Acute Renal Failure Following Coronary Artery By-Pass Surgery: Perioperative Risk Factors

Yıl 2009, Cilt: 12 Sayı: 1, 10 - 17, 01.01.2008

Mustafa Saçar Gökhan Önem Yal›n Tolga Yaylal› İbrahim Susam Fahri Adal› Ahmet Baltalarl›

Öz

Objective: Morbidity and mortality rates due to acute renal failure (ARF) developed in the postoperative period in patients undergoing coronary artery by-pass surgery (CABG), are increasing. After the determination of risk factors for the development of ARF in the perioperative period, treatment strategies to prevent the development of ARF can be implemented. Methods: Three hundred and nine patients who had undergone isolated CABG between May 2005 and December 2006 were included in the study. Patients' data registered in the preoperative, intra-operative, and postoperative periods were collected in the electronic media. Factors possibly affecting the development of ARF in the postoperative period were determined by univariate analysis. Later, the independent risk factors affecting the development of ARF were determined by multivariate analysis. Results: Univariate analysis showed that there was a relation between old age, low ejection fraction (EF) in the preoperative period, presence of COPD, high preoperative serum creatinine levels, long CPB duration, the requirement of intra-operative inotropic support, the amount of postoperative mediastinal drainage, peak creatinine levels, the amount of blood transfusions and postoperative ARF development. At the end of the evaluation of these factors with multivariate analysis; old age, high creatinine levels in the preoperative period, the requirement of inotropic support during the operation and increased amounts of postoperative mediastinal drainage were found to be independent risk factors for the development of ARF. Conclusions: ARF development is found to be higher in patients with old age, low EF, impaired preoperative renal functions. We suggest that implementing a close follow up with appropriate measures for these patients can decrease the risk of ARF development postoperatively.

Anahtar Kelimeler

Coronary artery bypass surgery, acute renal failure, ICU

Koroner Baypas Cerrahisi Sonras›nda Görülen Akut Böbrek Yetmezli¤i: Perioperatif Risk Faktörleri

Öz

Amaç: Koroner Baypas cerrahisi sonras›nda geliflen akut böbrek yetmezli¤ine (ABY) ba¤l› olarak mortalite ve morbidite oran› giderek art›fl göstermektedir. Perioperatif dönemde ABY geliflimine neden olabilecek risk faktörlerinin belirlenmesi ile ABY gelifliminin önlenmesi ve tedavisine yönelik stratejiler gelifltirilebilmektedir. Yöntemler: May›s 2005 – Aral›k 2006 tarihleri aras›nda izole koroner baypas cerrahisi uygulanan 309 hasta çal›flmaya dahil edildi. Operasyon öncesindeki, operasyon esnas›ndaki ve operasyon sonras›ndaki hasta verileri bilgisayar kay›t sistemi ile topland›. Postoperatif dönemde ABY geliflimine neden olabilecek faktörler univaryans analiz ile saptand›. Ard›ndan ABY geliflimine neden olabilecek ba¤›ms›z risk faktörleri multivaryans analiz ile belirlendi. Bulgular: Univaryans analiz sonucunda ileri yafl, ameliyat öncesindeki düflük ejeksiyon fraksiyonu, KOAH varl›¤›, serum kreatinin yüksekli¤i, Kardiyopulmoner baypas süresinin uzamas›, ameliyat esnas›nda Amaç: Koroner Baypas cerrahisi sonras›nda geliflen akut böbrek yetmezli¤ine (ABY) ba¤l› olarak mortalite ve morbidite oran› giderek art›fl göstermektedir. Perioperatif dönemde ABY geliflimine neden olabilecek risk faktörlerinin belirlenmesi ile ABY gelifliminin önlenmesi ve tedavisine yönelik stratejiler gelifltirilebilmektedir. Yöntemler: May›s 2005 – Aral›k 2006 tarihleri aras›nda izole koroner baypas cerrahisi uygulanan 309 hasta çal›flmaya dahil edildi. Operasyon öncesindeki, operasyon esnas›ndaki ve operasyon sonras›ndaki hasta verileri bilgisayar kay›t sistemi ile topland›. Postoperatif dönemde ABY geliflimine neden olabilecek faktörler univaryans analiz ile saptand›. Ard›ndan ABY geliflimine neden olabilecek ba¤›ms›z risk faktörleri multivaryans analiz ile belirlendi. Bulgular: Univaryans analiz sonucunda ileri yafl, ameliyat öncesindeki düflük ejeksiyon fraksiyonu, KOAH varl›¤›, serum kreatinin yüksekli¤i, Kardiyopulmoner baypas süresinin uzamas›, ameliyat esnas›nda Amaç: Koroner Baypas cerrahisi sonras›nda geliflen akut böbrek yetmezli¤ine (ABY) ba¤l› olarak mortalite ve morbidite oran› giderek art›fl göstermektedir. Perioperatif dönemde ABY geliflimine neden olabilecek risk faktörlerinin belirlenmesi ile ABY gelifliminin önlenmesi ve tedavisine yönelik stratejiler gelifltirilebilmektedir. Yöntemler: May›s 2005 – Aral›k 2006 tarihleri aras›nda izole koroner baypas cerrahisi uygulanan 309 hasta çal›flmaya dahil edildi. Operasyon öncesindeki, operasyon esnas›ndaki ve operasyon sonras›ndaki hasta verileri bilgisayar kay›t sistemi ile topland›. Postoperatif dönemde ABY geliflimine neden olabilecek faktörler univaryans analiz ile saptand›. Ard›ndan ABY geliflimine neden olabilecek ba¤›ms›z risk faktörleri multivaryans analiz ile belirlendi. Bulgular: Univaryans analiz sonucunda ileri yafl, ameliyat öncesindeki düflük ejeksiyon fraksiyonu, KOAH varl›¤›, serum kreatinin yüksekli¤i, Kardiyopulmoner baypas süresinin uzamas›, ameliyat esnas›nda inotropik destek gereksinimi, ameliyat sonras›nda mediastinal drenaj miktar›, pik kreatinin seviyesi, kan transfüzyon miktar› ile postoperative ABY geliflimi iliflkili bulunmufltur. Bu faktörlerin multivaryans analiz ile de¤erlendirilmeleri sonucunda ileri yafl, operasyon öncesindeki yüksek kreatinin düzeyi, ameliyat esnas›ndaki inotropik destek gereksinimi ve ameliyat sonras›nda mediastinal drenaj miktar› ABY gelifliminde ba¤›ms›z risk faktörleri olarak belirlendi. Sonuç: Operasyon öncesinde renal foksiyonlar› s›n›rda olan, ileri yafltaki ve düflük ejeksiyon fraksiyonu olan hastalarda ABY geliflimi daha s›k görülmektedir. Bu hastalarda uygun destek tedavileri ile ABY gelifliminin önüne geçilebilece¤ini düflünüyoruz.

Anahtar Kelimeler

Koroner arter baypas cerrahisi, Akut böbrek yetmezli¤i, Yo¤un bak›m ünitesi

Kaynakça

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