Mustafa Saçar, Gökhan Önem, Yaln Tolga Yaylal, İbrahim Susam, Fahri Adal, Ahmet Baltalarl

Koroner Baypas Cerrahisi Sonrasnda Görülen Akut Böbrek Yetmezli¤i: Perioperatif Risk Faktörleri

Amaç: Koroner Baypas cerrahisi sonrasnda geliflen akut böbrek yetmezli¤ine (ABY) ba¤l olarak mortalite ve morbidite oran giderek artfl göstermektedir. Perioperatif dönemde ABY geliflimine neden olabilecek risk faktörlerinin belirlenmesi ile ABY gelifliminin önlenmesi ve tedavisine yönelik stratejiler gelifltirilebilmektedir. Yöntemler: Mays 2005 – Aralk 2006 tarihleri arasnda izole koroner baypas cerrahisi uygulanan 309 hasta çalflmaya dahil edildi. Operasyon öncesindeki, operasyon esnasndaki ve operasyon sonrasndaki hasta verileri bilgisayar kayt sistemi ile topland. Postoperatif dönemde ABY geliflimine neden olabilecek faktörler univaryans analiz ile saptand. Ardndan ABY geliflimine neden olabilecek ba¤msz 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 esnasnda Amaç: Koroner Baypas cerrahisi sonrasnda geliflen akut böbrek yetmezli¤ine (ABY) ba¤l olarak mortalite ve morbidite oran giderek artfl göstermektedir. Perioperatif dönemde ABY geliflimine neden olabilecek risk faktörlerinin belirlenmesi ile ABY gelifliminin önlenmesi ve tedavisine yönelik stratejiler gelifltirilebilmektedir. Yöntemler: Mays 2005 – Aralk 2006 tarihleri arasnda izole koroner baypas cerrahisi uygulanan 309 hasta çalflmaya dahil edildi. Operasyon öncesindeki, operasyon esnasndaki ve operasyon sonrasndaki hasta verileri bilgisayar kayt sistemi ile topland. Postoperatif dönemde ABY geliflimine neden olabilecek faktörler univaryans analiz ile saptand. Ardndan ABY geliflimine neden olabilecek ba¤msz 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 esnasnda Amaç: Koroner Baypas cerrahisi sonrasnda geliflen akut böbrek yetmezli¤ine (ABY) ba¤l olarak mortalite ve morbidite oran giderek artfl göstermektedir. Perioperatif dönemde ABY geliflimine neden olabilecek risk faktörlerinin belirlenmesi ile ABY gelifliminin önlenmesi ve tedavisine yönelik stratejiler gelifltirilebilmektedir. Yöntemler: Mays 2005 – Aralk 2006 tarihleri arasnda izole koroner baypas cerrahisi uygulanan 309 hasta çalflmaya dahil edildi. Operasyon öncesindeki, operasyon esnasndaki ve operasyon sonrasndaki hasta verileri bilgisayar kayt sistemi ile topland. Postoperatif dönemde ABY geliflimine neden olabilecek faktörler univaryans analiz ile saptand. Ardndan ABY geliflimine neden olabilecek ba¤msz 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 esnasnda inotropik destek gereksinimi, ameliyat sonrasnda 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 esnasndaki inotropik destek gereksinimi ve ameliyat sonrasnda mediastinal drenaj miktar ABY gelifliminde ba¤msz risk faktörleri olarak belirlendi. Sonuç: Operasyon öncesinde renal foksiyonlar snrda olan, ileri yafltaki ve düflük ejeksiyon fraksiyonu olan hastalarda ABY geliflimi daha sk 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 bakm ünitesi

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

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.

Keywords:

Coronary artery bypass surgery, acute renal failure, ICU,

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ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi