Kardiyak Cerrahide İzole Koroner Arter Baypass Uygulanan Hastalarda, Kan Kardiyoplejisi Ve Del Nido Kardiyoplejinin Postoperatif Yoğun Bakımda Kalma Süresi, Drenaj Ve Renal Fonksiyonlar Üzerindeki Karşılaştırmalı Etkilerinin Retrospektif Olarak Değerlendirilmesi
Yükleniyor...
Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Kalp cerrahisinde yapılan kalp ameliyatlarının etkin ve başarılı uygulanması için akciğerler ile kalbin
ameliyat esnasında işlevselliklerinin belli bir zaman süresince durdurulması ve diğer yandan dokulardaki
perfüzyonun ve fizyolojik dolaşımın bazal derecede sağlanması hayati önem taşımaktadır.Kalbin diastolde
durmasını sağlayan ve miyokardiyal korumayı sağlayan farklı içerikte kardiyopleji solüsyonları
kullanılmaktadır.Bu çalışmamızda Kan Kardiyolejisi ile Del Nido Kardiyoplejinin postoperatif yoğun
bakımda kalma süresi, drenaj ve renal fonksiyonlar üzerindeki etkilerini karşılaştırmayı amaçladık.
Yöntem: Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Hastanesi Kalp ve Damar Cerrahisi
Kliniğinde 01.01.2022-01.01.2023 tarihleri arasında izole koroner arter baypass operasyonu yapılan hastalar
retrospektiff olarak araştırıldı. Bu tarihler arasındaki hastalardan, 18 yaşından küçük olanlar, acil vakalar, reoperasyon
(redo) hastalar, eşlik eden kardiyak cerrahisi olan hastalar, gebe ve emziren hastalar, kanser olan
hastalar, akut ve/veya kronik böbrek yetmezliği olan hastalar, kanama diskrazisi olan hastalar, EF<30 olan
hastalar, Del Nido ve Kan kardiyoplejisi dışında kardiyoplejı kullanılan hastalar, aortik kross klemp
eşliğinde aortaya proksimal anastomozu yapılanlar ve üç koroner anastomozdan farklı sayıda anastomoz
yapılan hastalar çalışma dışı bırakılarak diğer kalan hastalardan randomize 120 hasta retrospektif olarak
incelendi. Uygulanan kardiyopleji çeşidine göre hastalar eşit iki gruba ayrıldı(Kan kardiyoplejisi,Del Nido
kardiyopleji). Hastaların demografik özellikleri, preop ilk 24 saat içinde üre, kreatinin, GFR değerleri ve
aortik kross klemp süreleri, toplam baypass süreleri, postop ilk 24 saat ve ikinci 24 saatlik üre,
kreatinin,GFR, idrar miktarları ve drenaj seviyeleri alındı ve AKIN sınıflamasına göre evrelendirildi.
Bulgular: Çalışmaya 60 DNK uygulanan, 60 KK uygulanan toplam 120 hasta dahil edilmiştir. Hastaların
94’ü (%78,3) erkek, 58’inde (%48,3) DM mevcut, 51’inde (%42,5) HT mevcut olarak tespit edildi.
Hastaların 60’ına (%50) 1 defa, 15’ine (%12,5) 2 defa, 39’una (%32,5) 3 defa, 6’sına (%5,0) 4 defa
kardiyopleji verildi. AKİN sınıflamasına göre hastaların 11’inde (%9,2) akut böbrek yetmezliği gelişti.
Böbrek yetmezliği gelişen hastaların 8’inin (%72,7) evre 1, 3’ünün (%27,3) evre 2 böbrek yetmezliği olduğu
belirlendi. DNK yapılan hastaların aortik oklüzyon süresi ortalaması (56,17±12,03 dk), KK yapılan hastaların
aortik oklüzyon süresi ortalamasından (50,77±11,70 dk) istatistiksel olarak anlamlı düzeyde yüksek bulundu
(p=0,014). DNK yapılan hastalarda kullanılan ortalama noradrenalin dozu (0,10±0,08), KK yapılan
hastalarda kullanılan ortalama noradrenalin dozundan (0,06±0,05) istatistiksel olarak anlamlı düzeyde yüksek
bulundu (p=0,004). DNK yapılan hastalarla KK yapılan hastaların total pompa süresi, YBÜ de kalış süresi,
hastanede toplam kalış süresi, postop drenaj miktarları, postop idrar miktarları, vücut yüzey alanına göre
postop idrar miktarları ve postop eritrosit replasman sayıları karşılaştırıldığında istatistiksel olarak anlamlı bir
fark tespit edilmedi (p>0,05) Otolog kan alınmayan hastalardan DNK uygulanan hastaların yoğun bakımda
kalış süresi ortalaması (61,04±28,94) KK uygulanan hastaların yoğun bakımda kalış süresi ortalamasından
(34,86±22,28) istatistiksel olarak anlamlı düzeyde yüksekti (p=0,006). Kardiyopleji yöntemine göre yapılan
karşılaştırmalarda uygulanan kardiyopleji yöntemiyle, postop üre, postop kreatinin, postop GFR, YBÜ’de
kalış süresi, hastanede kalış süresi ve postop drenaj miktarları arasında istatistiksel olarak anlamlı düzeyde
farklılık saptanmadı (p>0,05).
