas cerrahisi, hemoglobin A1c, diabetes mellitus, derin sternal yara infeksiyonu

Relationship Between Elevated HbA1c and Deep Sternal Wound Infection in Patients Undergoing Cardiac Surgery

Abstract

Introduction:
Hyperglycemia is common in patients with and
without diabetes mellitus (DM) following cardiac surgery. Intra- and
postoperative hyperglycemia has been shown to be an independent risk factor for
deep sternal wound infection (DSWI) after cardiac surgery. However, whether the
preoperative chronic glycemic control is associated with the risk of DSWI remains
controversial. Hemoglobin A1c (HbA1c) provides a measure of glucose control
over the prior 2-3 months. The aim of this study was to evaluate the
relationship between preoperative HbA1c levels and DSWI in patients with DM
undergoing coronary artery bypass grafting (CABG).

Patients
and Methods: Records of patients who underwent elective
on-pump CABG were retrospectively reviewed. A total of 180 patients with DM
were included in the study. Patients were excluded if their blood glucose
levels were not adequately controlled in the perioperative period. A total of
200 consecutive patients without DM were taken as controls.

Results:
Median HbA1c levels were significantly higher in
patients with DM [8.16 (7.2-10.4)] than in controls [5.49 (5-6)] (p< 0.001).
There was no significant difference in DSWI incidence between patients with DM
and controls [5% (n= 9) vs. 2% (n= 4); P= 0.1]. Hospital (p= 0.01) and
intensive care unit stays (p= 0.005) were significantly longer in patients with
DM.

Conclusion: We found that DSWI was not
associated with preoperative HbA1c levels in patients undergoing CABG. In
addition, with adequate glycemic control in the perioperative period, our study
demonstrated no significant difference with regard to DSWI between patients
with DM and controls.

Keywords

Mediastinitis, coronary artery bypass grafting, hemoglobin A1c, diabetes mellitus, deep sternal wound infection

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