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

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