Orhan BOZOĞLAN, Kemalettin ERDEM, Bülent MEŞE, Faruk SERHATLIOĞLU, Okan ÖZOCAK, Cemal KAHRAMAN

Koroner arter bypass cerrahisi uygulanan hastalarda N -asetil sisteinin miyokardiyal reperfüzyon hasarını önlemedeki rolü

Amaç: Bu çalışmada kardiyopulmoner bypass ile koronerarter bypass cerrahisi yapılan hastalarda gelişen iskemireperfüzyon hasarının başlangıç kardiyopleji solüsyonunaeklenen N -asetil sistein ile önlenmesi araştırıldı.Yöntem : Bu çalışma damar cerrahisi kliniğinde kardiyopulmoner bypass eşliğinde elektif koroner arter bypasscerrahisi yapılan 60 hasta (43 erkek, 17 kadın) dahil edildi.Ardışık olarak hastalar 30u kontrol, 30u çalışma grubuolarak ayrıldı. Çalışma grubuna kardiyopleji solüsyonuna300 mg N -asetil sistein eklendi. Hastalardan preoperatif,postoperatif kan örnekleri alın a rak myokardiyal hasarbelirteçleri (CK -MB, troponin) çalışıldı. Hastalar postoperatif inotrop ihtiyacı ve aritmi gel i şimi yönünden izlendi.Bulgular: Çalışma grubu ile kontrol grubu kıyaslandığındamiyokardiyal hasar belirteçlerinden Çalışmaya alınanhastaların demografik verileri, preoperatif eşlik eden riskfaktörleri, sol ventrikül ejeksiyon fraksiy o nu, hemoglobindeğerleri açısından istatistiksel anlamlı farklılık yoktu.Çalışma grubu ile kontrol grubu kıyasl and ığında miyoka rdiyal hasar belirteçlerinden CK -MB düzeyleri 24. ve 48.saatlerde, troponin düzeyleri ise 6. 12. 24. ve 48. saatlerdeistatistiksel olarak düşük bulundu. Postop e ratif inotropikdestek ihtiyacı ve aritmi görülme sıklığı çalışma grubundaistatistiksel olarak anlamlı olmak üzere daha az bulundu.Sonuç : Kardiyopulmoner bypass eşliğinde koroner arterbypass cerrahisi yapılan hastalarda kardiyopleji solüsyo nlarına 300 mg N -asetil sistein eklenmesi ile reperfüzyonhasarı oluşumu azaltılmaktadır. M iyokardiyal korunmayöntemleri hakkında en etkin yöntemin saptanması içingeniş çapta daha fazla çalışmaya ihtiyaç vardır.

The role of N- acetyl cystein for myocardial reperfusion damage protection, in patients who was performed coronary artery bypass surgery

Objective : In this study we researched prevention of is chemic reperfusion damage by adding N -acetyl -cystein toprimary cardioplegy s olution in patients underwent coronary artery bypass surgery with cardiopulmonary bypass . Method : In this study, 60 patients(43 male, 17 female)were enrolled who were performed coronary artery bypasssurgery with cardiopulmonary bypass at vascular sugeryclinic. Consecutively patients divide d as 30 patients forstudy and 30 patients for control groups. 300 mg N -acetylcystein added to study group s cardioplegy solution. My ocardial damage ma rkers(CK -MB, troponin) were obtainedfrom patients pre and postoperatively. Patients followedfor postop erative inotrpe need and developing arytmia.Results : There was no statistical significance in comparisonof demografic datas, preoperative accompanying risc fa ctors, left ventricule ejection fraction, hemoglobine levels ofpatients of the study. Comparing 24th and 48th hour pla sma CK -MB levels and 6th, 12th, 24th and 48th hours trop onine levels, study group s levels were lower than controlgroup.This difference was stastisticaly significant. Postop erative inotropic support need and incidance of aritmia waswas lower in the study group, and this was statisticalysignificant.Conclusion : Reperfusion damage decreases in patients whounderwent coronary artery bypass surgery with cardiopu lmonary bypass by adding 300 mg N -acetyl cystein. Furtherresearch is needed for detecting most effective procedureabout myocardial protection.

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