Kardiyopulmoner Bypass Sırasında Hemofiltrasyon/Ultrafiltrasyon Kullanımının Perioperatif Sonuçlar Üzerine Etkisi

Yıl 2024, Cilt: 5 Sayı: 1, 105 - 113, 30.04.2024

Bişar Amaç Murat Ziya Bağış

https://doi.org/10.58605/bingolsaglik.1400943

Öz

Bu çalışmada kardiyopulmoner bypass (KPB) sırasında konvansiyonel hemofiltrasyon/ultrafiltrasyon kullanımının intraoperatif ve postoperatif kan kullanımı, sistemik inflamatuar yanıt sendromu ve böbrek fonksiyonları üzerine olan etkilerini araştırmak amaçlandı.
KPB eşliğinde kardiyak cerrahisi uygulanmış, toplam 60 hasta retrospektif olarak çalışmaya dahil edildi. Operasyon sırasında KPB ekipmanı üzerinde konvansiyonel hemofiltrasyon/ultrafiltrasyon kullanılmamış ve kullanılmış olan hasta verileri gruplandırılarak karşılaştırıldı. Hastaların biyokimyasal, hematolojik ve diğer verileri gruplar arasında karşılaştırıldı.
Grupların demografik, tanımlayıcı ve preoperatif kan parametre verileri benzerdi (p>0,05). Grupların postoperatif 1.gün hemoglobin, hematokrit, üre, kreatinin, lökosit (WBC-White Blood Cell) ve C-reaktif protein (CRP) değerleri ve peroperatif değişkenlerinden; kan transfüzyon miktarı, peroperatif drenaj miktarı ve akut böbrek yetmezliği (ABY) oranı arasında anlamlı fark vardı (p<0,05). Grupların; idrar miktarı, intra-kardiyak defibrilasyon ihtiyacı, inotrop destek ihtiyacı, mekanik ventilasyon destek süresi, yoğun bakım ünitesi (YBÜ) kalış süresi, hastanede kalış süresi ve erken dönem mortalite oranları arasında ise anlamlı fark yoktu (p>0,05).
KPB eşliğinde kardiyak cerrahi operasyonu yapılan hastalarda KPB sırasında hemofiltrasyon/ultrafiltrasyon kullanımının intraoperatif ve postoperatif kan kullanımı, sistemik inflamatuar yanıt sendromu ve böbrek fonksiyonları üzerinde olumlu etkileri olduğunu düşünmekteyiz

Anahtar Kelimeler

Kardiyopulmoner Bypass, Perfüzyon, Hemofiltrasyon, Ultrafiltrasyon.

Etik Beyan

Bu araştırma için çalışma öncesi; çalışmanın yapılacağı kurum (Şanlıurfa Mehmet Akif İnan Eğitim ve Araştırma Hastanesi) ve yerel etik kurulundan (Harran Üniversitesi Klinik Araştırmalar Etik Kurulu) onay alındı (Etik Kurul Onay No: HRÜ/22.24.13, Tarih:12.12.2022). Çalışma Helsinki Bildirgesi prensiplerine uygun olarak yapıldı.

Effect of Hemofiltration/Ultrafiltration Use on Perioperative Outcomes During Cardiopulmonary Bypass

Öz

In this study, it was aimed to investigate the effects of conventional hemofiltration/ultrafiltration use on intraoperative and postoperative blood use, systemic inflammatory response syndrome and kidney functions during cardiopulmonary bypass (CPB).
A total of 60 patients who underwent CPB-guided cardiac surgery were included in the study retrospectively. The data of patients who did not use conventional hemofiltration/ultrafiltration on CPB equipment and which were used during the operation were grouped and compared. Biochemical, hematological and other data of the patients were compared between the groups.
Demographic, descriptive and preoperative blood parameterdata of the groups were similar (p>0.05). From the postoperative 1st day hemoglobin, hematocrit, urea, creatinine, leukocyte (WBC-White Blood Cell) and C-reactive protein (CRP) values and perioperative variables of the groups; there was a significant difference between the amount of blood transfusion, the amount of peroperative drainage and the rate of acute renal failure (ARF) (p<0.05). Groups; There was no significant difference between the amount of urine, need for intra-cardiac defibrillation, need for inotropic support, duration of mechanical ventilation support, duration of intensive care unit (ICU) stay, duration of hospital stay and early mortality rates (p>0.05).
We think that the use of hemofiltration/ultrafiltration during CPB has positive effects on intraoperative and postoperative blood use, systemic inflammatory response syndrome and renal functions in patients undergoing CPB-guided cardiac surgery.

Anahtar Kelimeler

Cardiopulmonary Bypass, Perfusion, Hemofiltration, Ultrafiltration.

