THE ROLE OF SUGAR DIABETES IN THE DEVELOPMENT OF BREAST INSTABILITY IN POSTOPERATIVE STERN MEDEDISTINE IN CARDIAC-SURGICAL PATIENTS

The article presents a three-year clinical observation of 48 patients where the role of diabetes mellitus in the development of mediastinitis and instability of the sternum in cardiosurgical patients who have undergone complete median sternotomy is established. It is concluded that in patients with diabetes, osteopenic syndrome, which leads to the predominance of bone resorption processes over the processes of bone formation. The aim of the research: establish the role of diabetes in the development of mediastinitis and instability of the sternum in cardiac patients who underwent complete median sternotomy. Material and methods: During the period from 2015 to 2017, 1275 patients with various cardiovascular pathologies were operated through the sternotomy access in the cardiac surgical department of the Federal Center for Cardiovascular Surgery in Krasnoyarsk. In 48 (3.7%) of them, the postoperative period was complicated by sternomediastinitis. In 32 (66%) patients, diastasis of only soft tissues was diagnosed, and in 16 (34%) diastasis of soft tissues and ster- num was diagnosed. Among them, women were 38 (80%), men 10 (20%). The age of the patients was as follows: 60-69 years - 30 (62.5%) patients, older than 70 years - 15 (31%) patients. Thus, the majority of patients exceeded the age of 60 years. The results of the study: All patients with unstable sternotomy wound had accompanying diseases. They were distributed as follows: type 2 diabetes mel- litus -12 (25%), chronic obstructive pulmonary disease (COPD) - 8 (16%), dyscirculatory encephalopathy - 18 (37%), obesity + diabetes mellitus - 8 (16%) patients, repeated access - 3 (6%) patients. Thus, 20 (41%) of the 48 patients who developed sternomediastinitis in the postoperative period suffered from diabetes mellitus of varying severity. Conclusion: Strotonediastinitis developed in 3.5% of cardiosurgical patients after complete median sternotomy. 41% of patients with mediastinitis had type 2 diabetes. Thus, against the background of diabetes mellitus develops an osteopenic syndrome, which leads to insufficiency of the sternum. Changes in bone mineral density appear locally in the area of the surgical intervention on the sternum. This is due to the prevalence of bone resorption processes, whereas bone formation remains at the same level. As an additional method of diagnosing diabetic osteopenia in cardiosurgical patients, it is necessary to use the definition of enzymes for bone formation and bone resorption.

Sternomediastinitis, sternum instability, osteopenic syndrome, soft tissue diastase, diabetic osteopenia

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