Kardiyopulmoner Bypassta Kullanılan Dört Farklı Membran Oksijenatörün Karşılaştırılması
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2020-07-10
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info:eu-repo/semantics/openAccess
Özet
Koroner arter bypass cerrahisinde sıklıkla kullanılan kardiyopulmoner bypass, kalp ve akciğer fonksiyonlarının çeşitli yöntemlerle geçici olarak devre dışı bırakılması ve bu fonksiyonların vücut dışında mekanik sistemlerle sağlandığı bir sistemdir. Bu sistemin temel komponentlerinden biri oksijenatörlerdir. Günümüzde farklı yüzey alanı, kaplama özellikleri ve fiber yapılara sahip pek çok hollow fiber membran oksijenatör kullanılmaktadır. Çalışmamızda fizyolojik dolaşımın yerini geçici olarak alan kardiyopulmoner bypassın organ sistemleri üzerindeki etkisi dört farklı membran oksijenatör üzerinde karşılaştırıldı. Retrospektif olarak yaptığımız çalışmamızda, 160 hasta için randomize dört grup oluşturuldu. Grupların cerrahi öncesindeki hemoglobin, hematokrit, trombosit, üre, kreatinin, aspartat aminotransferaz, alanin aminotransferaz, c-reaktif protein değerleri ile cerrahi sonrası 0. gün, 24. saat ve 48. saatlerdeki değerleri karşılaştırıldı. Kardiyopulmoner bypass süresince ve yoğun bakımda idrar ve drenaj miktarları ile hastane yatış süreleri ve kan transfüzyon miktarları karşılaştırıldı. Sonuç olarak çalışmamızda, yüzey alanı daha büyük heparin kaplı oksijenatör grubunun yoğun bakım yatış süresinin diğerlerine göre daha uzun olduğu ve daha fazla kan transfüzyonuna ihtiyaç duyulduğu görüldü. Heparin kaplı daha düşük yüzey alanına sahip diğer bir grup oksijenatörün ise Üre ve Kreatinin değerlerinde postop dönemde daha az yükselmeye neden olduğu ve KPB’da daha fazla idrar çıkışı sağladığı görüldü. Aynı grubun daha az kan transfüzyonuna ve C-reaktif protein yükselişine neden olduğu gözlendi. Birbirlerine göre farklı avantajları olan gruplarda daha geniş parametrelerle ve örnek sayısı ile detaylı araştırmalar yapılarak yeni oksijenatör sistemleri geliştirilebileceği ve açık kalp cerrahisine katkı sağlanabileceği düşünülmüştür.
Cardiopulmonary bypass that is frequently used in coronary artery bypass surgery, is a system in which heart and lung functions are temporarily disabled by various methods and these functions are performed by mechanical systems outside the body. One of the main components of this system is oxygenator. Today, many hollow fiber membrane oxygenators with different surface area, coating properties and fiber structures are used. In our study, effects of cardiopulmonary bypass which temporarily takes over the function of the physiological circulation, on organ systems were compared on four different membrane oxygenators. In our retrospective study, four randomized groups were created for 160 patients. Preoperative hemoglobin, hematocrit, platelets, ürea, creatinine, aspartate aminotransferase, alanine transferase, C-reactif protein values of the groups and their postoperative values in 0th day, 24th hour and 48th hour were compared. Urine and drainage amounts and hospitalization periods and blood transfusion amounts were compared during cardiopulmonary bypass and their stay in intensive care. Consequently, it was seen in our study that intensive care stay length of oxygenator group with larger surface area covered with heparin was longer than others and more blood transfusion was needed. It was also seen that another group of oxygenators with smaller surface area covered with heparin caused less increase in Urea and Creatinine values in postoperative period and enabled more urination on CPB. It was observed that same group caused less blood transfusion and C-reactif protein increase. It was thought that new oxygenator systems could be developed by conducting detailed researches with more parameters and samples in groups having different advantages from each other and contribution could be made to open heart surgery."
Cardiopulmonary bypass that is frequently used in coronary artery bypass surgery, is a system in which heart and lung functions are temporarily disabled by various methods and these functions are performed by mechanical systems outside the body. One of the main components of this system is oxygenator. Today, many hollow fiber membrane oxygenators with different surface area, coating properties and fiber structures are used. In our study, effects of cardiopulmonary bypass which temporarily takes over the function of the physiological circulation, on organ systems were compared on four different membrane oxygenators. In our retrospective study, four randomized groups were created for 160 patients. Preoperative hemoglobin, hematocrit, platelets, ürea, creatinine, aspartate aminotransferase, alanine transferase, C-reactif protein values of the groups and their postoperative values in 0th day, 24th hour and 48th hour were compared. Urine and drainage amounts and hospitalization periods and blood transfusion amounts were compared during cardiopulmonary bypass and their stay in intensive care. Consequently, it was seen in our study that intensive care stay length of oxygenator group with larger surface area covered with heparin was longer than others and more blood transfusion was needed. It was also seen that another group of oxygenators with smaller surface area covered with heparin caused less increase in Urea and Creatinine values in postoperative period and enabled more urination on CPB. It was observed that same group caused less blood transfusion and C-reactif protein increase. It was thought that new oxygenator systems could be developed by conducting detailed researches with more parameters and samples in groups having different advantages from each other and contribution could be made to open heart surgery."
Açıklama
Anahtar Kelimeler
cardiopulmonary bypass, membrane oxygenator, surface area, blood transfusion, drainage, Urea, Creatinine, kardiyopulmoner bypass, membran oksijenatör, yüzey alanı, kan transfüzyonu, drenaj, Üre, Kreatinin