Perioperative Use of Ultrafiltration in Patients with Chronical Renal Failure During Open Heart Surgery

Yıl 2008, Cilt: 13 Sayı: 3, 176 - 178, 01.06.2008

Ali Vefa Özcan İbrahim Gökşin Erkin Ocak Serper Pazarcıkcı Fahri Adalı

Öz

Objectives: Chronic renal failure patients who undergo open heart surgery have high morbidity and mortality rates in the postoperative period because of volume loading and electrolyte imbalance. In this study, we performed perioperative hemodiafiltration in our patients with chronic renal failure during open heart surgery and aimed to present our clinical results. Materials and Method: This is a retrospective study including 15 open heart surgery patients who were on the regular dialysis schedule before the operation. Mean age was 59. F/M = 3/12. Distributions of the operations were 13 CABG, 1 MVR and 1 AVR. Ultrafilter was tied on arterial line of pump and was used along with CPB. Mean withdrawed ultrafiltrate fluid was 3800 ml. Results: Mean cross clamp time was 83 min. Postoperative mean drainage was 725 ml/day. Cardiac tamponade occured in 1 patient, 2 had süperficial wound infection and 1 patient had postop pnomonia. Mean extubation time was 12h. Intensive care staying time was 4 days. Hospital staying time was 12.0 days. Mean number of blood transfusion was 4U. Hemodialysis was achieved in 1 of the patients (6.66%) postoperative 1st day, in 4 of them (26.66%) postoperative 2nd day, in 7 of the patients (46.66%) postoperative 3rd day, in 2 patients (13.33%) postoperative 4th day. Mortality was seen on 2 patients (13.33%) who were performed CABG in the early post operative period and 1(6.66%) patient who was performed CABG dead on postoperative 10th day. Conclusion: Surgery mortality rates, postoperative wound healing and systemic infection rates are acceptable belonging to administration of ultrafiltration during open heart surgery. Extubation time, intensive care staying time and hospitalization times are almost standart rates. ©2008, Firat University, Medical Faculty

Anahtar Kelimeler

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Açık Kalp Cerrahisi Sırasında Kronik Böbrek Yetmezlikli Hastalara Ultrafiltrasyon Uygulanması

Öz

Amaç: Kronik böbrek yetmezlikli açık kalp cerrahisi geçiren hastalar, ameliyat sonrası dönemde hem volüm yükü hem de elektrolit embalansı nedeniyle yüksek mortalite ve morbiditeye sahiptir. Bu çalışmada açık kalp cerrahisi yaptığımız diyaliz hastalarında, ameliyat sırasında ultrafiltrasyon uyguladık ve klinik sonuçlarımızı sunmayı amaçladık. Gereç ve Yöntem: Bu çalışma, ameliyat öncesi dönemde düzenli diyaliz programında olan ve açık kalp cerrahisi uyguladığımız 15 hastayı içeren retrospektif bir çalışmadır. Hastaların yaş ortalaması 59, K/E = 3/12. 13 hastaya CABG, 1'ine MVR 1'üne AVR, yapıldı. Kardiyopulmoner baypas süresince arteryel hat üzerine ultrafiltrat bağlandı ve ortalama 3800 ml mayi çekildi. Bulgular: Ortalama kros klemp süresi 83 dk ve operasyon sonrası ilk 24 saatlik drenaj 725.0 ml idi. Hastaların 1'inde kardiyak tamponat, 2'inde yüzeyel yara yeri enfeksiyonu, 1'inde ameliyat sonrası pnömoni gelişti. Ortalama ekstübasyon süresi 12 saat, yoğun bakımda kalış süresi 4 gün, hastanede kalış süresi 12.0 gündü. Ortalama 4 Ünite kan transfüzyonu yapıldı. Hastaların 1'ine (% 6.66) postop 1. gün, 5'ine (% 33.33) postop 2. gün, 7'ine (% 46.66) postop 3.gün, 2'ine (% 13.33) postop 4. gün hemodiyaliz uygulandı. 2 hastada (% 13.33) erken postop dönemde, 1 hastada (% 6.66) postop 10. günde mortalite görüldü. Sonuç: Açık kalp cerrahisi sırasında ultrafiltrasyon uygulanması ile cerrahi mortalite oranı, ameliyat sonrası yara iyileşmesi ve sistemik enfeksiyon oranları kabul edilebilir sınırlardadır. Ekstübasyon süresi, yoğun bakımda kalma ve hastanede kalma süreleri neredeyse standart oranlardadır.©2008, Fırat Üniversitesi, Tıp Fakültesi