Sonuç: DNK uygulanan hastalarda KK uygulanan hastalara oranla daha uzun Aortik Kross Klemp süresi,
daha fazla sayıda ABY ve daha yüksek dozda inotrop desteğine ihtiyaç olduğu tespit edildi. Kısıtlayıcı
faktörler minimize edilerek daha geniş çaplı meta analizlerin yapılması kardiyoplejinin tercih edilmesinde
önemli katkı sağlayacaktır.
Purpose: For the effective and successful implementation of cardiac surgeries, it is vital to temporarily halt the functionality of both the lungs and the heart during the surgical procedure for a specific duration while simultaneously maintaining tissue perfusion and physiological circulation at a basal level. Different cardioplegia solutions with varying compositions are utilized to induce diastolic arrest of the heart and ensure myocardial protection. In our study, we aimed to compare the effects of Blood Cardioplegia and Del Nido Cardioplegia on postoperative intensive care unit stay, drainage, and renal functions. Method: Patients who underwent isolated coronary artery bypass grafting surgery at the Department of Cardiovascular Surgery, Necmettin Erbakan University Meram Faculty of Medicine Hospital, between January 1, 2022, and January 1, 2023, were retrospectively investigated. Patients who were younger than 18 years old, emergency cases, redo patients, patients with concomitant cardiac surgery, pregnant and lactating patients, patients with cancer, patients with acute and/or chronic renal failure, patients with bleeding dyscrasia, patients with EF <30, patients who received cardioplegia other than Del Nido and Blood cardioplegia, patients who underwent proximal anastomosis to the aorta with aortic cross-clamp, and patients who underwent a different number of anastomoses than three coronary anastomoses were excluded from the study. A total of 120 patients were retrospectively analyzed from the remaining patients after randomization. Patients were divided into two equal groups based on the type of cardioplegia administered (Blood cardioplegia and Del Nido cardioplegia). The demographic characteristics of the patients, preoperative urea, creatinine, GFR values within the first 24 hours, aortic cross-clamp times, total bypass times, postoperative urea, creatinine, GFR, urine output, and drainage levels within the first 24 hours and second 24 hours were collected and staged according to the AKIN classification. Findings: The study included a total of 120 patients, with 60 patients receiving Del Nido Cardioplegia and 60 patients receiving Blood Cardioplegia. Of the patients, 94 (78.3%) were male, 58 (48.3%) had DM, and 51 (42.5%) had HT. Out of the patients, 60 (50%) received cardioplegia once, 15 (12.5%) received it twice, 39 (32.5%) received it three times, and 6 (5.0%) received it four times. According to the AKIN classification, acute kidney injury developed in 11 patients (9.2%). Of the patients who developed kidney failure, 8 (72.7%) were classified as stage 1, and 3 (27.3%) were classified as stage 2 kidney failure. The mean aortic occlusion time in patients who received Del Nido cardioplegia (56.17+/-12.03 minutes) was found to be statistically significantly higher than the mean aortic occlusion time in patients who received Blood cardioplegia (50.77+/-11.70 minutes) (p=0.014). The mean noradrenaline dose used in patients who received Del Nido cardioplegia (0.10 +/- 0.08) was found to be statistically significantly higher than the mean noradrenaline dose used in patients who received Blood cardioplegia (0.06 +/- 0.05) (p=0.004). Statistically significant differences were not observed when comparing the total pump time, ICU stay duration, total hospital stay duration, postoperative drainage amounts, postoperative urine volumes, postoperative urine volumes adjusted to body surface area, and postoperative erythrocyte replacement counts between patients who received Del Nido cardioplegia and those who received Blood cardioplegia (p > 0.05). The mean intensive care unit (ICU) stay duration in patients who did not undergo autologous blood collection and received Del Nido cardioplegia (61.04 +/- 28.94) was statistically significantly higher than the mean ICU stay duration in patients received Blood cardioplegia (34.86 +/- 22.28) (p=0.006). In the comparisons made according to the cardioplegia method, no statistically significant differences were found between the applied cardioplegia method and postoperative urea, postoperative creatinine, postoperative GFR, ICU stay duration, hospital stay duration, and postoperative drainage amounts (p>0.05). Result: It was observed that patients who received Del Nido cardioplegia required longer aortic cross-clamp time, a greater number of coronary artery bypass grafts, and a higher dose of inotropic support compared to patients who received Blood cardioplegia. Minimizing limiting factors will contribute significantly to conducting more comprehensive meta-analyses, which will be crucial in informing the preference for cardioplegia methods.
