Kardiyak cerrahi yapılan hastalarda arteriyel stiffness değerinin hemodinamik parametrelerle ilişkisi
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Tarih
2023
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Necmettin Erbakan Üniversitesi, Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Özet
Amaç: Genel anestezi indüksiyonu ile cerrahi başlangıcı arasındaki sürede daha çok görülen hipotansiyon hem kardiyak hem de kardiyak dışı cerrahi yapılan hastalarda olumsuz sonuçlarla ilişkilidir. Çalışmamızın amacı doppler ultrasonografi (USG) ile karotis/femoral nabız dalga hızı ölçümlerinden elde edilen arteriyel stiffness (sertlik) değerinin kardiyak cerrahi yapılan hastalarda başlıca hipotansiyon olmak üzere hemodinamik parametreler, hastanede ve yoğun bakım ünitesinde kalış zamanı ve mortalite ile ilişkilerinin incelenmesidir.
Yöntem: Çalışmaya kardiyak cerrahi yapılacak 121 hasta dahil edildi. Hastalara rutin monitörizasyona ek olarak USG’nin 3 lead elektrokardiyogram (EKG) kabloları da bağlandı. Ölçüm öncesi tüm hastalara sedasyon uygulandı. Supin pozisyonda sağ ana karotis arter ve femoral arterden doppler akım ölçümleri ile karotis/femoral nabız dalga hızı elde edildi. USG M modu ile sağ ana karotis arter ve internal juguler ven (İJV) maksimum ve minimum çap ölçümleri yapıldı. Parametreler arteriyel sertlik, sertlik indeksi, İJV kollapsibilite indeksi ve İJV/karotis indeksi olarak belirlendi. Nabız dalga hızı ölçümleri için hem ana karotis arter hem de femoral arterde doppler dalgasının başlangıç noktası ile EKG’de R dalgası arasındaki gecikme süresi belirlendi. Daha sonra görüntülemenin yapıldığı ana karotis arter ve femoral arter arası mesafe ölçüldü. İki nokta arasındaki mesafe gecikme süresi ile oranlandı. Üç ardışık dalga üzerinde ölçümler yapılarak ortalaması alındı. Elde edilen sonuçlar nabız dalga hızı metre/saniye olarak nitelendirildi. Bu değer arteriyel sertlik derecesi olarak kabul edildi. USG M mod ile ana karotis arter ve internal juguler ven maksimum ve minimum çaplarından sertlik indeksi, İJV kollapsibilite indeksi ve İJV/karotis indeksi hesaplandı. Tüm hastalara standart anestezi indüksiyonu sağlandı. Hipotansiyonu tanımlamak için çeşitli sistolik arter basıncı ve ortalama arter basıncının mutlak ve bazal eşik değerlerinde azalma kullanıldı. Operasyon boyunca hemodinamik yanıt analizleri vazoaktif inotropik skor (VİS) ile yapıldı. Postoperatif hastanede, yoğun bakım ünitesinde kalış süreleri ve mortalite oranları da kaydedildi. Bulgular: Arteriyel sertlik ile yaş ve minimum karotis çapı arasında ve sertlik indeksi ile bazal sistolik arter basıncı ve minimum karotis çapı arasında zayıf korelasyon görülmüştür (p˂0,05). Arteriyel sertlik, sertlik indeksi ve İJV/karotis indeksi parametrelerinin mortalite üzerindeki etki düzeyleri incelenmiş ve anlamlı bir etki profili veya anlamlı bir prediktif özellik tespit edilmemiştir (p>0,05). Arteriyel sertlik değerinin hipotansiyon üzerindeki etki düzeyleri ve hipotansiyona yönelik prediktif kabiliyetleri analiz edilmiş, parametrelerin her biri için ayrı ayrı olarak lojistik regresyon analizi gerçekleştirilmiştir. Hipotansiyon için belirlenmiş sınırlar baz alınarak yapılan incelemelerde parametrelerde anlamlı bir etki düzeyi ve/veya prediktif özellik görülmemiştir (p>0,05). Eksitus olan hastalarda toplam vazoaktif inotropik skor (p=0,012) ve yoğun bakım ünitesinde kalış süreleri (p=0,019) daha yüksek olarak görülmüş ve anlamlılık teşkil etmiştir.
