Fatih AYGÜN, Mehmet ÖZÜLKÜ, Mehmet Vedat ÇALDIR, Hüseyin Ulaş PINAR

Tedavi Edilmiş KOAH’lı Hastaların, KOAH Olmayan Hastalara Göre; KABGO Sonrası Akciğer Problemlerin Araştırılması

Giriş: Koroner arter baypas greftleme operasyonu (KABGO) öncesi tedavi almış kronik obstrüktif akciğer hastalığı (KOAH) olan bireylerle, KOAH olmayan bireyler, cerrahi sonrası uzamış mekanik solunum desteği (UMSD) ve alt solunum yolu infeksiyonu (ASYİ) açısından karşılaştırılmıştır. Hastalar ve Yöntemler: Kalp ve Damar Cerrahisi kliniğinde, valvüler patolojisi ve konnektif doku hastalığı (Marfan sendromu vb.) bulunmayan, izole on-pump KABGO yapılmış, 233 hasta çalışmaya alındı. Veriler retrospektif olarak toplandı. Operasyon öncesi dönemde kliniğimizde standart preoperatif laboratuvar tetkikleri, solunum sistemi sorgusunda veya muayenesinde patoloji saptanan kişilere solunum fonksiyon testi (Spirobank Spirometry, MIR Medical International Research Product) yapılmıştır. KOAH olan hastalarda, KOAH şiddetini belirlemek için GOLD kılavuzu kullanılmıştır. Bütün hastalar iki gruba ayrılmıştır. KOAH hastalarını içeren grup; grup 1, KOAH olmayan hastaları içeren grup; grup 2 olarak adlandırılmıştır. Bulgular: UMSD görülme hızı grup 1’de %4.8, grup 2’de %1.8 olduğu görülürken; ASYİ oranı grup 1’de %6.3, grup 2’de %1.7 olduğu tespit edildi. Sonuç: Çalışmamıza göre; operasyon öncesi tedavi görmüş KOAH hastalarının, KOAH olmayan hastalara göre on-pump KABGO sonrası, UMSD ve ASYİ açısından hızları yüksek olmakla birlikte istatistiksel olarak anlamsız olduğunu söyleyebiliriz. (UMSD açısından p= 0.348; ASYİ açısından p= 0.088).

Anahtar Kelimeler:

Koroner arter baypas, kalp akciğer makinası, akciğer hastalığı, kronik obstrüktif, mekanik, solunum, solunum yolu infeksiyonları

Investigation of Pulmonary Problems in COPD and non-COPD Patients Following CABG

Introduction: In our study COPD and non-COPD patients who underwent CABG were compared in terms of prolonged mechanical ventilation and lower respiratory tract infektion. Patients and Methods: A total of 233 patients without valvular pathology and connective tissue disorders, such as Marfan syndrome, who underwent isolated on-pump CABG in the Department of Cardiovascular Surgery were retrospectively studied. Preoperative laboratory tests and respiratory system test (Spirobank Spirometry, Medical International Research Product) were applied in patients who had pathology in respiratory system query or examination were performed at our clinic during the preoperative period. The severity of COPD in COPD patients was evaluated according to the COLD guideline. All patients were divided in two groups. The group including COPD patients was named group 1 and the other group including non-COPD patients was named gruop 2. Results: UMSD rates in groups 1 and 2 were 4.8% and 1.8%, respectively. Lower respiratory tract infection rates in groups 1 and 2 were 6.3% and 1.7%, respectively. Conclusion: According to our study, we can say that the rate of UMSB and lower respiratory tract infection occuring in treated COPD patients after CABG is statiscally indifferent according to non-COPD patient. (p= 0.348 for UMSD, p= 0.088 for lower respiratory tract infection).