Purpose: For the effective and successful implementation of cardiac surgeries, it is vital to temporarily halt the functionality of both the lungs and the heart during the surgical procedure for a specific duration while simultaneously maintaining tissue perfusion and physiological circulation at a basal level. Different cardioplegia solutions with varying compositions are utilized to induce diastolic arrest of the heart and ensure myocardial protection. In our study, we aimed to compare the effects of Blood Cardioplegia and Del Nido Cardioplegia on postoperative intensive care unit stay, drainage, and renal functions. Method: Patients who underwent isolated coronary artery bypass grafting surgery at the Department of Cardiovascular Surgery, Necmettin Erbakan University Meram Faculty of Medicine Hospital, between January 1, 2022, and January 1, 2023, were retrospectively investigated. Patients who were younger than 18 years old, emergency cases, redo patients, patients with concomitant cardiac surgery, pregnant and lactating patients, patients with cancer, patients with acute and/or chronic renal failure, patients with bleeding dyscrasia, patients with EF <30, patients who received cardioplegia other than Del Nido and Blood cardioplegia, patients who underwent proximal anastomosis to the aorta with aortic cross-clamp, and patients who underwent a different number of anastomoses than three coronary anastomoses were excluded from the study. A total of 120 patients were retrospectively analyzed from the remaining patients after randomization. Patients were divided into two equal groups based on the type of cardioplegia administered (Blood cardioplegia and Del Nido cardioplegia). The demographic characteristics of the patients, preoperative urea, creatinine, GFR values within the first 24 hours, aortic cross-clamp times, total bypass times, postoperative urea, creatinine, GFR, urine output, and drainage levels within the first 24 hours and second 24 hours were collected and staged according to the AKIN classification. Findings: The study included a total of 120 patients, with 60 patients receiving Del Nido Cardioplegia and 60 patients receiving Blood Cardioplegia. Of the patients, 94 (78.3%) were male, 58 (48.3%) had DM, and 51 (42.5%) had HT. Out of the patients, 60 (50%) received cardioplegia once, 15 (12.5%) received it twice, 39 (32.5%) received it three times, and 6 (5.0%) received it four times. According to the AKIN classification, acute kidney injury developed in 11 patients (9.2%). Of the patients who developed kidney failure, 8 (72.7%) were classified as stage 1, and 3 (27.3%) were classified as stage 2 kidney failure. The mean aortic occlusion time in patients who received Del Nido cardioplegia (56.17+/-12.03 minutes) was found to be statistically significantly higher than the mean aortic occlusion time in patients who received Blood cardioplegia (50.77+/-11.70 minutes) (p=0.014). The mean noradrenaline dose used in patients who received Del Nido cardioplegia (0.10 +/- 0.08) was found to be statistically significantly higher than the mean noradrenaline dose used in patients who received Blood cardioplegia (0.06 +/- 0.05) (p=0.004). Statistically significant differences were not observed when comparing the total pump time, ICU stay duration, total hospital stay duration, postoperative drainage amounts, postoperative urine volumes, postoperative urine volumes adjusted to body surface area, and postoperative erythrocyte replacement counts between patients who received Del Nido cardioplegia and those who received Blood cardioplegia (p > 0.05). The mean intensive care unit (ICU) stay duration in patients who did not undergo autologous blood collection and received Del Nido cardioplegia (61.04 +/- 28.94) was statistically significantly higher than the mean ICU stay duration in patients received Blood cardioplegia (34.86 +/- 22.28) (p=0.006). In the comparisons made according to the cardioplegia method, no statistically significant differences were found between the applied cardioplegia method and postoperative urea, postoperative creatinine, postoperative GFR, ICU stay duration, hospital stay duration, and postoperative drainage amounts (p>0.05). Result: It was observed that patients who received Del Nido cardioplegia required longer aortic cross-clamp time, a greater number of coronary artery bypass grafts, and a higher dose of inotropic support compared to patients who received Blood cardioplegia. Minimizing limiting factors will contribute significantly to conducting more comprehensive meta-analyses, which will be crucial in informing the preference for cardioplegia methods.
Açıklama
Anahtar Kelimeler
Del Nido, Kan Kardiyopleji, Renal Fonksiyonlar, Yoğun Bakım, Drenaj, Koroner Arter Baypas Greft, Del Nido and Blood Cardioplegia, Renal Functions, Intensive Care Unit, Drainage, Coronary Artery Bypass Graft
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Sarıgöl, Y. (2024). Kardiyak Cerrahide İzole Koroner Arter Baypass Uygulanan Hastalarda, Kan Kardiyoplejisi Ve Del Nido Kardiyoplejinin Postoperatif Yoğun Bakımda Kalma Süresi, Drenaj Ve Renal Fonksiyonlar Üzerindeki Karşılaştırmalı Etkilerinin Retrospektif Olarak Değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Kalp ve Damar Cerrahisi Anabilim Dalı, Konya.
