Ebru ARAL, Aslı DÖNMEZ, Gülnaz ARSLAN, Mehmet HABERAL

Böbrek transplantasyonunda genel ve epidural anestezinin tam kan sayımı, lökosit subgrupları ve natural killer hücre sayısına etkisi

Amaç: İmmün sistemi üremi nedeniyle süprese olan kronik böbrek yetmezlikli (KBY) hastalarda genel ve epidural anestezi uygulamalarının immün istem üzerine etkisi iyi bilinmemektedir. Çalışmamızın amacı, böbrek transplantasyonu yapılacak olan hastalarda genel ve epidural anestezinin immüniteye ve tam kan sayımına etkilerini araştırmaktır. Yöntem: Etik kurul izni alındıktan sonra böbrek transplantasyonu yapılacak 29 hasta çalışmaya alındı. Genel anestezi alan gruba (Grup G, n=15) tiyopental, fentanil ve atrakuryum ile yapılan anestezi indüksiyonunu takiben izofluran, N20 ve 02 verildi. Epidural anestezi uygulanan gruba ise (Grup E, n-14) epidural kateter yerleştirilerek 20 mL %2 prilokain ve 100 $mu$g fentanil verildi. İdame amacıyla %1'likprilokain + 2.5 $mu$g mL' fentanil (7 mL sa') infüzyonuna başlandı. Her iki gruptan dapreoperatif intraoperatif ve postoperatif 1. ve 3. günlerde kan alınarak tam kan analizi, lökosit subgruplan, CD3, CD16/56, BUN, kreatinin, Na+, K+ düzeyleri çalışıldı. Bulgular: Her iki grupta da demografik özellikler benzerdi. Grup E'de postoperatif 1. gündeki lökosit sayısı Grup G'den anlamlı yüksek, postoperatif 3. günde Hb ve Hct düzeyleri ise anlamlı olarak düşük bulundu. Bu farklar klinik olarak anlamlı değildi. Gruplar arasında CD3, CD16/56, BUN, kreatinin, Na+, K+ düzeylerinde fark bulunmadı. Sonuç: Böbrek transplantasyonu yapılan hastalarda genel ve epidural anestezi uygulamalarının tam kan sayımı, lökosit subgruplan, NK hücre sayısı, BUN, kreatinin, Na+, K+ düzeylerine etkileri benzer bulundu.

Anahtar Kelimeler:

Anestezi, epidural, Kan hücresi sayımı, Kreatin, Böbrek nakli, Antijenler, CD3, Ameliyat sonrası dönem, Lökositler, Öldürücü hücreler, doğal, Kan üre nitrojen, Anestezi, genel

The effects of general and epidural anesthesia on complete blood count, leukocyte subgroups, and natural killer cell count in patients undergoing renal transplantation

Objective: In chronic renal failure patients whose immunity has been supressed by uremia, the effect of general or epidural anesthesia on the immune system is not well-documented. The aim of our study was to evaluate the effect of general and epidural anesthesia on immunity and complete blood count in patients undergoing renal transplantation. Methods: Following ethics committee approval, 29 patients undergoing renal transplantation were included in the study. After anesthesia induction with thiopental, fentanyl, and atracurium, anesthesia was maintained with isoflurane, N20 and 02 in the general anesthesia group (Group G, n=15). Epidural catheter insertion was followed by injection of 20 mL 2% prilocain and 100 $mu$g fentanyl in the epidural anesthesia group (Group E, n-14). 1% prilocain and 2.5 $mu$g mL' fentanyl (7 mL hr'1) was infused for maintenance. Complete blood count, leukocyte subgroups, CD3, CD16/56, BUN, creatinine, Na+ and K+ levels were studied on preoperative, intraoperative and on the postoperative 1st and 3rd days in both groups. Results: Demographic data were similar in both groups. In Group E, the leukocyte count on the postoperative 1st day was significantly higher, Hb and Hct levels on the postoperative 3rd day were significantly lower than in Group G. These differences were not important clinically. No significant difference was found for CD3, CD16/56, BUN, creatinine, Na+, and K+ levels between groups. Conclusion: General and epidural anesthesia have similar effects on complete blood count, leukocyte subgroups, NK cell count, BUN, creatinine, Na+ and K+ levels in patients undergoing renal transplantation.

Keywords:

Anesthesia, Epidural, Blood Cell Count, Creatine, Kidney Transplantation, Antigens, CD3, Postoperative Period, Leukocytes, Killer Cells, Natural, Blood Urea Nitrogen, Anesthesia, General,

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