Keywords:

Coronary artery bypass, heart lung machine, pulmonary disease, chronic obstructive, respiration, artificial, respiratory tract infections,

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1. Ulaşlı SS, Ünlü M. KOAH’ın ağırlık sınıflamasında yeni konsept. Güncel Göğüs Hastalıkları Serisi 2013;1:13-9.
2. Dongelmans DA, Hemmes SN, Kudoga AC, Veelo DP, Binnekade JM, Schultz MJ. Positive end expiratory pressure following coronary artery bypass grafting. Inerva Anestesiol 2012;78:790-800.
3. Salenger R, Gammie JS, Vander Salm TJ. Postoperative care of cardiac surgical patients. In: Cohn LH, Edmunds LH Jr (eds). Cardiac surgery in the adult. 3th ed. New York: McGraw-Hill, 2003;p439-69.
4. Martin CG, Turkelson SL. Nursing care of the patient undergoing coronary artery bypass grafting. J Cardiovasc Nurs 2006;21:109-17.
5. Daganou M, Dimopoulou I, Michalopoulos N, Papadopoulos K, Karakatsani A, Geroulanos S, et al. Respiratory complications after coronary artery bypass surgery with unilateral or bilateral internal mammary artery grafting. Chest 1998;113:1285-9.
6. Huckabay L, Daderian AD. Effect of choices on breathing exercises post-open heart surgery. Dimens Crit Care Nurs 1990;9:190-201.
7. Imperial-Perez F, Rourke DA. Surgical management of heart disease. In: Kinney MR, Packa DR (eds). Andreoli’s comprehensive cardiac care. 8th ed. St. Louis: Mosby 1996:359-74.
8. Kjaergaard S, Rees SE, Grønlund J, Nielsen EM, Lambert P, Thorgaard P, et al. Hypoxaemia after cardiac surgery: clinical application of a model of pulmonary gas exchange. Eur J Anaesthesiol 2004;21:296-301.
9. Liu LL, Gropper MA. Respiratory and hemodynamic management after cardiac surgery. Curr Treat Options Cardiovasc Med 2002;4:161-9.
10. Simková I, Kozlovski M, Riecanski I, Fischer V, Kanáliková K, Bilcíková E. Pulmonary complications after heart surgery. Bratisl Lek Listy 1997;98:258-68.
11. Spivack SD, Shinozaki T, Albertini JJ, Deane R. Preoperative prediction of postoperative respiratory outcome. Coronary artery bypass grafting. Chest 1996;109:1222-30.
12. Wynne R, Botti M. Postoperative pulmonary dysfunction in adults after cardiac surgery with cardiopulmonary bypass: clinical significance and implications for practice. Am J Crit Care 2004;13:384-93.
13. Nicholson DJ, Kowalski SE, Hamilton GA, Meyers MP, Serrette C, Duke PC. Postoperative pulmonary function in coronary artery bypass graft surgery patients undergoing early tracheal extubation: a comparison between short-term mechanical ventilation and early extubation. J Cardiothorac Vasc Anesth 2002;16:27-31.
14. Weissman C. Pulmonary complications after cardiac surgery. Semin Cardiothorac Vasc Anesth 2004;8:185-211.
15. Wynne R, Botti M. Postoperative pulmonary dysfunction in adults after cardiac surgery with cardiopulmonary bypass: clinical significance and implications for practice. Am J Crit Care 2004;13:384-93.
16. Yende S, Wunderink R. Causes of prolonged mechanical ventilation after coronary artery bypass surgery. Chest 2002;122:245-52.
17. Bartz RR, Ferreira RG, Schoder JN, Davies J, Liu WW, Camara A, et al. Prolonged pulmonary support after cardiac surgery: incidence, risk factors and outcomes: a retrospective cohort study. J Crit Care 2015;30:940-4.
18. Canver CC, Chanda J. Intraoperative and postoperative risk factors for respiratory failure after coronary bypass. Ann Thorac Surg 2003;75:853-7.
19. Quadrelli SA, Brandani LM. Gas exchange changes in the postoperative period of heart surgery. Medicina (B Aires) 1995;55:300-6.

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