Diabetes Mellitusun Koroner Arter Bypass Cerrahisinde Erken Dönem Morbidite ve Mortaliteye Etkisi

Year 2006, Volume: 13 Issue: 1, 16 - 21, 20.04.2009

İlker Kiriş Şenol Gülmen İlker Tekin Hüseyin Okutan

Abstract

SüleymanDemirel Üniversitesi
TIP FAKÜLTESİ DERGİSİ: 2006 Mart; 13(1)




Diabetes Mellitusun Koroner Arter Bypass Cerrahisinde Erken
Dönem Morbidite ve Mortaliteye Etkisi

Ilker Kiriş, Şenol Gülmen, Ilker Tekin, Hüseyin Okutan

Özet

Günümüzde, koroner arter bypass cerrahisi (KABC) uygulanan hastaların % 20-30.u diyabetikdir. Bununla birlikte, diabetes mellitus (DM).un KABC sonrası erken dönem mortalite ve morbiditeye olan etkisi tartışmalıdır. Bu retrospektif çalışmanın amacı, DM.un KABC uygulanan hastalarda erken dönem morbidite ve mortaliteyi anlamlı derecede arttırıp arttırmadığını araştırmaktır. Haziran 2003 ile Eylül 2005 tarihleri arasında kliniğimizde KABC uygulanan toplam 246 hasta çalışmaya alındı. Çalışmaya alınan hastaların ortalama yaşı 59.8 ± 9.75 olup 187.si erkek (% 76) ve 59.u kadın (% 23.9) idi. DM tanısı olan 79 (% 32.1) hasta DM grubunu, diğer 167 (% 67.8) hasta da kontrol grubunu oluşturdu. Gruplar, postoperatif erken dönemde morbidite verileri ve mortalite oranı açısından birbiri ile karşılaştırıldı. Intra aortik balon pompası, akut böbrek yetmezliği, multi organ yetmezliği, serebro vasküler olay, yüzeyel yara yeri enfeksiyonu, sternal dehissens, mediastinit ve mediastinal kanama nedenli reoperasyon oranları açısından gruplar birbiri ile karşılaştırıldığında istatistiksel olarak anlamlı fark bulunmadı (p > 0.05). Mortalite oranları DM grubunda % 3.7, kontrol grubunda ise %4.7 idi ve aradaki fark istatistiksel olarak anlamlı değildi (p > 0.05). Yüzeyel yara yeri enfeksiyonu oranı, insülin kullanan diyabetik hastalarda, hem oral antidiyabetik kullanan diyabetik hastalara hem de kontrol grubuna göre anlamlı derecede daha yüksekti (p = 0.066). Sonuç olarak, bu çalışmada, DM.un KABC uygulanan hastalarda erken dönem morbidite ve mortaliteyi anlamlı derecede arttırmadığını bulduk. KABC, enfeksiyona karşı azami önlemler alınarak, diyabetik olan hastalarda da diyabetik olmayan hastalarda olduğu gibi güvenle uygulanabilir.


Anahtar kelımeler: Diabetes mellitus, koroner arter bypass cerrahisi, morbidite, mortalite


Abstract

Effect of Diabetes Mellitus on Short-Term Morbidity and Mortality in Coronary Artery Bypass Surgery


Currently, 15 % to 30 % of the patients that undergo coronary artery bypass grafting (CABG) are diabetics. However, the effect of diabetes mellitus (DM) on short-term morbidity and mortality after CABG iscontroversial. The aim of this retrospective study was to investigate whether DM increases short-term morbidity and mortality after CABG or not. Two-hundred-fourty-eight patients who underwent CABG operations in our clinic between June 2003 and September 2005 were included in the study. Mean age of the patients was 59.8 ± 9.75 and there were 187 male (% 76) and 59 female (% 23.9). Seventy-nine patients (%32.1) were diabetic (DM group) and 167 patients (% 67.8) were nondiabetic (control group). The groups were compared for morbidity data and mortality rates in the postoperative short-term. When the groups were compared for the incidence of intra aortic balloon pumping, acute renal failure, multi organ failure, cerebro vascular complications, superficial wound infection, sternal dehiscence, mediastinitis and reoperation due to mediastinal bleeding, there were no statisticaly significant difference (p > 0.05). Mortality rates in the DM group and the control group were % 3.7 and %4.7, respectively but there were no statisticaly significant difference (p > 0.05). The incidence of superficial wound infection were significantly higher in the patients with insulin-treated DM than both in the patients with oral antidiabetic-treated DM and in the nondiabetic patients (p = 0.066). In conclusion, in this study we found that DM does not significantly increase short-term morbidity and mortality in the patients who undergo CABG. Provided that strict measures are taken against infections, CABG can be performed in diabetic patients as safely as it is being performed in nondiabetic patients.


Key words: diabetes mellitus, coronary artery bypass surgery, morbidity, mortality

Keywords

Diabetes mellitus, koroner arter bypass cerrahisi, morbidite, mortalite

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