Kardiyak cerrahide perfüzyon süresinin laktat düzeyi üzerine etkisi

Year 2021, Volume: 7 Issue: 1, 45 - 53, 23.04.2021

Mustafa Abanoz , Bişar Amaç , Mehmet Tercan

https://doi.org/10.30569/adiyamansaglik.800494

Abstract

Amaç: Çalışmamızda koroner arter bypass greft ameliyatı olan hastaların perfüzyon süresi ile hastaların kan laktat düzeyleri arasındaki ilişkinin karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem: Çalışmaya üçlü koroner arter bypass greft ameliyatı olan toplam 195 hasta dahil edildi. Hastalar kalp-akciğer makinesinden ayrıldıktan hemen sonra ölçülen kan laktat düzeylerine göre iki gruba ayrıldı.
Bulgular: Grupların ortalama laktat düzeyleri arasında anlamlı fark vardı (p<0,05). Laktat düzeylerine göre belirlenen her iki grubunda ''perfüzyon süreleri'' arasında anlamlı fark vardı (p<0,05). Uzun kardiyopulmoner bypass (KPB) süresine bağlı oluşan hiperlaktatemili grupta morbidite ve mortalite oranının daha yüksek olduğu görüldü.
Sonuç: Çalışmamızda perfüzyon süresinin ve aortik kross klemp süresinin uzamasına bağlı olarak laktat düzeyinin de artığı görülmüştür.

Keywords

Kardiyopulmoner Bypass;, Laktat, Perfüzyon Süresi.

The effect of perfusion time on lactate level in cardiac surgery

Abstract

Aim: In our study, we aimed to compare the relationship between perfusion time and blood lactate levels of patients undergoing coronary artery bypass graft surgery.
Materials and Methods: A total of 195 patients who underwent triple coronary artery bypass graft surgery were included in the study. The patients were divided into two groups according to the blood lactate levels measured immediately after leaving the heart-lung machine.
Results: There was a significant difference between the mean lactate levels of the groups (p<0.05). There was a significant difference between "perfusion times" in both groups determined according to lactate levels (p<0.05). Morbidity and mortality rates were found to be higher in hyperlactatemia group due to long cardiopulmonary bypass (CPB) duration.
Conclusion: In our study, it was observed that the lactate level increased due to the prolongation of the perfusion time and the duration of aortic cross clamping.

