Akut normovolemik hemodilüsyonun koroner arter bypass cerrahisinde etkileri
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Dosyalar
Tarih
2005
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Türk Göğüs Kalp Damar Cerrahisi Dergisi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Öz: Amaç: Bu çalışmada akut normovolemik hemodilüsyonun koroner arter bypass cerrahisi geçirecek olgularda, hemodinami, doku oksijenizasyonu, allojenik kan transfüzyonu ihtiyacı ve operasyon sonrası yirmi dört saatteki mediastinal drenaj miktarına etkileri karşılaştırıldı. Materyal ve Metod: Otuzüç olgu çift kör randomize olarak iki gruba ayrıldı. Hemodilüsyon grubundaki (G1, n = 16) olgulardan, anestezi indüksiyonunu takiben hemotokrit < %35 oluncaya kadar bir veya iki ünite kan alındı. Aynı anda periferik venden kolloid infüzyonu ile volüm replasmanı sağlandı. Kontrol grubuna (G2, n = 17) ek işlem yapılmadı. Hemodinamik, oksijenizasyon ve hematolojik parametreler indüksiyon öncesi, pulmoner arter kateteri takıldıktan sonra, kan alma işlemi bittikten 5 dakika sonra veya kontrol grubunda indüksiyondan 40 dakika sonra, protamin sonrası, postoperatif 6. ve 24. saatte değerlendirildi. Bulgular: Veriler neticesinde pompa öncesi %29-30, pompa sırasında %18-20, pompa çıkışı ve operasyon sonrası dönemde ise %24-26 hemotokritin tolere edilebileceği görüldü. Hemodilüsyon ile paralel olarak pulmoner ve sistemik vasküler rezistansların düştüğü, kalp hızı artışı olmaksızın kardiyak indeks artışının gerçekleştiği gözlendi. Hemodilüsyon sonrasında erken dönemde doku oksijenizasyonunun bozulmadan korunduğu, ekstübasyon sonrası dönemlerde ise kontrol grubunda daha fazla olmak üzere, laktat değerlerinde artmalar, mikst venöz oksijen satürasyonunda ise azalmalar olduğu kaydedildi. İstatistiksel olarak farklılık olmamasına rağmen, G1 ile kıyaslandığında G2’de mediastinal drenaj %11.3, allojenik kan transfüzyonu ihtiyacı ise %31.5 oranında daha fazla bulundu. Sonuç: Koroner arter bypass cerrahisi geçirecek olgularda akut normovolemik hemodilüsyonun, hemodinami ve oksijenizasyonda ek bozulmalara yol açmadan kullanılabileceği kanısına varıldı.
Abstract: Backgrounds: In this study we aimed to compare the effects of acute normovolemic hemodilution on cardiac hemodynamia, tissue oxygenation, allogenic blood transfusion requirements and the amount of mediastinal drainage during the first postoperative day in patients undergoing coronary artery bypass graft surgery. Methods: Thirty three patients were randomly allocated into two groups. After induction of anesthesia, one or two units of blood was taken from the patients in the hemodilution group (G1, n = 16) until having a hemotocrit value of < 35%. At the same time, volume replacement was achieved with same amount of colloid infusion. Any additional procedure was not performed in the control group (G2, n = 17). Hemodynamic oxygenation and hematological parameters were measured before induction, after pulmonary catheter replacement, five minutes after removal of blood. In the control group, these parameters were measured 40 minutes after anesthesia induction, after protamine infusion and in the postoperative 6th hours and 24th hours. Results: Hemotocrit 29-30% before pump, 18-20% with mild hypothermia during pump and 24-26% after pump and in the postoperative periods were found to be well tolerated. During hemodilution pulmonary and systemic vascular resistances decreased while cardiac index increased without an increase in heart rate. Tissue oxygenation was preserved in the early periods after hemodilution but increased lactate levels and decreased mixed venousoxygen saturation were detected in the postextubation period. These findings were more prominent in the control group. The allogenic blood transfusion requirements (31.5%) and the amount of mediastinal drainage (11.3%) were found to be higher in G2 when compared with G1 but this was not significant. Conclusions: Acute normovolemic hemodilution can be used in coronary artery patients without any additional deterioration in hemodynamics and oxygenation, and acute normovolemic hemodilution can have positive effects on mediastinal drainage and allogenic blood transfusion requirements.
Abstract: Backgrounds: In this study we aimed to compare the effects of acute normovolemic hemodilution on cardiac hemodynamia, tissue oxygenation, allogenic blood transfusion requirements and the amount of mediastinal drainage during the first postoperative day in patients undergoing coronary artery bypass graft surgery. Methods: Thirty three patients were randomly allocated into two groups. After induction of anesthesia, one or two units of blood was taken from the patients in the hemodilution group (G1, n = 16) until having a hemotocrit value of < 35%. At the same time, volume replacement was achieved with same amount of colloid infusion. Any additional procedure was not performed in the control group (G2, n = 17). Hemodynamic oxygenation and hematological parameters were measured before induction, after pulmonary catheter replacement, five minutes after removal of blood. In the control group, these parameters were measured 40 minutes after anesthesia induction, after protamine infusion and in the postoperative 6th hours and 24th hours. Results: Hemotocrit 29-30% before pump, 18-20% with mild hypothermia during pump and 24-26% after pump and in the postoperative periods were found to be well tolerated. During hemodilution pulmonary and systemic vascular resistances decreased while cardiac index increased without an increase in heart rate. Tissue oxygenation was preserved in the early periods after hemodilution but increased lactate levels and decreased mixed venousoxygen saturation were detected in the postextubation period. These findings were more prominent in the control group. The allogenic blood transfusion requirements (31.5%) and the amount of mediastinal drainage (11.3%) were found to be higher in G2 when compared with G1 but this was not significant. Conclusions: Acute normovolemic hemodilution can be used in coronary artery patients without any additional deterioration in hemodynamics and oxygenation, and acute normovolemic hemodilution can have positive effects on mediastinal drainage and allogenic blood transfusion requirements.
Açıklama
Anahtar Kelimeler
Kaynak
Türk Göğüs Kalp Damar Cerrahisi Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
13
Sayı
1
Künye
KARAASLAN K,DURMUŞ M,BUT A. K,ERSOY M. Ö,ARINÇ H (2005). Akut normovolemik hemodilüsyonun koroner arter bypass cerrahisinde etkileri. Türk Göğüs Kalp Damar Cerrahisi Dergisi, 13(1), 77 - 83.
