Erişkin Kalp Cerrahisinde Kardiyopulmoner Baypas Sırasındaki Beyin Perfüzyonu ile Mortalite Skorlarının Etkileşimi

Abstract

Giriş: Bu çalışmada erişkin kalp cerrahisi ameliyatları sırasındaki beyin perfüzyonu ile mortalite skorlarının etkileşimlerinin araştırılması amaçlandı.

 

Hastalar ve Yöntem: Nisan 2018-Ağustos 2018 tarihleri arasında kliniğimizde kardiyopulmoner baypas (KPB) ile ameliyat edilecek erişkin hastalar çalışmaya dahil edildi (n= 91). Beyin perfüzyonunu belirlemek için “Near Infrared Spectroscopy (NIRS)” yöntemi kullanıldı. Ölçümler dört zaman aralığında yapıldı. T0: KPB öncesi, T1: soğuma periyodu, T2: ısınma periyodu, T3: KPB sonrası. Mortalite skorları olarak EuroSCORE II ve “Acute Physiology and Chronic Health Evaluation (APACHE)” II skoru değerleri her bir hasta için kaydedildi.

 

Bulgular: Ameliyat verileri, koroner arter baypas cerrahisi (n= 41, %45), kapak ameliyatları (n= 47, %51), koroner arter baypas cerrahisi ve kapak ameliyatlarının birlikte uygulandığı hastalar (n= 3, %4) olarak saptandı. Ortalama Euroscore II 1.1 (0.7-36.6) ve ortalama APACHE II skoru 6 (0-23) bulundu. Ölüm gelişen dört hastada EuroSCORE II C indeksi 0.702 (Confidence interval 0.411-0.993, p= 0.048) ve APACHE II score C indeksi 0.871 (Confidence interval 0.660-1, p= 0.010) belirlendi. Ameliyat sırasında T3 dönemindeki NIRS ölçüm değerleri düşük bulunan ve T0-T3 periyodundaki NIRS değeri değişiklikleri anlamlı olan hastalarda APACHE II skoru ölçümlerinde anlamlı değişiklik saptandı.

 

Sonuç: NIRS ölçümlerindeki değişiklikler, mortalite ve morbidite skorlama yöntemleri ölçümleriyle paralellik gösterir. Bu nedenle ameliyat öncesi ve sonrası dönemdeki hasta yönetimi açısından NIRS ölçümü iyi bir belirteçtir.

Keywords

• Erişkin kalp cerrahisi,kardiyopulmoner baypas,serebral NIRS

Relation Between Cerebral Perfusion Changes and Mortality Scores During Cardiopulmonary Bypass at Adult Cardiac Surgery

Abstract

Introduction: This study aims to investigate the correlation between cerebral perfusion changes and mortality rate in individuals undergoing adult cardiac surgery.

 

Patients and Methods: Between April 2018-August 2018, 91 adult individuals who underwent open heart surgery with cardiopulmonary bypass (CPB) were prospectively evaluated. Cerebral perfusion was monitored via near-infrared spectroscopy (NIRS). The NIRS values were recorded at four intervals: T0, just before CPB; T1, cooling period (time taken to reach targeted hypothermia); T2, warming period (time taken to reach normal body temperature); and T3, following minutes of termination of CPB. Euro Score II and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were recorded for each individual.

 

Results: The operations performed include coronary artery bypass surgery (n= 41, 45%), valvular surgery (n= 47, 51%), and coronary artery bypass combined with valvular surgery (n= 3, 4%). Median Euro Score II was calculated to be 1.1 (range 0.7-36.6), and median APACHE II score was calculated to be 6 (range 0-23). Mortality occurred in four individuals for whom the Euro Score II C index was 0.702 (confidence interval, 0.411- 0.993; p= 0.048) and APACHE-II score C index was 0.871 (confidence interval, 0.660-1; p= 0.010). During the operative period, cerebral NIRS values decreased during T3 period, and significant changes occurred at T0-T3 period, consequently leading to an increase in the APACHE-II scores and the prediction of mortality.

 

Conclusion: The changes at NIRS values were related with higher mortality, morbidity, and predicting scores. It is now suggested that these changes can eventually be a good guide and predictor for the management of patients during preoperative and postoperative periods.

Keywords

• Adult cardiac surgery,cardiopulmonary bypass,cerebral NIRS

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