Koroner Arter Baypas Cerrahisi Sırasında Yapılan Kan Transfüzyonunun Hastane Mortalitesi Üzerine Etkisi

Abstract

Giriş: Kan transfüzyonu kalp cerrahisinde hayat kurtarıcı olabildiği gibi ölümcül de olabilmektedir. Son yıllarda kan ürünlerinin kullanımının azaltılması yönünde deliller artmıştır. Kan ürünlerinin hem erken dönem hem de geç dönem artmış mortalite ile birlikteliğini destekleyen pek çok yazı mevcut. Ancak transfüzyonun açık kalp cerrahisi uygulanan hastalarda hangi aşamada daha tehlikeli olduğuna dair delil az bulunmaktadır. Bu sebeple biz intraoperatif kan transfüzyonu uygulanmış hastalarda görülen mortalite oranı ile postoperatif kan transfüzyonu uygulanmış hastalarda görülen mortaliteyi kıyasladık. Hastalar ve Yöntem: Çalışma Nisan 2008 ve Şubat 2013 tarihlerinde 108 (%78.8)’i erkek, 29 (%21.2)’u kadın olmak üzere toplam 137 olgu ile yapılmıştır. Çalışmaya dahil ettiğimiz hastalarda kardiyopulmoner baypas (KPB) sırasında hedef hematokrit %20-25 KPB sonrasıda hedef %25-%30 olarak belirlendi. Postoperatif dönemde hastalarımızda eğer anemiye sekonder semptom yok ise hedef hematokrit %26’nın üzeri olarak belirlendi. Ancak semptomatik hastalarda semptom giderilmesi hedeflendi. Taze donmuş plazma (TDP) sadece hacim genişletmek için değil ayrıca koagülapatinin düzeltilmesi içinde kullanıldı. Anemi düzeltilmesi için sadece eritrosit süspansiyonu (ES) transfüzyonu sağlandı. Bulgular: Çalışma 108 (%78.8)’i erkek, 29 (%21.2)’u kadın olmak üzere toplam 137 olgu ile yapılmıştır. Olguların yaşları 36 ile 82 yıl arasında değişmekte olup, ortalama yaş 60.88 ± 9.84 yıldır. Olguların 109 (%79.6)’u yaşamakta iken, 28 (%20.4)’i eksitus olmuştur. Operasyon sırasında kullanılan eritrosit miktarı iki ve daha fazla olduğunda eksitusu öngörmedeki duyarlılığı %46.43, özgüllüğü %81.65, pozitif kestirim değeri %36.39 ve negatif kestirim değeri %85.58 saptanmıştır. Sonuç: Baypas uygulanan hastalarda intraoperatif transfüzyon hastane mortalitesi üzerine olumsuz etkisi mevcut. Bu haliyle peroperatif dönemde tranfüzyondan kaçınmak için gerekli önlemlerin alınması uygun olur.

Keywords

• Kan transfüzyonu,kalp cerrahisi,mortalite

Effects of Blood Transfusion on Hospital Mortality During Coronary Artery Bypass Grafting

Abstract

Introduction: Blood transfusion in cardiac surgery patients may cause mortality although it is a life saver under specific conditions. Recently published papers advocate that reduction in blood products due to transfusion caused early and long-term mortality. In cardiac surgery patients, it is unclear as to which period of perioperative transfusion is more hazardous. Here, we studied perioperative mortality according to transfusion. Patients and Methods: A total of 137 patients (29 female) were enrolled between April 2008 and February 2013. Target hematocrit levels during cardiopulmonary bypass were (HTC) 20%-25%, and post cardiopulmonary bypass target hematocrit levels were 25%-30%. During postoperative follow-up, transfusion was performed if patients had symptoms due to anemia. Otherwise, the lowest postoperative target hematocrit level was 26%. Fresh frozen plasma was used either for volume expansion or for coagulopathy correction. For anemia correction, only erythrocyte suspension was used. Results: A total of 137 patients participated in this study. Of those 137, 108 were male (78.8%). The mean age of the patients in the study group was 60.88 ± 9.84 (range, 36-82) years. Hospital mortality was observed in 28 (20.4%) patients. Intraoperative 2 or more transfusion of erythrocyte suspension has 81.65% specificity and 46.43% sensitivity to predicts mortality. Conclusion: Intraoperative transfusion during cardiopulmonary bypass negatively affects hospital mortality. Hence, necessary precautions should be taken to avoid transfusion.

Keywords

• Blood transfusion,cardiac surgery,mortality

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