The role of N-acetyl cystein for myocardial reperfusion damage protection, in patients who was performed coronary artery bypass surgery

Abstract

Objective: In this study we researched prevention of ischemic reperfusion damage by adding N-acetyl-cystein to primary cardioplegy solution in patients underwent coronary artery bypass surgery with cardiopulmonary bypass. Method: In this study, 60 patients 43 male, 17 female were enrolled who were performed coronary artery bypass surgery with cardiopulmonary bypass at vascular sugery clinic. Consecutively patients divided as 30 patients for study and 30 patients for control groups. 300 mg N-acetyl cystein added to study group’s cardioplegy solution. Myocardial damage markers CK-MB, troponin were obtained from patients pre and postoperatively. Patients followed for postoperative inotrpe need and developing arytmia. Results: There was no statistical significance in comparison of demografic datas, preoperative accompanying risc factors, left ventricule ejection fraction, hemoglobine levels of patients’ of the study. Comparing 24th and 48th hour plasma CK-MB levels and 6th, 12th, 24th and 48th hours troponine levels, study group’s levels were lower than control group.This difference was stastisticaly significant. Postoperative inotropic support need and incidance of aritmia was was lower in the study group, and this was statisticaly significant. Conclusion: Reperfusion damage decreases in patients who underwent coronary artery bypass surgery with cardiopulmonary bypass by adding 300 mg N-acetyl cystein. Further research is needed for detecting most effective procedure about myocardial protection.

Keywords

• Coronary artery bypass surgery,myocardial protection,n-acetyl cysteine

Koroner arter bypass cerrahisi uygulanan hastalarda n-asetil sisteinin miyokardiyal reperfüzyon hasarını önlemedeki rolü

Abstract

AMAÇ: Bu çalışmada kardiyopulmoner bypass ile koroner arter bypass cerrahisi yapılan hastalarda gelişen iskemi reperfüzyon hasarının başlangıç kardiyopleji solüsyonuna eklenen N-asetil sistein ile önlenmesi araştırıldı.YÖNTEMLER: Bu çalışma damar cerrahisi kliniğinde kardiyopulmoner bypass eşliğinde elektif koroner arter bypass cerrahisi yapılan 60 hasta 43 erkek, 17 kadın dahil edildi. Ek kardiyak cerrahi girişim planlanan hastalar, sol ventrikül ejeksiyon fraksiyonu < 30 olan hastalar, acil vakalar, karaciğer ve renal fonksiyon bozukluğu olan, 80 yaş ve üzeri hastalar çalışmaya alınmadı. Ardışık olarak hastalar 30’u kontrol, 30’u çalışma grubu olarak ayrıldı. Çalışma grubuna kardiyopleji solüsyonuna 300 mg N-asetil sistein eklendi. Hastalardan preoperatif, postoperatif kan örnekleri alınarak myokardiyal hasar belirteçleri CK-MB, troponin çalışıldı. Hastalar postoperatif inotrop ihtiyacı ve aritmi gelişimi yönünden izlendi.BULGULAR: Çalışmaya alınan hastaların demografik verileri, preoperatif eşlik eden risk faktörleri, sol ventrikül ejeksiyon fraksiyonu, hemoglobin değerleri açısından istatistiksel anlamlı farklılık yoktu. Çalışma grubu ile kontrol grubu kıyaslandığında miyokardiyal hasar belirteçlerinden Çalışmaya alınan hastaların demografik verileri, preoperatif eşlik eden risk faktörleri, sol ventrikül ejeksiyon fraksiyonu, hemoglobin değerleri açısından istatistiksel anlamlı farklılık yoktu. Çalışma grubu ile kontrol grubu kıyaslandığında miyokardiyal hasar belirteçlerinden CK-MB düzeyleri 24. ve 48. saatlerde, troponin düzeyleri ise 6. 12. 24. ve 48. saatlerde istatistiksel olarak düşük bulundu. Postoperatif inotropik destek ihtiyacı ve aritmi görülme sıklığı çalışma grubunda istatistiksel olarak anlamlı olmak üzere daha az bulundu.SONUÇ: Kardiyopulmoner bypass eşliğinde koroner arter bypass cerrahisi yapılan hastalarda kardiyopleji solüsyonlarına 300 mg N-asetil sistein eklenmesi ile reperfüzyon hasarı oluşumu azaltılmaktadır. Miyokardiyal korunma yöntemleri hakkında en etkin yöntemin saptanması için geniş çapta daha fazla çalışmaya ihtiyaç vardır.

Keywords

• Koroner arter bypass cerrahisi, miyokardiyal koruma, n-asetil sistein.

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