Sonuç: Kardiyak cerrahi hastalarında yapılan bu çalışmada USG ile değerlendirilen arteriyel sertlik, sertlik indeksi, İJV/karotis indeksi ve İJV kollapsibilite indeksi ile hipotansiyon, yoğun bakım ünitesinde ve hastanede kalış süreleri ve mortalite arasında anlamlı bir ilişki bulunamamıştır. Arteriyel sertlik ölçümünde USG kullanımı ve arteriyel sertlik değerinin hemodinamik bir indeks göstergesi olarak kullanılabilmesi için daha geniş kapsamlı, prospektif, randomize kontrollü çalışmalara ihtiyaç vardır.
Purpose: Hypotension, which is more common in the period between the induction of general anesthesia and the beginning of surgery, is associated with negative outcomes in both cardiac and non-cardiac surgery patients. The aim of our study is to examine the relationship of the arterial stiffness value obtained from Doppler ultrasonography (USG) and carotid/femoral pulse wave velocity measurements with hemodynamic parameters, mainly hypotension, time of stay in the hospital and intensive care unit, and mortality in patients undergoing cardiac surgery. Method: 121 patients who would undergo cardiac surgery were included in the study. In addition to routine monitoring, 3-lead electrocardiogram (ECG) cables of USG were connected to the patients. All patients were sedated before the measurement. Carotid/femoral pulse wave velocity was obtained by Doppler flow measurements from the right common carotid artery and femoral artery in the supine position. Maximum and minimum diameter measurements of the right common carotid artery and internal jugular vein (IJV) were made with USG M mode. Parameters were determined as arterial stiffness, stiffness index, IJV collapsibility index and IJV/carotid index. For pulse wave velocity measurements, the delay time between the starting point of the Doppler wave in both the common carotid artery and femoral artery and the R wave in the ECG was determined. Then, the distance between the common carotid artery and the femoral artery where the imaging was performed was measured. The distance between two points was proportional to the delay time. Measurements were made on three consecutive waves and averaged. The results obtained were described as pulse wave velocity (PWV) meters per second (m/s). This value was accepted as the degree of arterial stiffness. Stiffness index, IJV collapsibility index and IJV/carotid index were calculated from the maximum and minimum diameters of the common carotid artery and internal jugular vein with USG M mode. Standard anesthesia induction was provided to all patients. Various reductions in absolute and basal threshold values of systolic arterial pressure and mean arterial pressure were used to define hypotension. During the operation, hemodynamic response analyzes were performed using the vasoactive inotropic score. Postoperative hospital stay, intensive care unit stay and mortality rates were also recorded. Results: A weak correlation was observed between arterial stiffness and age and minimum carotid diameter, and between stiffness index and basal systolic arterial pressure and minimum carotid diameter (p˂0,05). The effect levels of arterial stiffness, stiffness index and IJV/carotid index parameters on mortality were examined and no significant effect profile or significant predictive feature was detected (p>0,05). The effect levels of arterial stiffness value on hypotension and their predictive ability for hypotension were analyzed, and logistic regression analysis was performed separately for each of the parameters. In the examinations based on the limits determined for hypotension, no significant effect level and/or predictive feature was observed in the parameters (p>0,05). Total vasoactive inotropic score (p=0,012) and length of stay in the intensive care unit (p=0,019) were seen to be higher in patients who died and were significant. Conclusion: In this study conducted on cardiac surgery patients, no significant relationship was found between arterial stiffness, stiffness index, IJV/carotid index and IJV collapsibility index evaluated by USG and hypotension, length of stay in the intensive care unit and hospital, and mortality. More comprehensive, prospective, randomized controlled studies are needed to use USG in arterial stiffness measurement and to use arterial stiffness value as a hemodynamic index indicator.
