Per-operative levosimendan use in high-risk patients undergoing coronary artery bypass surgery

Year 2012, Volume: 65 Issue: 1, 61 - 66, 01.01.2012

Ulaș Kumbasar Ali Can Hatemi Mustafa Canikoğlu Aybala Tongut Mete Gürsoy Kadir Çeviker İlhan Özgöl Murat Bașkurt Cem Bostan Kamil Karaoğlu

https://doi.org/10.1501/Tipfak_0000000809

Abstract

Keywords

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Yüksek Riskle Koroner Arter Cerrahisi Uygulanan Hastalarda Per-Operatif Levosimendan Kullanımı

Abstract

Amaç: Kardiyopulmoner bypass (KPB) desteğinin sonlandırılması sırasında miyokardın desteklenmesi için konvansiyonel inotropik ajanlar birçok çalıșmada incelendiği halde yeni ve kalsiyum duyarlılığını arttırarak etki gösteren levosimendan hakkında çalıșmalar sınırlıdır. Bu çalıșmada, koroner arter bypass cerrahisi (KABC) uygulanan ve KPB’den çıkıșta zorlanan hastalarda peroperatif dönemde yükleme dozu yapılmadan bașlanan levosimendanın etkinliği araștırıldı. Materyal ve Method: KABC uygulanan ve yüksek Euroscore’a (>6) sahip 42 hasta çalıșmaya alındı. Hastalara yükleme dozu olmadan, per-operatif dönemde 24 saat boyunca 0.1 mcg/kg/dk hızında intravenöz yolla levosimendan uygulandı. İlaveten tüm hastalara dopamin (5-15 mcg/kg/dk), 39 hastaya adrenalin (0.03-0.2 mcg/kg/dk) ve 9 hastaya da dobutamin (6-20 mcg/kg/dk) infüzyonu uygulandı. KPB’den ayrılamayan 4 hastaya intraaortik balon pompası (İABP) uygulandı. Pre ve postoperatif demografik özellikler, ekokardiyografik ve hemodinamik parametreler ve operatif veriler analiz edildi. Sonuçlar: Ortalama hasta yașı 61.36±9.1 (min:39, maks:77) idi. Ortalama ekstübasyon zamanı 18.34±6.2 saat (min:9, maks:34), ortalama yoğun bakımda kalıș süresi 5.45±2.3 gün (min:1, maks:15) olarak hesaplandı. Pre-operatif ölçümlerle karșılaștırıldığında, levosimendan kullanımını takiben post-operatif dönemde hastalarda istatistiksel olarak anlamlı olacak șekilde sol ventrikül ejeksiyon fraksiyonunda (LVEF) artma, sol atriyum (LA), sol ventrikül (LV) ve sağ ventrikül (RV) diyastol sonu çaplarında küçülme saptandı. Pro-BNP seviyesindeki post-operatif 3. gün görülen artıș da anlamlı bulundu. Ancak, postoperatif 6. aydaki pro-BNP seviyeleri pre-operatif seviyelerden farklı bulunmadı. Kalp hızı ile sistolik ve diyasyolik kan basınçları perfüzyonun 23. saatinde ve perfüzyon kesildikten 1 saat sonra kaydedildi. Kalp hızı sabit kaldığı halde kan basınçlarında anlamlı artıș meydana geldi. Sonuç: Kardiyopulmoner bypass uygulanarak yapılan koroner arter cerrahisinde, özellikle düșük kardiyak debili hastalarda levosimendan konvansiyonel inotroplarla birlikte kullanıldığında etkili bir ilaç olarak görülmektedir.

Keywords

Koroner arter bypass cerrahisi, Düșük kardiyak debi, Kardiprotektif ilaçlar, Euroscore

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