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

Yıl 2019, Cilt: 22 Sayı: 2, 85 - 90, 15.08.2019

Hakan Saçlı Mevriye Serpil Diler

Öz

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.

Anahtar Kelimeler

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• 1. Ovalı C, Şahin A. Chronic obstructive pulmonary disease and off-pump coronary surgery. Ann Thorac Cardiovascular Surg 2018;24:193-9.
• 2. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstrucctive Lung Disease (GOLD) 2017. Available from: http://goldcopd.org-2017-global-strategy-diagnosis-manage-ment-preventşon-copd/.
• 3. Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. The European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothrac Surg 1999;16:9-13.
• 4. Biancari F, Vasques F, Mikkola R, Martin M, Lahtinen J, Heikkinen J. Validation of EuroSCORE II in patients undergoing coronary artery bypass. Ann Thorac Surg 2012;93:1930-5.
• 5. Viceconte M, Rocco IS, Pauletti HO, Vidotto M, Arena R, Gomes WJ, et al. Chronic obstructive pulmonary disease severity influences outcomes after off-pump coronary artery bypass. J Thorac Cardiovasc Surg 2018;156:1554-61.
• 6. Güler M, Kırali K, Toker ME, Bozbuğa N, Ömeroğlu SN, Akıncı E, et al. Different CABG methods in patients with chronic obstructive pulmonary disease. Ann Thorac Surg 2001;71:152-7.
• 7. Kocabaş A. Kronik obstrüktif akciğer hastaliği epidemiyolojisi ve risk faktörleri. TTD Toraks Cerrahisi Bülteni 2010;1:105-13.
• 8. Hattler BG, Madia C, Johnson C, Armitage JM, Hardesty RL, Kormos RL, et al. Risk stratification using the Society of Thoracic Surgeons Program. Ann Thorac Surg 1994;58:1348-52.
• 9. Özkurt S, Bostancı M, Altın, R, Özşahin A, Akdağ B. Tıp fakültesi çalışanlarında sigara içme prevalansı, nikotin bağımlılığı ve solunum fonksiyon testleri. Tuberk Toraks 2000;48:140-7.
• 10. Hankinson JL, Odencrantz JR, Fedan KB. Spirometric reference values from a sample of the general US population. Am J Respir Crit Care Med 1999;159:179-87.
• 11. Shahian DM, O’Brien SM, Sheng S, Grover FL, Mayer JE, Jacobs JP, et al. Predictors of long-term survival after coronary artery bypass grafting surgery: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (the ASCERT study) Circulation 2012;125:1491-500.
• 12. Braun SR, Birnbaum ML, Chopra PS. Pre and postoperative pulmonary function abnormalities in coronary artery revascularization surgery. Chest 1978;73:316-20.
• 13. Savas Oz B, Kaya E, Arslan G, Karabacak K, Cingoz F, Arslan M. Pre-treatment before coronary artery bypass surgery improves post-operative outcomes in moderate chronic obstructive pulmonary disease patients. Cardiovasc J Afr 2013;24:184-7.
• 14. Fuster RG, Argudo JA, Albarova OG, Sos FH, Lopez SC, Codoner MB, et al. Prognostic value of chronic obstructive pulmonary disease in coronary artery bypass grafting. Eur J Cardiothorac Surg 2006;29:202-9.
• 15. Türkay C, Akbulut E, Özbudak Ö, Gölbaşı İ, Şahin N, Mete A, et al. Koroner bypass cerrahisi uygulanan hastalarda kronik obstrüktif akciğer hastalığının mortalite ve morbiditeye etkisi. Turk Gogus Kalp Dama 2000;8:678-81.
• 16. Ng CS, Arifi AA, Wan S, Ho AM, Wan IY, Wong EM, et al. Ventilation during cardiopulmonary bypass: impact on cytokine response and cardiopulmonary function. Ann Thorac Surg 2008;85:154-62.
• 17. John LC, Ervine IM. A study assessing the potential benefit of continued ventilation during cardiopulmonary bypass. Interact Cardiovasc Thorac Surg 2008;7:14-7.
• 18. Bignami E, Guarnieri M, Saglietti F, Belletti A, Trumello C, Giambuzzi I, et al. Mechanical ventilation during cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2016;30:1668-75.
• 19. van Belle AF, Wesseling GJ, Penn OC, Wouters EF. Postoperative pulmonary function abnormalities after coronary artery bypass surgery. Respir Med 1992;86:195-9.
• 20. Metersky ML, Wang Y, Klompas M, Eckenrode S, Bakullari A, Eldridge N. Trend in ventilator-associated pneumonia rates between 2005 and 2013. JAMA 2016;316: 2427-9.
• 21. Incalzi RA, Pistelli R, Fuso L, Cocchi A, Bonetti MG, Giordano A. Cardiac arrhythmias and left ventricular function in respiratory failure from chronic obstructive pulmonary disease. Chest 1990;97:1092-7.
• 22. Manganas H, Lacasse Y, Bourgeois S, Perron J, Dagenais F, Maltais F. Postoperative outcome after coronary artery bypass grafting in chronic obstructive pulmonary disease. Can Respir J 2007;14:19-24.
• 23. Saleh HZ, Mohan K, Shaw M, Al-Rawi O, Elsayed H, Walshaw M, et al. Impact of chronic obstructive pulmonary disease severity on surgical outcomes in patients undergoing non-emergent coronary artery bypass grafting. Eur J Cardiothorac Surg 2012;42:108-13.
• 24. Samuels LE, Kaufman MS, Morris RJ, Promisloff R, Brockman SK. Coronary artery bypass grafting in patients with COPD. Chest 1998;113:878-82.