Adölesan idiyopatik skolyoz cerrahisinde cell saver kullanımının etkinliği

Öz

Amaç:Bu çalışmanın amacı adölesan idiyopatik skolyoz hastalarının pedikül vidası ve rod kombinasyonu ile cerrahi tedavisinde otolog kan transfüzyonu cell saver yönteminin allojenik kan replasmanı üzerine etkisini araştırmaktı.

Çalışma planı: Adölesan idiyopatik skolyoz nedeniyle ameliyat edilen 33 hasta (5 erkek, 28 kadın) çalışmaya alındı. Cell saver kullanılan 16 hasta (ortalama yaş: 17.1±3.9; Grup A) ve kontrol amaçlı, cell saver kullanılmayan 17 hasta (ortalama yaş: 18.7±6.8; Grup B) olmak üzere iki grup oluşturuldu. Hastaların Cobb açıları, pedikül tespit seviyeleri, operasyon süreleri, operasyon sonrası drenajları, hemoglobin değişimleri, allojenik kan replasmanları ve otolog eritrosit miktarları kaydedildi.

Bulgular: Her iki grupta tespit edilen omur seviyeleri 12.9±1.54 (Grup A), 12.8±1.47 (Grup B) ve kullanılan vida sayıları 21.1±3.21 (Grup A), 18.7±3.59 (Grup B) idi (p>0.05). Ortalama ameliyat süresi 224 dakika, gruplara göre dağılımı 228±58 (Grup A), 221±60 (Grup B) dakika olarak kaydedildi. Demografik özellikler açısından iki grup arasında istatistiksel olarak anlamlı bir farklılık saptanmadı (p>0.05). Ameliyat öncesi iki grup arasındaki hemoglobin değerleri 12.2±1.47 mg/dl (Grup A) ve 13.1±1.56 mg/dl (Grup B) iken, operasyon sonrası hemoglobin değerleri ise 11.3±1.62 mg/dl (Grup A) ve 9.86±0.93 mg/dl (Grup B) olarak bulundu (p=0.004). Otolog eritrosit replasman miktarı 284±139 ml olarak kaydedildi. Operasyon sonrası birinci günde meydana gelen drenaj miktarı 834±253 ml (Grup A), 759±380 ml (Grup B) idi (p>0.05). Hastalara verilen toplam allojenik kan replasman miktarı 1.88±0.88 ünite (Grup A) ve 1.94±1.34 ünite (Grup B) olarak ölçüldü (p>0.05).

Çıkarımlar: Adölesan idiyopatik skolyozun cerrahi tedavisinde cell saver kullanımı ile otolog eritrosit transfüzyonu yapılabilmesine rağmen allojenik kan replasman miktarında anlamlı azalma sağlanamamaktadır.

Anahtar Kelimeler

• Adölesan idiyopatik skolyoz; allojenik kan replasmanı; cell saver; eritrosit replasmanı

The efficacy of cell saver method in the surgicaltreatment of adolescent idiopathic scoliosis

Öz

Objective:The aim of the study was to evaluate the efficacy of the intraoperative blood salvage cell saver method for allogeneic blood transfusion in the surgical treatment of adolescent idiopathic scoliosis with pedicle screw and rod combination.

Methods: The study included 33 patients (5 males and 28 females) who underwent surgery due to adolescent idiopathic scoliosis. Patients were divided into 2 groups; 16 patients (mean age: 17.1±3.9 years) in Group A were operated using the cell saver (Medtronic Autolog; autologous cell saver machine) method and the 17 patients (mean age 18.7±6.8 years) in Group B (control group) were treated without cell saver. The Cobb angle, levels of pedicle fixation, operation time, postoperative bleeding, hemoglobin change, allogeneic blood replacement and the amount of autologous erythrocytes were recorded.

Results: Mean level of pedicle fixation was 12.9±1.54 vertebra using a mean of 21.1±3.21 screws in Group A and 12.8±1.47 vertebra using 18.7±3.59 screws in Group B (p>005). The mean operation time was 224 (Group A: 228±58; Group B: 221±60) minutes. There were no statistically significant differences in the demographic characteristics of both groups (p>0.05). The preoperative mean hemoglobin levels were 12.2±1.47 mg/dl in Group A and 13.1±1.56 mg/dl in Group B. Postoperative mean hemoglobin level was 11.3±1.62 mg/dl in Group A and 9.86±0.93 mg/dl in Group B (p=0.004). The mean amount of autologous erythrocyte replacement was 284±139 ml. The mean postoperative bleeding was 834±253 ml in Group A and 759±380 ml in Group B (p>0.05). The mean allogeneic blood replacement was 1.88±0.88 units in Group A and 1.94±1.34 in Group B (p>0.05).

Conclusion: Autologous erythrocyte replacement was possible using the cell saver method. However, there was no decrement in allogeneic blood replacement using cell saver in the surgical treatment of adolescent idiopathic scoliosis.

Anahtar Kelimeler

• Adolescent idiopathic scoliosis
• allogeneic blood transfusion
• cell saver
• erythrocyte replacement

Kaynakça

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