مقایسه میزان نوسانات قند خون بیماران دیابتیک حین عمل جراحی بای‌پس عروق کرونر دردو روش بیهوشی جنرال و بیهوشی جنرال به همراه اسپاینال

Introduction: The stress response caused by surgery makes sending messages from the site of injury or surgery to the central nervous system and the hypothalamus and pituitary and in turn to the liver and adrenal medulla. In response; release of adrenocorticotropic hormone, growth hormone, vasopressin and the subsequent release of cortisol and insulin release inhibition occurs which leading to increased glucose (hyperglycemic response), intensified lipolysis, the breakdown of proteins and gluconeogenesis in the liver and insulin resistance in the cells will appear. It seems that the use of spinal anesthesia with local anesthetics as a method of inhibiting impulse afferent and efferent waves of central nervous system have an important role in the inhibition of this reaction. Therefore, this study aimed to investigate the effect of general anesthesia along with spinal in diabetic patients during coronary artery bypass surgery (CABG). Materials and Methods: This study was a single-blind randomized clinical trial in patients undergoing coronary artery bypass in 2015-2016. Patients were divided randomly into two groups. The control group (under general anesthesia) and test group (under general and spinal anesthesia). Blood sugar levels and insulin levels were assessed before, during and after surgery. Also the Norepinephrine, Inderal, Thrinitroglycerine and Atropine drugs required in the two groups were compared. Finally data were analyzed via independent T sample test and one way Anova. Results: Blood sugar levels were significantly higher in the intervention group than the control in all three periods before (229.75>152.17), during (178.41>131.20) and after (185.08>143.29) surgery. Also average of Insulin required intervention group (113.58) was more than control group (70.58). An increasing proportion of insulin needed during surgery in the treatment group was lower than control. There were no significant difference in amount of atropine (control: 0.50 intervention: 0.145) and Inderal (control: 0.291 intervention: 0.333) required for groups while differences in Norepinephrine (control: 6. 91 intervention: 0.00) and Thrinitroglycerine (control: 2.00 intervention: 7.08) used in the two groups was significant (P<0.00). Conclusion: Spinal anesthesia along with general can control blood sugar in diabetics and reduce the need for insulin, as well as blood pressure and heart rate in improving the quality of anesthesia, improve the outcome of surgery, pain and quality of life of diabetic patients undergoing coronary artery bypass surgery.