İzole koroner arter baypas cerrahisi uygulanan hastalarda bretschneıder – histidin triptofan ketoglutarat solüsyonu ve soğuk kan kardiyoplejisinin sistemik endotel fonksiyonları üzerine etkisinin karşılaştırılması
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Dosyalar
Tarih
2018
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Ekstrakorporeal dolaşım (EKD) eşliğinde yapılan koroner baypas cerrahisi sırasında sistemik enflamatuvar bir reaksiyonunun oluşmasına sebep olmakta ve vasküler endotelyal fonksiyonları bozulmaktadır. EKD esnasında miyokardı korumak için kullanılan ve birçok midifikasyonu olan kardiyopleji solüsyonu mevcuttur. Çalışmamızda, Bretschneider-HTK Solüsyonuve soğuk kan kardiyoplejisinin sistemik endotel fonksiyonları üzerine etkilerinin araştırılması, sekonder sonlanım noktası olarak ise perioperatif morbidite ve mortalitenin karşılaştırılması amaçlanmıştır. Materyal Metod: Mart 2018 – Mayıs 2018 tarihleri arasında izole koroner baypascerrahisi yapılan 50hasta grup 1 (Bretschneider – HTK n=25) ve grup 2 (soğuk kan kardiyoplejisi n=25) olmak üzere iki gruba ayrıldı. Her iki gruptada demografik ve anjiografik veriler, kliniközellikler, cerrahi prosedür benzerdi. Preoperatifve postoperatif laboratuvar tetkikleri, intraoperatif ve postoperatif veriler, preoperatifve postoperatif değerlerine bakıldı. Yine peri operatif morbidite, gelişen komplikasyonlar, derlenme sürecine dair tüm veriler her iki grup için de kayıt altına alındı. Endotel disfonksiyonunu tesbit etmek için Akım aracılı dilatasyon ultrasonografik olarak ölçülüp, Endotelin-1, Von Willebrand Faktör, Asimetrik Dimetilarjinin değerleri ölçüldü. Her iki grup karşılaştırıldı. Bulgular: Çalışmamızın en önemli bulgusu postoperatif takiplerde ET-1 seviyesinin doğuk kan kardiyoplejisi grubunda Bretschneider – HTK grubuna göre anlamlı olarak yüksek bulunmasıydı (p<0.001). Akım aracılı dilatasyon (FMD) değeri ise postoperatif 0. Günde ve postoperatif 1. Günde Bretschneider – HTK grubunda yatış seviyesinde göre daha az düşüş gösterdi (p=0, 002, p=0, 030). Bretschneider – HTK grubunda, kalbin fibrile şekilde çalışması anlamlı şekilde daha fazlaydı (p=0, 024). CK-MB değerleri ve CK değerleri, Soğuk kan kardiyoplejisi grubunda postop takiplerinde daha yüksek tesbit edilmiştir (p = 0, 002). Troponin-I seviyesinde ise iki grup arasında anlamlı farklılık gözlenmedi. Hospitalizasyon süresi Bretschneider – HTK grubunda daha düşük idi. (p<0, 05). Andak postoperatif komplikasyonlar değerlendirildiğinde anlamlı fark gözlenmedi. (p>0, 05). Her iki solüsyonun da güvenlik profilinin benzer olduğu görüldü. Diğer parametrelerde anlamlı farklılık gözlenmedi (p>0.05) Tartışma ve Sonuç: Kardiyopulmoner Bypass, endotel fonksiyonlarında bozulmaya neden olmaktadır. Tesbit ettiğimiz bulgular, kardiyopleji solüsyonu olarak Bretschneider – HTK verien hastalarda, soğuk kan kardiyoplejisine göre daha az endotel hasarına sebep olduğu yönündedir. Miyokardiyal hasar göstergelerinin Bretschneider – HTK grubunda anlamlı olarak düşük bulunması, tek doz verilen Bretschneider – HTK kardiyoplejisinin, miyokardı soğuk kan kardiyoplejisine kıyasla daha iyi koruduğunu göstermektedir. Yine hospitalizasyon süresinin düşük olması da Bretschneider – HTK solüsyonu kullanımının hasta derlenmesi üzerine daha etkin olduğunu düşündürmektedir. Ancak postoperatif komplikasyonlar açısından anlamlı farklılık bulunmaması, her iki kardiyoplejinin de güvenle kullanılabileceğini düşündürmektedir. Kardiyopulmoner baypas eşliğinde yapılan koroner baypas cerrahisinde Bretschneider – HTK solüsyonunun kaçınılmaz olan endotelyal hasarını içerdiği histidin, triptofan ve ketoglutarat sayesinde asgari düzeye indirgeyerek, miyokardiyal hasar üzerine olumlu etkileri ile postoperatif sağkalım üzerine daha etkili olduğu kanaatindeyiz.