Purpose: Hypotension, which is more common in the period between the induction of general anesthesia and the beginning of surgery, is associated with negative outcomes in both cardiac and non-cardiac surgery patients. The aim of our study is to examine the relationship of the arterial stiffness value obtained from Doppler ultrasonography (USG) and carotid/femoral pulse wave velocity measurements with hemodynamic parameters, mainly hypotension, time of stay in the hospital and intensive care unit, and mortality in patients undergoing cardiac surgery. Method: 121 patients who would undergo cardiac surgery were included in the study. In addition to routine monitoring, 3-lead electrocardiogram (ECG) cables of USG were connected to the patients. All patients were sedated before the measurement. Carotid/femoral pulse wave velocity was obtained by Doppler flow measurements from the right common carotid artery and femoral artery in the supine position. Maximum and minimum diameter measurements of the right common carotid artery and internal jugular vein (IJV) were made with USG M mode. Parameters were determined as arterial stiffness, stiffness index, IJV collapsibility index and IJV/carotid index. For pulse wave velocity measurements, the delay time between the starting point of the Doppler wave in both the common carotid artery and femoral artery and the R wave in the ECG was determined. Then, the distance between the common carotid artery and the femoral artery where the imaging was performed was measured. The distance between two points was proportional to the delay time. Measurements were made on three consecutive waves and averaged. The results obtained were described as pulse wave velocity (PWV) meters per second (m/s). This value was accepted as the degree of arterial stiffness. Stiffness index, IJV collapsibility index and IJV/carotid index were calculated from the maximum and minimum diameters of the common carotid artery and internal jugular vein with USG M mode. Standard anesthesia induction was provided to all patients. Various reductions in absolute and basal threshold values of systolic arterial pressure and mean arterial pressure were used to define hypotension. During the operation, hemodynamic response analyzes were performed using the vasoactive inotropic score. Postoperative hospital stay, intensive care unit stay and mortality rates were also recorded. Results: A weak correlation was observed between arterial stiffness and age and minimum carotid diameter, and between stiffness index and basal systolic arterial pressure and minimum carotid diameter (p˂0,05). The effect levels of arterial stiffness, stiffness index and IJV/carotid index parameters on mortality were examined and no significant effect profile or significant predictive feature was detected (p>0,05). The effect levels of arterial stiffness value on hypotension and their predictive ability for hypotension were analyzed, and logistic regression analysis was performed separately for each of the parameters. In the examinations based on the limits determined for hypotension, no significant effect level and/or predictive feature was observed in the parameters (p>0,05). Total vasoactive inotropic score (p=0,012) and length of stay in the intensive care unit (p=0,019) were seen to be higher in patients who died and were significant. Conclusion: In this study conducted on cardiac surgery patients, no significant relationship was found between arterial stiffness, stiffness index, IJV/carotid index and IJV collapsibility index evaluated by USG and hypotension, length of stay in the intensive care unit and hospital, and mortality. More comprehensive, prospective, randomized controlled studies are needed to use USG in arterial stiffness measurement and to use arterial stiffness value as a hemodynamic index indicator.
Açıklama
Anahtar Kelimeler
Arteriyel sertlik, doppler ultrasonografi, hemodinami, kardiyak cerrahi, nabız dalga hızı, sertlik indeksi, Arterial stiffness, cardiac surgery, doppler ultrasonography, hemodynamics, pulse wave velocity, stiffness index
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Künye
Aydemir, M. (2023). Kardiyak cerrahi yapılan hastalarda arteriyel stiffness değerinin hemodinamik parametrelerle ilişkisi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Anesteziyoloji ve Reanimasyon Anabilim Dalı, Konya.
