Osman YAPAKÇI, Seda Banu AKINCI, Bilge ÇELEBİOĞLU

Kardiyak cerrahi sonrası enfeksiyonlarda anesteziye ait risk faktörleri

Anestezinin kendisi veya anesteziyoloğun perioperatif girişimleri, cerrahi geçiren hastalarda immün fonksiyonları, dolayısıyla postoperatif seyri etkilemektedir. Kan transfüzyonları, dopamin, adrenalin, metoklopramid, steroidler, vazopresörler gibi perioperatif dönemde sıklıkla kullanılan ilaçlar immün sistem üzerinde etkili olmaktadır. Bu çalışmanın amacı kardiak cerrahi sonrası enfeksiyonlarda anesteziye ait risk faktörlerini belirlemektir. Kliniğimizde bir yılda açık kalp cerrahisi geçiren tüm erişkin hastaların kayıtları retrospektif olarak incelendi ve postoperatif enfeksiyonları artırabileceği düşünülen etkenler araştırıldı. 202 hastanın 22'sinde, Enfeksiyon Hastalıkları Bölümünce klinik olarak tanı konulup izlenmiş, antibiyotikle tedavi edilmiş, pozitif kültür sonuçlarıyla desteklenmiş postoperatif enfeksiyon saptandı. 13 hasta (%6) yara enfeksiyonu, 6 hasta (%3) idrar yolu enfeksiyonu, 5 hasta (%2.5) pnömoni tanısı aldı. Bu enfeksiyonlardan ikisi sepsisle sonuçlandı. Intraoperatif steroid, adrenalin, dopamin desteğine ihtiyacı olan, postoperatif uzun süre mekanik ventilatöre bağlı kalan hastaların enfeksiyon riskinin arttığı görüldü. Enfeksiyonu olanların, enfeksiyonu olmayan gruba göre hastanede kalış süresi daha uzundu. Uygulanan anestezi dozunun ve şeklinin klinik olarak enfeksiyon oranını etkilemediği gözlendi. Adrenalin (OR 7.7; CI, 1.7-34.2, p=0.007) ve steroid (OR, 2.9 ; CI, 1-8.1, p=0.036) kullanımı, postoperatif enfeksiyon riskini artıran bağımsız parametreler olarak belirlendi. Düşük kardiyak debili olgularda, intraoperatif olarak steroid ve vazopresör kullanımının, postoperatif enfeksiyon riskini artıran ve taburculuk süresini uzatan risk faktörleri olduğu gözlendi.

Anahtar Kelimeler:

Enfeksiyon, Kalp cerrahi işlemleri, Vazokonstriktör ajanlar, Geriyedönük çalışma, Risk faktörleri

Infection after cardiac surgery: Anesthesia related risk factors

Anesthesia itself or perioperative interventions such as blood transfusion, steroids or aprotonin for antiinflammatory properties, vasopressors may alter immune function with potential impact on postoperative course. The study is aimed to identify anesthesia related risk factors associated with the increased risk of postoperative infection in cardiac surgery. We retrospectively reviewed medical records of all adult patients who underwent open-heart surgery in our institution in one year with institutional approval and we collected the clinical and laboratory data relevant to postoperative infection. Univariate and multivariate logistic analyses were done. Of the 202 patients 22 had a culture-proved postoperative infection. 13 patients (6%) had wound infection, 6 patients (3%) had urinary tract infections and 5 patients (2.5%) had pneumonia. Two infections led to generalized sepsis. The patients with infections after cardiac surgery were more likely to have required intraoperative steroid, dopamine, adrenalin support and longer postoperative mechanical ventilation period. As expected, the length of stay was significantly longer in the infected group than in the uninfected group. The types and dosages of the used anesthetics do not seem to change the infection rate clinically. The use of adrenalin (odds ratio (OR), 7.7; CL 1.7-34.2, p=0.007) and steroids (OR, 2.9; CI, 1-8.1, p=0.036) were the independent variables predicting infection in the multivariate logistic regression. We emphasize that low cardiac output states and the use of intraoperative steroids and vasopressors are risk factors for postoperative infection and longer hospital stay.

Keywords:

Infection, Cardiac Surgical Procedures, Vasoconstrictor Agents, Retrospective Studies, Risk Factors,

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