Beschreibung:
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<jats:italic>Background—</jats:italic>
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This study sought to determine whether tight glycemic control with a modified glucose-insulin-potassium (GIK) solution in diabetic coronary artery bypass graft (CABG) patients would improve perioperative outcomes.
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<jats:italic>Methods and Results—</jats:italic>
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One hundred forty-one diabetic patients undergoing CABG were prospectively randomized to tight glycemic control (serum glucose, 125 to 200 mg/dL) with GIK or standard therapy (serum glucose <250 mg/dL) using intermittent subcutaneous insulin beginning before anesthesia and continuing for 12 hours after surgery. GIK patients had lower serum glucose levels (138±4 versus 260±6 mg/dL;
<jats:italic>P</jats:italic>
<0.0001), a lower incidence of atrial fibrillation (16.6% versus 42%;
<jats:italic>P</jats:italic>
=0.0017), and a shorter postoperative length of stay (6.5±0.1 versus 9.2±0.3 days;
<jats:italic>P</jats:italic>
=0.003). GIK patients also showed a survival advantage over the initial 2 years after surgery (
<jats:italic>P</jats:italic>
=0.04) and decreased episodes of recurrent ischemia (5% versus 19%;
<jats:italic>P</jats:italic>
=0.01) and developed fewer recurrent wound infections (1% versus 10%,
<jats:italic>P</jats:italic>
=0.03).
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<jats:italic>Conclusions—</jats:italic>
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Tight glycemic control with GIK in diabetic CABG patients improves perioperative outcomes, enhances survival, and decreases the incidence of ischemic events and wound complications.
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