Anahtar Kelimeler

Açık kalp cerrahisi, kronik böbrek yetmezliği, ultrafiltrasyon

Kaynakça

• Erek E, Süleymanlar G, Serdengeçti K. Türkiye’de Nefroloji- Dializ ve Transplantasyon (Registry-2006), Türk Nefroloji Derneği Yayınları. Yorum Danışmanlık – İstanbul , 2007.
• Coladonato JA, Griffith TF, Owen WF. Yoğun bakım uygulamalarında dializ tedavisi. In: Irwin RS, Rippe JM, Curley FJ, Heard SO. Yoğun bakımda girişimler ve teknikler. Çeviri editörü, Yelken BB. 3.baskı, Nobel matbaacılık. 2005, p:263-285.
• Patient Registration Committee, Japanese Society for Dialysis Therapy. An overview of regular dialysis treatment in Japan as of 31 December 2003. Ther Apher Dial 2005; 9: 431-458.
• Foley RN, Parfrey PS, Sarnak MJ: Cardiovascular disease in chronic renal disease. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998; 32: 112– 19.
• Magilligan DJ. Indications for ultrafiltration in the cardiac surgical patient.J Thorac Cardiovasc Surg 1985;89:183-189.
• Klineberg PL, Kam CA, Johnson DC, Cartmill TB, Brown JH. Hematocrit and blood volume control during cardiopulmonary bypass with the use of hemofiltration. Anesthesiology 1984; 60: 478-480.
• Journois D, Pouard P, Greeley WL, et al. Hemofiltration during cardiopulmonary Anesthesiology 1994; 81: 1181-1189. pediatric cardiac surgery.
• Luciani GB, Menon T, Vecchi B, Auriemma S, Mazzucco A. Modified ultrafiltration reduces morbidity after adult cardiac operations: a prospective, randomized clinical trial. Circulation 2001; 104: I253-1259.
• Kaul TK, Fields BL, Reddy MA, Kahn DR. Cardiac operations in patients with end-stage renal disease. Ann Thorac Surg 1994; 57: 691-696.
• Kamohara K, Yoshikai M, Yunoki J, et al. Safety of perioperative hemodialysis and continuous hemodiafiltration for dialysis patients with cardiac surgery. Gen Thorac Cardiovasc Surg 2007; 55: 43- 49.
• Ariyoshi T, Eishi K, Yamachika S, et al. Perioperative and mid- term results of coronary bypass surgery in patients undergoing chronic dialysis. Ann Thorac Cardiovasc Surg 2006;12: 257-264.
• Onoe M, Magara T, Yamamoto Y, Nojima T. Modified ultrafiltration removes serum interleukin-8 in adult cardiac surgery. Perfusion 2001; 16: 37-42.
• Osipov V, Lurie G, Khodas M, et al. Hemoconcentration during open heart operations. Thorac Cardiovasc Surg 1985; 3: 81-85.
• Elliott MJ. Ultrafiltration and modified ultrafiltration in pediatric open heart operations. Ann Thorac Surg 1993; 56: 1518-1522.
• Kınıoğlu B, Güden M, Kızıltan T ve ark. Yenidoğan ve infant açık kalp cerrahisinde intraoperatif ultrafiltrasyon uygulanması. GKDCD 1996; 1: 36-40.
• Ko W, Kreiger KH, Isom AV. Cardiopulmonary bypass procedures in dialysis patients. Ann Thorac Surg 1986; 42: 12-15.
• Kabul Tarihi:15.05.2008