Kardiyopulmoner Baypasa Girilen Açık Kalp Cerrahisi Hastalarında Solunum Fonksiyon Testlerinin Mortalite ve Morbiditeye Etkisi

Abstract

Giriş: Solunum fonksiyon testi değerleri normal ve düşük olan açık kalp cerrahisi uygulanan hastalarda solunum fonksiyonlarının mortalite ve morbiditeye olan etkilerini incelemeyi amaçladık.

 

Hastalar ve Yöntem: Çalışmaya Mayıs 2018-Ekim 2018 tarihleri arasında açık kalp cerrahisine giren 60 hasta katıldı. Hastalar iki gruba ayrıldı. Düşük solunum fonksiyon testine (SFT) sahip hastalar Grup 1 (n= 30), normal solunum fonksiyon testi olan hastalar Grup 2 (n= 30) olarak planlandı. Tüm hastalar kardiyopulmoner baypas (KPB)’a girilerek açık kalp cerrahisi işlemi gerçekleştirilen hastalardan oluşmaktaydı. Acil ameliyat edilen hastalar ve SFT yapılması kontrendike olması dolayısıyla yapılamayan hastalar çalışmaya dahil edilmedi. Tüm hastalarda standart cerrahi prosedürler uygulanmıştır. Karşılaştırma ameliyat öncesi demografik veriler, ameliyat esnasındaki cerrahi veriler, ameliyat sonrası dönemde ise hemodinamik veriler, entübasyon süresi, inotrop kullanımı ve süresi, yoğun bakım ve serviste kalış süresi verileri ile birlikte komplikasyon ve mortalite gelişimi durumuna göre yapıldı.

 

Bulgular: Erken dönemde gruplar arasında mortalite açısından fark yoktu (p= 1.000). Ekstübasyon süreleri ve inotrop kullanım süreleri Grup 1’de daha yüksek idi ancak istatistiksel olarak anlamlı sonuç elde edilmedi (p= 0.170). Solunumsal komplikasyonlar Grup 1’de daha yüksek görüldü (Grup 1; n= 10 (%33.33), Grup 2; n= 6 (%20), p= 0.125). Devamlı pozitif hava yolu basınçlı (CPAP) invaziv olmayan ventilasyon destek ihtiyacı ve solunum fonksiyonları ile ilişkili aritmi ve atriyal fibrilasyon (AFR) görülme sıklığı istatistiksel olarak Grup 1’de anlamlı idi (sırasıyla p= 0.043, p= 0.049).

 

Sonuç: Solunum fonksiyon değerleri düşük olan hastalarda KPB’ye girilen açık kalp cerrahisi sonrası erken dönemde mortalite etkilenmese de ameliyat sonrası morbiditeye etki edecek solunumsal komplikasyonlar ve hayati ritm problemleri daha sık görülmektedir. Bu hastalarda ameliyat öncesi iyi bir değerlendirme ve risk oranını düşürmek için solunumsal tedavi gerekmektedir.

Keywords

• Kardiyopulmoner baypas,solunum fonksiyon testi,spirometri testi,kronik obstrüktif akciğer hastalığı,koroner arter baypas cerrahisi,açık kalp cerrahisi

Effect of Pulmonary Function Tests on Mortality and Morbidity Associated with Open Heart Surgery Performed with Cardiopulmonary Bypass

Abstract

Introduction: We aimed to evaluate the relationship of mortality and morbidity associated with normal and low pulmonary function test results of patients undergoing open cardiac surgery.

 

Patients and Methods: Sixty patients who underwent open cardiac surgery between May 2018 and September 2018 were included in the study. Patients were divided into two groups: Group 1 (n= 30) included patients with low pulmonary function test results and Group 2 (n= 30) included patients with normal pulmonary function test results. Cardiopulmonary bypass (CPB) was used in all patients who underwent open cardiac surgery. Patients who underwent emergency surgery and who could not undergo respiratory function tests for contraindicated reasons were excluded from the study. Surgical procedures were same in both the groups. Comparison was made using preoperative demographic data, intraoperative surgical data, postoperative hemodynamic data, intubation process data, inotropic support use and duration, complication status, intensive care unit and day care unit stays, and mortality.

 

Results: Mortality rate was similar in both the groups (p= 1.000). Extubation time and inotropic support time was longer in Group 1 than in Group 2 but was not statistically significant (p= 0.170). However, respiratory complications were more common in Group 1 [n= 10 (33.33%) in Group 1; n= 6 (20%) in Group 2; p value= 0.125]. Non-invasive ventilation requirement using continuous positive airway pressure was more common in Group 1 than in Group 2 (p= 0.043). Life-threatening supraventricular arrhythmia and new-onset atrial fibrillation was more common in Group 1 than in Group 2 (p= 0.049).

 

Conclusion: Early period mortality is not affected so much in the patients with low pulmonary function test results who are undergoing open heart surgery with CPB. Nevertheless respiratory complications and life threatening arrhythmias are more common in this group of patients. Preoperative, detailed examination and respiratory interventions are necessary and useful to reduce the risk of operation.

Keywords

• Cardiopulmonary bypass,respiratory function test,spirometry,chronic obstructive pulmonary disease,coronary artery bypass surgery,open heart surgery

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