Kardiyopulmoner bypass ile açık kalp cerrahisi uygulanan hastalarda orta ve hafif hipotermik bypass yöntemlerinin neutrophil gelatinase associated lipocalin (NGAL), cystatin c ve near infrared spectroscopy (NIRS) yöntemi ile ölçülen renal perfüzyon üzerine etkilerinin karşılaştırılması
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Tarih
2014
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Selçuk Üniversitesi Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Özet
Kardiyopulmoner bypass ile açık kalp cerrahisi uygulanan hastalarda orta ve hafif hipotermik bypass yöntemlerinin neutrophil gelatinase associated lipocalin (NGAL), cystatin C ve nearinfrared spectroscopy (NIRS) yöntemi ile ölçülen renal perfüzyon üzerine etkilerinin karşılaştırılması. Selçuk Üniversitesi Tıp fakültesi, Kalp ve Damar Cerrahisi Tezi. Konya, 2014. Giriş: Kardiyopulmoner bypass (KPB) kullanılarak yapılan açık kalp cerrahisi sonrası gelişen akut böbrek hasarı (ABH), postoperatif morbidite, mortalite, hastanede kalış süresi ve maliyet artışında kardiyak riskler dışında en etkin faktör olarak tespit edilmiştir. Preoperatif risk faktörleri, anestezi uygulamaları ve KPB yöntemleri postoperatif ABH'de başlıca etkili faktörlerdir. Son yıllarda normotermik yöntemlerin tercih edilmesi KPB sırasında hipotermi uygulamalarının organ koruyucu etkilerinin yeniden tartışılmasına neden olmuştur. Postoperatif gelişen ABH'nin erken dönemde tespitinde nötrofil jelatinaz ilişkili lipokalin (NGAL) ve sistatin C (Cyc-C) sıklıkla kullanılmaktadır. Açık kalp cerrahisinde renal oksijenizasyonun peroperatif Near infrared spectroscopy (NIRS) ile değerlendirilmesi postoperatif renal fonksiyonların değerlendirilmesinde artan sıklıkla kullanılmaktadır. Biz de KPB ile açık kalp cerrahisi uygulanan hastalarda orta ve hafif hipotermik bypass yöntemlerinin NGAL, Cyc-C ve NIRS yöntemi ile ölçülen renal perfüzyon üzerine olan etkilerini karşılaştırılmayı amaçladık. Gereç ve Yöntem: Selçuk Üniversitesi Tıp Fakültesi Kalp Damar Cerrahisi Anabilim Dalı'nda KPB ile açık kalp cerrahisi uygulanan 40-70 yaş arası 40 hasta çalışmaya dahil edildi. Hastalar, KPB sırasında uygulanan ısılarına göre mild hipotermi (320C); Grup MLD (n=20) ve moderate hipotermi (280C); Grup MOD (n=20) olarak iki gruba ayrıldılar. Preoperatif, postoperatif 6., 12., 24. ve 48. saatte idrar NGAL ve serum Cyc-C ölçümleri ile intraoperatif, postoperatif 12 saat süre ile, postoperatif 24. ve 48. saatlerde ise NIRS değerleri kaydedildi. Bulgular: Grup MLD'de Grup MOD'a göre ABH daha sık görüldü (p<0.05). İdrar NGAL ve Cyc-C düzeyleri yine Grup MLD'de Grup MOD'a göre anlamlı olarak yüksek olarak tespit edildi (p<0.05). İntraoperatif NIRS değerleri ile postoperatif NGAL değerleri arasında korelasyon saptanmadı (p>0.05). İntraoperatif NIRS değerleri ile postoperatif Cyc-C ve SKr değerleri arasında orta düzeyli bir korelasyon saptandı (p<0.05). Gruplar arasında tüm zamanlarda NIRS değerleri arasında anlamlı farklılık saptanmadı (p>0.05). Tartışma ve Sonuç: Moderate hipotermi uygulanan gruba göre mild hipotermi uygulanan grupta idrar NGAL ve serum Cyc-C düzeyleri anlamlı olarak yüksek bulunurken NIRS değerleri arasında farklılık bulunmamıştır. Hipoterminin renal fonksiyonlara etkisini değerlendirmede postoperatif idrar NGAL ve serum Cyc-C düzeylerinin değişiminin daha yakından takip edilmesi gerektiği, intraoperatif ve postopearatif NIRS değerlerinin ise klinik izlem yönünden yeterli olmadığı kanısına vardık.
