Açık kalp cerrahisi uygulanan siyanoti/non-siyanotik konjenital kalp hastalıklarında modifiye ultrafiltrasyonun postoperatif karaciğer ve böbrek fonksiyonları üzerine etkisi: Retrsopektif çalışma

Öz

Amaç: Pediatrik kardiyopulmoner baypas total vücut sıvında ve damar geçirgenliğinde artmaya neden olur. Dokular aralarına sızan bu sıvı organ fonksiyonlarında bozulmalara neden olmaktadır. Modifiye ultrafiltrasyon çocuklarda kardiyopulmoner baypasa bağlı oluşan toplam vücut sıvı artışının neden olduğu organ fonksiyon bozukluklarını önlemek amacıyla geliştirilmiştir. Bu çalışmada amacımız konjenital kalp hastalığı nedeni ile kardiyopulmoner baypas kullanılarak opere edilen siyanotik ve siyanotik olmayan çocuklarda MUF kullanımının karaciğer ve böbrek fonksiyonları üzerine etkisiniaraştırmaktı. Gereç ve Yöntemler: Ocak 2009 ile ağustos 2011 yılları arasında Ankara Üniversitesi Tıp Fakültesi Kalp ve damar cerrahisi kliniğinde opere edilen modifiye ultrafiltrasyon kullanılan (grup 1) n:63, kullanılmayan (grup 2) n:31 toplam 93 hasta çalışmaya dahil edildi. Daha önceden bilinen operasyon ve organ fonksiyon bozukluğu olan, acil şartlarda operasyona alınan, sistemik ve otoimmün hastalığı olan ve kompleks kardiyak anomali nedeni ile parsiyel düzeltme yapılan hastalar çalışmaya dahil edilmedi. Organ fonksiyonlarının değerlendirilmesi amacıyla operasyon öncesinde ve sonrasında kan örnekleri alındı. Hastalar operasyon sonrası ilk 8 ve 24.saat idrar miktarı, drenaj miktarı, diüretik kullanımı, inotrop kullanımı, kan ve kan ürünü kullanımı, diyaliz ihtiyacı ve mortalite açısından retrospektif olarak incelendi. Bulgular: Preoperatif verileri ve operasyon verileri açısından gruplar benzerdi. Grup 1 için kreatinin düzeyinin operasyon sonrasında yüzde değişim oranı %56,5, grup 2 için %25,8 olarak hesaplandı. Vücut yüzey alanına göre univaryant analizde anlamlı olarak bulundu. (p:0,031<0,05) Total protein değerlerinin operasyon sonrası değişim yüzdesi (-)%6,5, grup 2 için (-)%5,5 olarak hesaplandı. Bu sonuçlar istatistiksel olarak anlamlı bulundu. (p:0,04<0,05) Albümin düzeylerindeki yüzde değişim oranı açısından grup1 (-)%18,2, grup 2 için (-)%13,4 olarak hesaplandı. Bu değişimler vücut yüzey alanına göre yeniden univaryant analiz ile değerlendirildiğinde anlamlı istatsitiksel fark saptandı (p=0,05). Grup 1 için dializ ihtiyacı olan hasta sayısı 2, Grup 2 için 4 hasta olarak bulundu. Bu sonuç istatistiksel olarak anlamlı bulundu (p=0,05). Mortalite grup1 için 4 hasta, grup 2 için 1 hasta olarak bulundu. Mortalite açısından gruplar arasında anlamlı istatistiksel fark hesaplanmadı (p>0,05). Sonuç: Pediatrik açık kalp cerrahisinde modifiye ultrafiltrasyonun kullanımının böbrek yetmezliği gelişimini azalttığı ve karaciğer fonksiyonlarını koruduğunu düşünmekteyiz.

Anahtar Kelimeler

• modifiye ultrafiltrasyon
• kardiyopulmoner baypas
• pediatrik açık kalp cerrahisi

Effects of modified ultrafiltration on postoperative hepatic and renal function of pediatric patients with congenital cyanotic/non-cyanotic heart defect who underwent open heart surgery: Retrospective study

Öz

Aim: Increased total body water and capillary permeabilty in pediatric cardiopulmonary bypass can cause organ disfunction. Modified ulltrafiltration is developed for decrease total body water and attenuate organ disfunction. The purpose of this study, is to investigate retrospective effects of modified ultrafiltration on postoperative hepatic and renal functions of pediatric patients with congenital siyanotic/nonsiyanotic heart defect who underwent open heart surgery. Material and methods: In this study, we assessed 93 children who underwent pediatric cardiac surgery with cardiopulmonary bypass from January 2009 to August 2011.Patients were divided into two groups. Group 1 (n=62) patiens, to whom modified ultrafiltration was performed, compared with 31control patients (group 2). Patients who had redo cardiac surgery, preoperative organ disfunction, otoimmune disease, genetic disorders, shunt and emergency operations were excluded. Pre and postoperative biochemical parameters, postoperative urine output, chest tube drenaige, diüretic usage, blood and blood product transfusion, dialysis requirement and mortality were compared. Results: Age, weight, body surface area, congenital defect type and number, preoperative and intraoperative blood samples measurement, cross clamp time, cardiopulmonary bypass time were similar between 2 groups (p>0,05).The difference in percent increase in creatinine leves of 2 group was statistically significant When these changes were re-evaluated according to the body surface area by univariate analysis(p<0,05). Percent increase in total plasma protein level was also statistically significant between the groups (p<0,05) (It was-6,5% in group 1 and -5,5% in group 2). Percent increase in plasma albumin level was -18,2% in group 1, and -13,4% in group 2. When these changes were re-evaluated according to the body surface area by univariate analysis, a significant statistical difference was detected. (p<0,05). While two patients required dialysis in group 1, dialysis was performed in 4 patients in group 2. There was no statistically difference between the groups in terms of dialysis needed(p<0,05). There was no difference between the groups in terms of mortality (p>0,05) Conclusion: Hemodynamic, pulmonary, hematologic and immunologic effects of modified ultrafiltration are well known. Although our study group was not big enough to get a conclusion, we believe that modified ultrafiltration can be an effective method in preservation of renal and hepatic function of the patients who underwent total reconstructive congenital heart surgery.

Anahtar Kelimeler

• modified ultrafiltration
• cardiopulmonary bypass
• pediatric open heart surgery

Kaynakça

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