Myokard korunmasında kristalloid ve kan kardiyoplejisi
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Dosyalar
Tarih
1996
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Selçuk Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Koroner bypass operasyonu uygulanan 30 hasta iki gruba ayrılarak kristalloid ve kan kardiyoplejisi grubu oluşturuldu.Kan kardiyoplejisi ve kristalloid kardiyoplejinin myokard korunmasındaki yeri enzim seviyesinde araştırıldı. Ayrıca KPB süresi ve AKZ ile enzim seviyesi ilişkisi ortaya konulmaya çalışıldı.Kristalloid ( grup 1) ve kan ( grup 2 ) kardiyoplejisinde hasta başına distal anastomoz sayısı sırasıyla, 2.4 ± 0.6 ve 2.4 + 0.7 idi. Her iki grup da homojen hale getirildi.Kristalloid ve kan kardiyoplejisi aort kökünden verildi. Hastalar 30 ° C'ye kadar soğutuldu. Değerlendirmede aşağıdaki parametreler dikkate alındı: 1. Postoperatif pozitif inotrop velABP desteği 2. Postoperatif CK-MB, LDH, CK ve SGOT enzim seviyeleri 3. EKG değişiklikleri 4. Krosklemp kalktıktan sonra spontan sinüs ritmine dönüş Kan kardiyopleji grubunda hasarla ilgili daha düşük enzim değerleri elde edildi. Birinci grupta 3 ( % 20 ), ikinci grupta 2 ( % 13.3 ) hastada postoperatif erken dönemde ÎABP desteği gerekti. Yine 1. grupta 14 hastada ( % 93.3 ), 2.grupta 1 ( % 6.6 ) hastada postoperatif pozitif inotrop ihtiyacı oldu.İkinci grupta 2 hasta ( % 13.3 ) Mf geçirdi.Her iki grupta ciddi ritm problemi gözlenmedi.Kristalloid kardiyopleji grubunda krosklemp kalktıktan sonra fibrilasyon gözlenirken, kan kardiyoplejisi grubunda sadece 2 hastada fibrilasyon gözlendi ve defibrile edildi.Bu grupta 13 hastada spontan sinüs ritmi döndü. Her iki grupta enzim seviyeleri ile KPB süresi ve AKZ zamanı arasında pozitif doğrusal bir ilişki farkedildi Sonuçlar, kan kardiyoplejisi ile daha iyi bir myokardial koruma sağlanabileceğini düşündürmektedir.Kan kardiyoplejisinin iyi klinik sonuçlar ve düşük enzim seviyeleri ile myokard korunmasının güvenilir alternatif bir yolu olduğunu söyleyebiliriz.
Comparison of cardioprotection with crystalloid and cardioplegia in CABG patients and corelation of between CPB time & enzyme values Methots and Results: 30 patients scheduled for elective coronary artery bypass grafting (CABG) were randomly allocated to two groups for myocardial preservation. Crystalloid cardioplegia ( group 1 ), blood cardioplegia ( group 2 ). In group 1, 2.4 ± 0.6 distal anastomoses per patient were performed. In the next group ( group 2 ), the number of distal anastomoses was 2.4 ± 0.7. The demographic profiles were identical. Crystalloid and blood cardioplegia were delivered through the aortic root intermittently.The patient temperature was kept at 30 ° C. The study ptotocol comprised recording of the following parameters: /.Postoperatively positive inotropic and IABP support 2. Postoperatively CK-MB, LDH, SGOT and CK enzyme studies 3. ECG changes ( rhythm disturbances ) 4. Spontaneous sinus rhythm ( after removing cross-clamp ). Postoperatively, the blood cardioplegia group had lower CK-MB values. P values of 1st hour, 6th hour, 18th hour and 36th hour were 0.03, 0.01, 0.01, 0.01 respectively ( using t test ). This group had lower LDH,CK and SGOT enzyme values. Three patients ( 20 % ) in the group 1 and two patients ( 13.3 % ) group 2 needed IABP support in the early postoperative period. 14 patients ( 93.3 % ) in the group 1 and one patient ( 6.6 % ) in the group 2 needed positive inotropic support. 2 patients ( 13.3 % ) in the group 2 suffered postoperative myocardial infarction. There were no rhythm disturbances in both groups. 13 patients in the grup 2 did not receive any electric counter shock, in the other group all patients received electric counter shock ( after removing cross-clamp ). The cross-clamping and cardiopulmonary bypass time were found correlated with enzyme levels. This might indicate that there was an interaction on between the cross- clamping -cardiopulmonary bypass time and enzyme levels. CPB and cross-clamping time demonsrated a positive correlation with enzyme levels ( 1> r > 0 ). Conclusions: The results in this study suggest that better myocardial protection may be thought to occur by blood cardiopegia. We can say that blood cardiopegia is a safe alternative way of myocardial protection with good clinical results and lower enzyme levels
Comparison of cardioprotection with crystalloid and cardioplegia in CABG patients and corelation of between CPB time & enzyme values Methots and Results: 30 patients scheduled for elective coronary artery bypass grafting (CABG) were randomly allocated to two groups for myocardial preservation. Crystalloid cardioplegia ( group 1 ), blood cardioplegia ( group 2 ). In group 1, 2.4 ± 0.6 distal anastomoses per patient were performed. In the next group ( group 2 ), the number of distal anastomoses was 2.4 ± 0.7. The demographic profiles were identical. Crystalloid and blood cardioplegia were delivered through the aortic root intermittently.The patient temperature was kept at 30 ° C. The study ptotocol comprised recording of the following parameters: /.Postoperatively positive inotropic and IABP support 2. Postoperatively CK-MB, LDH, SGOT and CK enzyme studies 3. ECG changes ( rhythm disturbances ) 4. Spontaneous sinus rhythm ( after removing cross-clamp ). Postoperatively, the blood cardioplegia group had lower CK-MB values. P values of 1st hour, 6th hour, 18th hour and 36th hour were 0.03, 0.01, 0.01, 0.01 respectively ( using t test ). This group had lower LDH,CK and SGOT enzyme values. Three patients ( 20 % ) in the group 1 and two patients ( 13.3 % ) group 2 needed IABP support in the early postoperative period. 14 patients ( 93.3 % ) in the group 1 and one patient ( 6.6 % ) in the group 2 needed positive inotropic support. 2 patients ( 13.3 % ) in the group 2 suffered postoperative myocardial infarction. There were no rhythm disturbances in both groups. 13 patients in the grup 2 did not receive any electric counter shock, in the other group all patients received electric counter shock ( after removing cross-clamp ). The cross-clamping and cardiopulmonary bypass time were found correlated with enzyme levels. This might indicate that there was an interaction on between the cross- clamping -cardiopulmonary bypass time and enzyme levels. CPB and cross-clamping time demonsrated a positive correlation with enzyme levels ( 1> r > 0 ). Conclusions: The results in this study suggest that better myocardial protection may be thought to occur by blood cardiopegia. We can say that blood cardiopegia is a safe alternative way of myocardial protection with good clinical results and lower enzyme levels
Açıklama
Anahtar Kelimeler
Myocardium, Miyokard, Crystalloids, Kristalloid, Cardioplegic solutions, Kardiyoplejik solüsyonlar, Heart arrest induced, Kalp durdurulması, Tissue preservation, Doku prezervasyonu, Kardiyovasküler cerrahi, Cardiovascular surgery
Kaynak
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Künye
Durgut, K. (1996). Myokard korunmasında kristalloid ve kan kardiyoplejisi. Selçuk Üniversitesi, Yayımlanmış uzmanlık tezi, Konya.