During the coronary bypass surgery accompanied by extracorporeal circulation (EKD), it causes a systemic inflammatory reaction and impair vascular endothelial functions. Cardioplegia solution with various modifications, which is used to protect the myocardium during the EKD is available. In our study, our aim is to examine the effects of HTK solution and cold blood cardioplegia on systemic endothelial functions and to compare perioperative morbidity and mortality as the secondary endpoint. Material Method: 50 patients who went through isolated coronary bypass surgery between March 2018 – May 2018 were divided into two groups as Group 1 (Bretschneider – HTK n=25) and Group 2 (cold blood cardioplegia n=25). Demographic and angiographic data, clinical features and surgical procedures were similar in both groups. Preoperative and postoperative laboratory examinations, intraoperative and postoperative data, preoperative and postoperative values were investigated. All data related to perioperative morbidity, complications and recovery period were recorded for both groups. In order to identify the endothelial dysfunction, flow-mediated dilatation (FMD) was measured ultrasonographically and Endothelin-1, Von Willebrand Factor, Asymmetrical Dimethylarginine values were also measured. Both groups were compared. Findings: The most significant finding of our study was that the ET-1 levels in postoperative monitoring was significantly higher in cold blood cardioplegia group, compared to the Bretschneider – HTK group (p<0.001). It was found that Flow-mediated dilatation (FMD) value showed a lower decrease in post-operative 0. day and postoperative 1. Day in Bretscneider – HTK group compared to the lying position (p=0.002, p=0.030). Fibrillated functioning of the heart was significantly higher in Bretscneider – HTK group (p=0.024). CK-MB values and CK values were found to be higher in cold blood cardioplegia group during the post-op follow-ups (p = 0.002). No significant difference was observed between the two groups in terms of Troponin-1 level. Hospitalization period was shorter in Bretscneider – HTK group (p<0.05). However, no significant difference was found in the evaluations of postoperative complications (p>0.05). It was seen that both solutions had a similar safety profile. No significant difference was found in other parameters (p>0.05) Discussion And Result: Cardiopulmonary Bypass causes an impairment in endothelial functions. Detected findings indicate that patients in Bretscneider – HTK group had less endothelial damage compared to the cold blood cardioplegia. Significantly lower myocardial damage indicators in Bretscneider – HTK group have demonstrated that a single dose of Bretscneider – HTK cardioplegia protects the myocardia better than the cold blood cardioplegia. Moreover, it has been considered that the use of Bretscneider – HTK solution is more effective for the patient recovery due to the shorter hospitalization period. However, no significant difference found between the groups in terms of postoperative complications also indicate that both cardioplegia could be used safely. Moreover, we believe that Bretscneider – HTK solution minimizes the inevitable endothelial damage during the coronary bypass surgery accompanied by cardiopulmonary bypass, due to its hystidine, tryptophan and ketoglutarate content and that it will be more effective in postoperative survival with its positive effects on myocardial damage.
During the coronary bypass surgery accompanied by extracorporeal circulation (EKD), it causes a systemic inflammatory reaction and impair vascular endothelial functions. Cardioplegia solution with various modifications, which is used to protect the myocardium during the EKD is available. In our study, our aim is to examine the effects of HTK solution and cold blood cardioplegia on systemic endothelial functions and to compare perioperative morbidity and mortality as the secondary endpoint. Material Method: 50 patients who went through isolated coronary bypass surgery between March 2018 – May 2018 were divided into two groups as Group 1 (Bretschneider – HTK n=25) and Group 2 (cold blood cardioplegia n=25). Demographic and angiographic data, clinical features and surgical procedures were similar in both groups. Preoperative and postoperative laboratory examinations, intraoperative and postoperative data, preoperative and postoperative values were investigated. All data related to perioperative morbidity, complications and recovery period were recorded for both groups. In order to identify the endothelial dysfunction, flow-mediated dilatation (FMD) was measured ultrasonographically and Endothelin-1, Von Willebrand Factor, Asymmetrical Dimethylarginine values were also measured. Both groups were compared. Findings: The most significant finding of our study was that the ET-1 levels in postoperative monitoring was significantly higher in cold blood cardioplegia group, compared to the Bretschneider – HTK group (p<0.001). It was found that Flow-mediated dilatation (FMD) value showed a lower decrease in post-operative 0. day and postoperative 1. Day in Bretscneider – HTK group compared to the lying position (p=0.002, p=0.030). Fibrillated functioning of the heart was significantly higher in Bretscneider – HTK group (p=0.024). CK-MB values and CK values were found to be higher in cold blood cardioplegia group during the post-op follow-ups (p = 0.002). No significant difference was observed between the two groups in terms of Troponin-1 level. Hospitalization period was shorter in Bretscneider – HTK group (p<0.05). However, no significant difference was found in the evaluations of postoperative complications (p>0.05). It was seen that both solutions had a similar safety profile. No significant difference was found in other parameters (p>0.05) Discussion And Result: Cardiopulmonary Bypass causes an impairment in endothelial functions. Detected findings indicate that patients in Bretscneider – HTK group had less endothelial damage compared to the cold blood cardioplegia. Significantly lower myocardial damage indicators in Bretscneider – HTK group have demonstrated that a single dose of Bretscneider – HTK cardioplegia protects the myocardia better than the cold blood cardioplegia. Moreover, it has been considered that the use of Bretscneider – HTK solution is more effective for the patient recovery due to the shorter hospitalization period. However, no significant difference found between the groups in terms of postoperative complications also indicate that both cardioplegia could be used safely. Moreover, we believe that Bretscneider – HTK solution minimizes the inevitable endothelial damage during the coronary bypass surgery accompanied by cardiopulmonary bypass, due to its hystidine, tryptophan and ketoglutarate content and that it will be more effective in postoperative survival with its positive effects on myocardial damage.
Açıklama
Anahtar Kelimeler
Ekstrakorporeal dolaşım, Extracorporeal circulation, Endotelyum-vasküler, Endothelium-vascular, Kalp durdurulması, Heart arrest-induced
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Mercan, İ. (2018). İzole koroner arter baypas cerrahisi uygulanan hastalarda bretschneıder – histidin triptofan ketoglutarat solüsyonu ve soğuk kan kardiyoplejisinin sistemik endotel fonksiyonları üzerine etkisinin karşılaştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Göğüs Cerrahisi Anabilim Dalı, Konya.
