Koroner arter bypass operasyonunda aortik vent ve pulmoner vent kullanılmasının akciğer hasarlanması üzerine etkileri
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2012
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Maltepe Üniversitesi, Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Özet
Kardiyopulmoner bypass sonrasında olusan inflamatuar yanıt sonucundagelisebilecek akciğer hasarı, postoperatif morbidite ve mortalitenin artmasındaönemli rol oynamaktadır. Koroner arter bypass cerrahisi sırasında ventriküle dolankan, ventrikül duvar gerilimine neden olarak ciddi ventrikül disfonksiyonu ilesonuçlanır ve pulmoner venöz basınç artarak pulmoner hasar ve ödeme sebep olur.Bu hasarlanma ameliyat sırasında kardiyak vent kullanılarak önlenebilir. Buçalısmada koroner arter bypass ameliyatında kullanılan aortik vent ve pulmonerarteriyel vent sistemleri arasında pulmoner hasarlanma yönünden fark olup olmadığıincelendi.Çalısmaya Grup A (n = 11) aortik vent ve Grup B (n = 11) pulmoner arteriyelvent kullanılan toplamda 22 hasta alındı. ?ki grubun arteriyel kan gazları, plazmadeğerleri ve demografik özellikleri karsılastırıldı. Örneklemeler kalp akciğer pompamakinesine girmeden önce (T1), pompada kros klemp alındıktan sonra ilk 3 dakikaiçinde (T2), protamin verildikten sonra ilk 10 dakika içinde (T3) yapıldı. Alınan kanörneklerinden plazma C-reaktif protein (CRP), alfa-1 antitripsin (A1A), interlökin-6(IL-6), glukoz ve kan gazı ölçümlerinden PO2, PCO2, laktat değerleri karsılastırıldı.Peroperatif verilerden Grup B'nin pompa dengesi Grup A'dan düsük bulundu(p = 0,037). Grup A'nın laktat ortalamaları T1PV, T2PV ve T3PV'den, T2PV'deT3PV'den anlamlı derecede düsük bulundu (p = 0,0001),(p = 0,02). Grup B`ninT2PV IL-6 ortalaması Grup A'dan düsük bulundu (p = 0,021). Grup A'nın T2PV IL-6 ortalaması T3PV'den düsük bulundu (p = 0,021). Grup B'nin postoperatifkullanılan TDP oranları Grup A'dan yüksek bulundu (p = 0,019). Çalısmamızdatespit edilen IL-6, A1A ve laktat düzeyleri istatistiki sonuçlarına dayanarak akciğerkorunmasında pulmoner ventin aortik vente göre daha faydalı olduğunu belirtebiliriz.
Lung injury as a result of the inflammatory response plays an important roleon the postoperative morbidity and mortality after cardiopulmonary bypass.Ventricle filled with blood during coronary artery bypass surgery results severeventricular dysfunction due to the ventricular wall tension, and increased pulmonaryvenous pressure leads to the pulmonary damage, and edema. Cardiac vent usageduring surgery can prevent the damage. In this study we analyzed the differencesbetween the pulmonary artery and aortic root venting on pulmonary functionsfollowing coronary artery bypass graft (CABG) surgery.There were total of 22 patients, aortic vent was used in Group A (n = 11) andpulmonary arterial vent in Group B (n = 11). Arterial blood gases, plasma values, anddemographic characteristics of the two groups were compared. Samples werecollected before cardiopulmonary bypass (T1), 3 minutes after cross clamp (T2), andwithin the first 10 minutes after protamine administration (T3). Plasma C-reactiveprotein (CRP), alpha-1 antitrypsin (A1A), interleukin-6 (IL-6), glucose and fromarterial blood gas PO2, PCO2, lactate values were compared from the blood samples.The mean perioperative data of the pump balance was lower in Group Acompared to Group B (p = 0.037). The mean lactate levels of T1PV weresignificantly lower than T2PV and T3PV and T2PV lower than T3PV in Group A (p= 0.0001), (p = 0.02). The mean IL-6 levels of T2PV of Group B was significantlylower than T2PV of Group A (p = 0.021). The mean IL-6 levels of T2PV wassignificantly lower than the T3PV in Group A (p = 0.021). Postoperatively used freshfrozen plasma ratios were higher in Group B compared to Group A (p = 0.019). Inthis study we can mentioned that the pulmonary vent is more useful than aortic ventregarding the pulmonary lung preservation according to the results of the statisticallevels of IL-6, A1A and lactate.
Lung injury as a result of the inflammatory response plays an important roleon the postoperative morbidity and mortality after cardiopulmonary bypass.Ventricle filled with blood during coronary artery bypass surgery results severeventricular dysfunction due to the ventricular wall tension, and increased pulmonaryvenous pressure leads to the pulmonary damage, and edema. Cardiac vent usageduring surgery can prevent the damage. In this study we analyzed the differencesbetween the pulmonary artery and aortic root venting on pulmonary functionsfollowing coronary artery bypass graft (CABG) surgery.There were total of 22 patients, aortic vent was used in Group A (n = 11) andpulmonary arterial vent in Group B (n = 11). Arterial blood gases, plasma values, anddemographic characteristics of the two groups were compared. Samples werecollected before cardiopulmonary bypass (T1), 3 minutes after cross clamp (T2), andwithin the first 10 minutes after protamine administration (T3). Plasma C-reactiveprotein (CRP), alpha-1 antitrypsin (A1A), interleukin-6 (IL-6), glucose and fromarterial blood gas PO2, PCO2, lactate values were compared from the blood samples.The mean perioperative data of the pump balance was lower in Group Acompared to Group B (p = 0.037). The mean lactate levels of T1PV weresignificantly lower than T2PV and T3PV and T2PV lower than T3PV in Group A (p= 0.0001), (p = 0.02). The mean IL-6 levels of T2PV of Group B was significantlylower than T2PV of Group A (p = 0.021). The mean IL-6 levels of T2PV wassignificantly lower than the T3PV in Group A (p = 0.021). Postoperatively used freshfrozen plasma ratios were higher in Group B compared to Group A (p = 0.019). Inthis study we can mentioned that the pulmonary vent is more useful than aortic ventregarding the pulmonary lung preservation according to the results of the statisticallevels of IL-6, A1A and lactate.
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Erden, B. (2012). Koroner arter bypass operasyonunda aortik vent ve pulmoner vent kullanılmasının akciğer hasarlanması üzerine etkileri / The effect of aortic vent and pulmonary vent on lung injury during coronary artery bypass surgery (Yayımlanmamış Uzmanlık Tezi). Maltepe Üniversitesi, Tıp Fakültesi, İstanbul.
