Diabetes and Coronary Surgery Metabolic and clinical studies on diabetic patients after coronary surgery with special reference to cardiac metabolism and high-dose GIK
نویسنده
چکیده
.......................................................................................................................................................... 3 LIST OF PAPERS................................................................................................................................................. 4 TABLE OF CONTENT ........................................................................................................................................ 5 ABBREVIATIONS................................................................................................................................................ 6 INTRODUCTION ................................................................................................................................................. 7 AIMS OF THE STUDY ...................................................................................................................................... 10 MATERIAL AND METHODS .......................................................................................................................... 11 Patients ............................................................................................................................................................ 11 Clinical management..................................................................................................................................... 13 High-dose GIK............................................................................................................................................... 14 Study protocol ................................................................................................................................................ 14 Methods........................................................................................................................................................... 17 CALCULATIONS AND DEFINITIONS .......................................................................................................... 20 ETHICAL ASPECTS.......................................................................................................................................... 20 RESULTS............................................................................................................................................................. 21 Metabolism of the diabetic heart after coronary surgery (paper I) ......................................................... 21 Effects of high-dose GIK on arterial levels and myocardial uptake of substrates (paper II) .............. 23 Effects of high-dose GIK on systemic glucose uptake (papers II, IV)................................................... 27 Hemodynamic effects of high-dose GIK in diabetics after elective CABG (paper II) ........................ 28 Hemodynamic recovery in patients treated with high-dose GIK because of postoperative heart failure (paper IV) ........................................................................................................................................... 29 Clinical safety issues associated with high-dose GIK (papers III, IV)................................................... 30 Neurological injury after surgery for ischemic heart disease: risk factors (paper III) ......................... 34 Diabetes and neurological outcome after cardiac surgery (papers III, V) ............................................ 35 Early postoperative outcome and long-term survival in diabetics and non-diabetics after isolated CABG (paper V) ............................................................................................................................................ 36 GENERAL DISCUSSION.................................................................................................................................. 40 The metabolic state of the heart in type II diabetics patients after elective coronary surgery............ 40 High-dose GIK can modulate cardiac metabolism in type II diabetic patients after CABG .............. 43 Systemic glucose uptake induced by high-dose GIK ............................................................................... 44 Beneficial hemodynamic impact of high-dose GIK ................................................................................. 45 High-dose GIK can be safely used in clinical practice............................................................................. 45 Neurological injury after surgery for ischemic heart disease – risk factors and role of diabetes....... 47 Acceptable short-term mortality but increased postoperative morbidity and poorer longterm survival in diabetic patients after CABG.................................................................................................... 49 Concluding remarks....................................................................................................................................... 51 SUMMARY.......................................................................................................................................................... 54 REFERENCES .................................................................................................................................................... 57
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