Acute kidney injury (AKI) after cardiopulmonary bypass graft surgery was found to be the most effective factor in postoperative morbidity, mortality, length of hospital stay and cost efficiency besides cardiac risks. Preoperative risk factors, methods of both anesthesia and cardio-pulmonary bypass (CPB) are the main influential factors in postoperative AKI. The choice of normothermic method during CPB in recent years has led to a discussion in the organ protective effect of hypothermia. Neutrophil gelatinase associated lipocalin (NGAL) and cystatin C (Cyc-C) is often used in in the early detection of developing postoperative AKI. In open-heart surgery,the evaluation of renal oxygenation in the perioperative period with Near infrared spectroscopy (NIRS) is used increasinglyin the assessment of postoperative renal function. In this study we aimed to compare the effects of mild and moderate hypothermia on renal perfusion evaluated with NGAL, Cystatin-C and NIRS in patients undergoing coronary artery bypass grafting (CABG) surgery. Materials and Methods Forty adult patients between 40-70 years of age who underwent open heart surgery with CPB in Selcuk University Faculty of Medicine Department of Cardiovascular Surgery were included in the study. Patients were divided into two groups according to the level of hypothermia during CPB: mild hypothermia, (320C), MLD group (n = 20) and moderate hypothermia (280C), MOD group (n = 20). Urinary NGAL and serum Cystatin-C were measured preoperatively and at postoperative 6th, 12th, 24th and 48thhours and NIRS values were recorded during intraoperative and postoperative 12 hours, and at postoperative 24th and 48th hours. Results AKI occurred more common in Group MLD than Group MOD (p<0.05). Urinary NGAL and serum Cystatin-C levels were also found higher in Group MLD than group MOD (p<0.05). There wasn't any correlation between intraoperative NIRS values and postoperative NGAL values. We found a moderate correlation between intraoperative NIRS values and postoperative Cystatin-C and serum creatinine values (p<0.05). There was not any statistically significant difference between groups regarding NIRS values at all times. Conclusion Urinary NGAL and serum Cystatin-C levels were significantly higher in mild hypothermia group than moderate hypothermia group but there was no difference between groups regarding NIRS values. We think that in the evaluation of the effects of hypothermia on renal function, postoperative urinary NGAL and serum Cystatin-C levels should be monitored closely and we conclude that intraoperative and postopearatif NIRS values are not sufficient enough in terms of clinical follow-up.
Acute kidney injury (AKI) after cardiopulmonary bypass graft surgery was found to be the most effective factor in postoperative morbidity, mortality, length of hospital stay and cost efficiency besides cardiac risks. Preoperative risk factors, methods of both anesthesia and cardio-pulmonary bypass (CPB) are the main influential factors in postoperative AKI. The choice of normothermic method during CPB in recent years has led to a discussion in the organ protective effect of hypothermia. Neutrophil gelatinase associated lipocalin (NGAL) and cystatin C (Cyc-C) is often used in in the early detection of developing postoperative AKI. In open-heart surgery,the evaluation of renal oxygenation in the perioperative period with Near infrared spectroscopy (NIRS) is used increasinglyin the assessment of postoperative renal function. In this study we aimed to compare the effects of mild and moderate hypothermia on renal perfusion evaluated with NGAL, Cystatin-C and NIRS in patients undergoing coronary artery bypass grafting (CABG) surgery. Materials and Methods Forty adult patients between 40-70 years of age who underwent open heart surgery with CPB in Selcuk University Faculty of Medicine Department of Cardiovascular Surgery were included in the study. Patients were divided into two groups according to the level of hypothermia during CPB: mild hypothermia, (320C), MLD group (n = 20) and moderate hypothermia (280C), MOD group (n = 20). Urinary NGAL and serum Cystatin-C were measured preoperatively and at postoperative 6th, 12th, 24th and 48thhours and NIRS values were recorded during intraoperative and postoperative 12 hours, and at postoperative 24th and 48th hours. Results AKI occurred more common in Group MLD than Group MOD (p<0.05). Urinary NGAL and serum Cystatin-C levels were also found higher in Group MLD than group MOD (p<0.05). There wasn't any correlation between intraoperative NIRS values and postoperative NGAL values. We found a moderate correlation between intraoperative NIRS values and postoperative Cystatin-C and serum creatinine values (p<0.05). There was not any statistically significant difference between groups regarding NIRS values at all times. Conclusion Urinary NGAL and serum Cystatin-C levels were significantly higher in mild hypothermia group than moderate hypothermia group but there was no difference between groups regarding NIRS values. We think that in the evaluation of the effects of hypothermia on renal function, postoperative urinary NGAL and serum Cystatin-C levels should be monitored closely and we conclude that intraoperative and postopearatif NIRS values are not sufficient enough in terms of clinical follow-up.
Açıklama
Anahtar Kelimeler
Kardiyopulmoner bypass, Akut böbrek hasarı, İdrar nötrofil jelatinaz ilişkili lipokalin, Serum sistatin C, Near infrared spectroscopy, Near-infrared spektroskopi, Cardiopulmonary bypass, Acute kidney injury, Urine neutrophil gelatinase-associated lipocalin, Serum cystatin C
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Scopus Q Değeri
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Künye
Yıldırım, S. (2014). Kardiyopulmoner bypass ile açık kalp cerrahisi uygulanan hastalarda orta ve hafif hipotermik bypass yöntemlerinin neutrophil gelatinase associated lipocalin (NGAL), cystatin c ve near infrared spectroscopy (NIRS) yöntemi ile ölçülen renal perfüzyon üzerine etkilerinin karşılaştırılması. Selçuk Üniversitesi, Yayımlanmış uzmanlık tezi, Konya.
