الفهرس 
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Abstract
Outcome of Intraoperative Dynanmic Tight Glycemic Control in Patients Undergoing Coronary Artery Bypass Grafting
Samia I. Sharaf(MD), Nermin S. Nasr(MD), Khaled H. Saad(MD), Eeman A.Bayoumi(Msc).
from the Department of Anesthesiology and intensive care, Faculty of Medicine, Ain Shams university, Cairo Egypt.
Background:Hyperglycemia occurs frequently in the perioperative period in the patients with and without diabetes during coronary artery bypass grafting especially during the use of cardiopulmonary bypass. Several studies have demonstrated that tight intraoperative glycemic control significantly reduces morbidity and motrality in the diabetic and non diabetic cardiac surgical patients while other studies failed to prove any difference. The goal of our study was to assess the effect the use of intraoperative dynamic tight glycemic control regimen compared to a conventional regimen on the morbidity and mortality of coronary artery bypass grafting patients.
Methods:In this prospective randomized controlled non-blinded single center trial, patients were randomly allocated to receive either intraoperative tight glycemic control regimen targeting blood glucose values between 80-100mg/dl or conventional insulin infusion regimen targeting blood glucose value of less than or equal to 180mg/dl. The tight glycemic control regimen was continued postoperatively in the intensive care unit for both groups. The outcome was studied regarding the glycemic control , patient morbidity, and mortality.
Results:One hundred patients were enrolled in this study, 50 patients in each study group. Tight glycemic control did not significantly reduce mortality when compared to conventional control. There was no statistically significant difference regarding achieving glycemic target in both groups but hypoglycemia was significantly higher in tight glycemic control group(P=0.027).There was a decreased incidence of morbidity in the tight glycemic control group regarding the duration of ventilation (P=0.046), duration of intropic support use(P=0.022), the incidence of wound infection(P=0.041), and length of intensive care stay(P=0.05).There was no statistically significant reduction in the duration of inotropic support use, incidence of renal impairment, or need for renal replacement therapy.
Conclusion: The application of dynamic tight glycemic control in coronary artery bypass grafting patients did not reduce patient mortality but reduced patient morbidity.