Keywords

Cardiopulmonary Bypass;, Lactate, Perfusion Time

References

• Erdolu B, As AK, Engin M. The Relationship between the HATCH Score, Neutrophilto Lymphocyte Ratioand Postoperative Atrial Fibrillation After Off-Pump Coronary Artery Bypass Graft Surgery. Heart Surg Forum. 2020;23(1):E88-E92. doi: 10.1532/hsf.2771
• Pala AA, Taner T, Tatli AB, Ozsin KK, Yavuz S. The Effect of Preoperative Hematocrit Level on Early Outcomes After Coronary Artery Bypass Surgery. Cureus. 2020;12(4):e7811. doi:10.7759/cureus.7811
• Engin M. Are Preand Postoperative Plateletto Lymphocyte Ratio and Neutrophilto Lymphocyte Ratio Associated with Early Postoperative AKI Following CABG? Braz J Cardiovasc Surg. 2020;35(2):239. doi: 10.21470/1678-9741-2019-0482
• Cori CF, Cori GT. The mechanism of epinephrine action. IV. The influence of epinephrine on lactic acid production and blood sugar utilization. J Biol Chem. 1929; 84:683-98.
• Yılmaz Ş. Koroner arter baypas cerrahisinde hiperlaktatemi: belirleyicileri ve mortalite ilişkisi. Yayınlanmamış uzmanlık tezi. Sağlık Bakanlığı Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye, 2008.
• Hamulu A, Özbaran M, Atay Y, Posacıoğlu H, Aras I, Büket S. Koroner bypass ameliyatında mortalite ve morbiditeye etki eden risk faktörlerinin belirlenmesi ve değerlendirilmesi. GKDA Derg. 1995;3:245-252.
• Jabbari A, Banihashem N, Alijanpour E, Vafaey HR, Alereza H, Rabiee SM. Serum lactate as a prognostic factor in coronary artery bypass graft operation by on pump method. Caspian J Intern Med.2013;4:662-666.
• Maillet JM, Le Besnerais P, Cantoni M, Nataf P, Ruffenach A, Lessana A, et al. Frequency, risk factors, andoutcome of hyperlactatemia after cardiac surgery. Chest. 2003;123(5):1361-6. doi:10.1378/chest.123.5.1361
• Andersen LW. Lactate elevation during and after major cardiac surgery in adults: A review of etiology, prognostic value, and management. Anesth Analg. 2017;125(3):743-52. doi:10.1213/ANE.0000000000001928
• Jakob SM, Ensinger H, Takala J. Metabolic changes after cardiac surgery. Curr Opin Clin Nutr Metab Care. 2001;4(2):149-55. doi:10.1097/00075197-200103000-00012
• Ranucci M, Carboni G, Cotza M, Bianchi P, DiDedda U, Aloisio T, et al. Hemodilution on cardiopulmonary bypass as a determinant of early postoperative hyperlactatemia. PLoSOne. 2015:18;10(5):e0126939. doi:10.1371/journal.pone.0126939
• Madhavan S, Chan SP, Tan WC, Eng J, Li B, Luo HD, et al. Cardiopulmonary bypass time: every minute counts. J Cardiovasc Surg (Torino). 2018;59(2):274-281. doi:10.23736/S0021-9509.17.09864-0
• Xu S, Liu J, Li L, Wu Z, Li J, Liu Y, et al. Cardiopulmonary bypass time is an independent risk factor for acute kidney injury in emergent thoracic aortic surgery: a retrospective cohort study. J Cardiothorac Surg. 2019;14(1):90. doi:10.1186/s13019-019-0907-x
• Aslankurt S, Yapıcı N, Kudsioğlu T, Atalan N, Çetin Y, Uğur İ, et al. The Prevalance Of Delirium After Open Heart Surgery and The Efficacy of Dexmedetomidine. GKDA Derg. 2016;22(4):152-160. doi:10.5222/GKDAD.2016.152
• Cremer J, Martin M, Redl H, Bahrami S, Abraham C, Graeter T, et al. Systemic inflammatory response after cardiac operations. Ann Thorac Surg. 1996;61(6):1714-1720. doi:10.1016/0003-4975(96)00055-0
• Ryan T, Balding J, McGovern EM, Hinchion J, Livingstone W, Chughtai Z, et al. Lactic acidosis after cardiac surgery is associated with polymorphisms in tumor necrosis factor and interleukin 10 genes. Ann Thorac Surg. 2002;73(6):1905-9. doi:10.1016/S0003-4975(02)03530-0
• Gülşan S, Şahutoğlu C, Kocabaş S, Aşkar ZF. Koroner Arter Baypas Greftleme Cerrahisinde Laktat Düzeyleri ile Komplikasyonlar Arasındaki İlişki. GKDA Derg.2018;24(2):74-81. doi:10.5222/GKDAD.2018.93064
• Matteucci M, Ferrarese S, Cantore C, Cappabianca G, Massimi G, Mantovani V, et al. Hyperlactatemia during cardiopulmonary bypass: risk factors and impact on surgical results with a focus on the long-termoutcome. Perfusion. 2020;0267659120907440. doi:10.1177/0267659120907440
• Naik R, George G, Karuppiah S, Philip MA. Hyperlactatemia in patients undergoing adult cardiac surgery under cardiopulmonary bypass: Causative factors and its effect on surgical outcome. Ann Card Anaesth. 2016;19(4):668‐675. doi:10.4103/0971-9784.191579
• Duchnowski P, Hryniewiecki T, Kuśmierczyk M, Szymański P. The usefulness of perioperative lactate blood levels in patients undergoing heart valve surgery. Kardiochir Torakochirurgia Pol. 2019;16(3):114‐117. doi:10.5114/kitp.2019.88599
• Badreldin AM, Doerr F, Elsobky S, Brehm BR, Abuldahab M, Lehmann T, et al. Mortality prediction after cardiac surgery: blood lactate is in dispensible. Thorac Cardiovasc Surg. 2013;61(8):708-17. doi:10.1055/s-0032-1324796
• Zhang Z, Xu X, Chen K. Lactate clearance as a useful biomarker for the prediction of all-cause mortality in critically ill patients: a systematic review study protocol. BMJ Open. 2014;4(5):e004752. doi:10.1136/bmjopen-2013-004752
• Ladha S, Kapoor PM, Singh SP, Kiran U, Chowdhury UK. The role of blood lactate clearance as a predictor of mortality in children undergoing surgery for tetralogy of Fallot. Ann Card Anaesth. 2016;19(2):217-224. doi:10.4103/0971-9784.179589
• Haas SA, Lange T, Saugel B, Petzoldt M, Fuhrmann V, Metschke M, et al. Severe hyperlactatemia, lactate clearance and mortality in unselected critically ill patients. Intensive Care Med. 2016;42(2):202-210. doi:10.1007/s00134-015-4127-0
• Puskarich MA, Jones AE. Clearing lactate is clearly better…but how much?. Crit Care Med. 2014;42(9):2149-2150. doi:10.1097/CCM.0000000000000455
• Murtuza B, Wall D, Reinhardt Z, Stickley J, Stumper O, Jones TJ, et al. The importance of blood lactate clearance as a predictor of early mortality following the modified Norwood procedure. Eur J Cardiothorac Surg. 2011;40(5):1207-1214. doi:10.1016/j.ejcts.2011.01.081
• Evans AS, Levin MA, Lin HM, Lee K, Weiner MM, Anyanwu A, et al. Prognostic Value of Hyperlactatemia and Lactate Clearance After Mitral Valve Surgery. J Cardiothorac Vasc Anesth. 2018;32(2):636-643. doi:10.1053/j.jvca.2017.08.002