Kaynakça

• Sarkar M, Prabhu V. Basics of cardiopulmonary bypass. Indian J Anaesth. 2017;61(9):760-767.
• Phoon PHY, Hwang NC. conventional ultrafiltration-no more role in elective adult cardiac surgery?. J Cardiothorac Vasc Anesth. 2021;35(5):1319-1320.
• Freitas Leal J, Vermeer H, Lazari D, et al. The impact of circulation in a heart-lung machine on function and survival characteristics of red blood cells. Artif Organs. 2020;44(8):892-899.
• Passaroni AC, Silva MA, Yoshida WB. Cardiopulmonary bypass: development of John Gibbon's heart-lung machine. Rev Bras Cir Cardiovasc. 2015;30(2):235-245.
• Talwar S, Sujith NS, Rajashekar P, et al. Modified ultrafiltration and postoperative course in patients undergoing repair of tetralogy of fallot. J Card Surg. 2021;36(10):3679-3687.
• Stammers AH, Tesdahl EA, Mongero LB, et al. Zero-balance ultrafiltration during cardiopulmonary bypass is associated with decreased urine output. J Extra Corpor Technol. 2021;53(1):27-37.
• Mongero L, Stammers A, Tesdahl E, Stasko A, Weinstein S. The effect of ultrafiltration on end-cardiopulmonary bypass hematocrit during cardiac surgery. Perfusion. 2018;33(5):367-374.
• Low ZK, Gao F, Sin KYK, Yap KH. Modified ultrafiltration reduces postoperative blood loss and transfusions in adult cardiac surgery: a meta-analysis of randomized controlled trials. Interact Cardiovasc Thorac Surg. 2021;32(5):671-682.
• Mongero LB, Tesdahl EA, Stammers A, Weinstein S. The influence of ultrafiltration on red blood cell transfusion during cardiopulmonary bypass. Perfusion. 2019;34(4):303-309.
• McNair ED, McKay WP, Mondal PK, Bryce RDT. transfusion use and hemoglobin levels by blood conservation method after cardiopulmonary bypass. Ann Thorac Surg. 2020;110(5):1520-1526.
• Naveed D, Khan RA, Malik A, Shah SZ, Ullah I, Hussain A. Role of modified ultrafiltration in adult cardiac surgery: a prospective randomized control trial. J Ayub Med Coll Abbottabad. 2016;28(1):22-25.
• Suzuki H, Oshima N, Watari T. Effect of modified ultrafiltration on cytokines and hemoconcentration in dogs undergoing cardiopulmonary bypass. J Vet Med Sci. 2020;82(11):1589-1593.
• Manning MW, Li YJ, Linder D, et al. conventional ultrafiltration during elective cardiac surgery and postoperative acute kidney injury. J Cardiothorac Vasc Anesth. 2021;35(5):1310-1318.
• Matata BM, Scawn N, Morgan M, et al. A single-center randomized trial of intraoperative zero-balanced ultrafiltration during cardiopulmonary bypass for patients with impaired kidney function undergoing cardiac surgery. J Cardiothorac Vasc Anesth. 2015;29(5):1236-1247.
• Paugh TA, Dickinson TA, Martin JR, et al. Impact of ultrafiltration on kidney injury after cardiac surgery: The Michigan Experience. Ann Thorac Surg. 2015;100(5):1683-1688.
• Kandil OA, Motawea KR, Darling E, et al. Ultrafiltration and cardiopulmonary bypass associated acute kidney injury: A systematic review and meta-analysis. Clin Cardiol. 2021;44(12):1700-1708.
• Song LO, Yinglong LI, Jinping LI. Effects of zero-balanced ultrafiltration on procalcitonin and respiratory function after cardiopulmonary bypass. Perfusion. 2007;22(5):339-343.
• de Baar M, Diephuis JC, Moons KG, Holtkamp J, Hijman R, Kalkman CJ. The effect of zero-balanced ultrafiltration during cardiopulmonary bypass on S100b release and cognitive function. Perfusion. 2003;18(1):9-14.
• Kosour C, Dragosavac D, Antunes N, Almeida de Oliveira RA, Martins Oliveira PP, Wilson Vieira R. Effect of ultrafiltration on pulmonary function and interleukins in patients undergoing cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2016;30(4):884-890.
• Shinozaki K, Lampe JW, Kim J, et al. The effects of early high-volume hemofiltration on prolonged cardiac arrest in rats with reperfusion by cardiopulmonary bypass: a randomized controlled animal study. Intensive Care Med Exp. 2016;4(1):25.
• Soliman R, Fouad E, Belghith M, Abdelmageed T. Conventional hemofiltration during cardiopulmonary bypass increases the serum lactate level in adult cardiac surgery. Ann Card Anaesth. 2016;19(1):45-51.