Renal functional effects of using N-Acetyl-Cysteine ( NAC ) in cardiac surgery

Amaç: Kardiak cerrahi sonrası gelişen akut böbrek yetmezliği, çok önemli morbidite ve mortalite nedenlerindendir. Çeşitli uygulamalarla bu risk azaltılmıştır. Bu çalışmada; koroner cerrahi sonrasında 2 farklı yöntem ile N-Asetil-Sistein (NAC) kullanımının renal fonksiyonlar üzerine etkilerini değerlendirilmesi amaçlanmaktadır. Method: Etik kurul otıayı alındıktan sonra, normal ıvnal fonksiyona sahip 60 hasta (18-75 yaş). 3 grup olacak şekilde çalışmaya katılmıştır. Grup T deki hastalarda. 50 mg kg ' NAC pompa priming solüsyonuna eklenmiştir. Grup IT deki hastalarda ise; indüksiyon sonrasında 50 mg kg' NAC i.v. ve operasyon boyunca ise 20 mg kg1 sa ' infiizyon ile uygulanmıştır. Grup III, kontrol grubu olarak belirlenmiştir. Demografik and perioperatif veriler, sıvı alımı, idrar çıkışı, drenaj miktarları; operasyon sonunda, postoperatif 24. ve 48. saatlerde kaydedilmiştir. Hemodinamik veriler. BUN. kreatinin. kan ve idrar elektrolitleri, beta-2 globulin değerleri ölçülmüştür. Kreatinin klirensi ve fraksiyone Na ekskresyonu (FeNa); indüksiyon öncesinde (Tl), pompa öncesinde (T2), pompanın 30. dk'smda (T3), pompa sonrasında (T4), operasyon sonunda (T5), postoperatif 24. (T6) ve 48. (T7) saatlerde hesaplanmıştır. Sonuçlar: Demografik veriler ve klinik bulgular açısından tüm gruplar benzerdi. Total verilen sıvı miktarı, idrar çıkışı ve drenaj açısından gruplar arasında fark yoktu. BUN değerlerinde bir azalma olsa da, riim gruplar için bu benzerdi. İdrar albiimin/ kreatinin oranları; pompanın hemen sonrasında Grup UT de (T2) (p< 0,05), pompanın 30. dk'sında (T3)ise Grupll'de artmasına rağmen; Grup İT de fark bulunamadı. Kreatinin seviyeleri: postoperatif dönemde (T6-T7), tüm gruplarda belirgin olarak bir artış gösterdi (p< 0,05). Beta-2 globulin, kontrol grubunda, postoperatif 24. saatte başlayan bir atış göstermesine rağmen; Grup 1 and II'de bu artış postoperatif 48. saatte gözlendi. Tartışma: İki farklı N-Asetil-sistein uygulama rejimi de koroner baypas greft cerrahisi olan hastalarda benzer yararlı etkiler göstermiştir; fakat bu koruyucu etkileri operasyondan 24 saat sonra göstermeyi başaramadı.

Kardiyak cerrahide N-Asetil-Sistein (NAC) kullanımının renal fonksiyon üzerine etkileri

Objective: Acute renal failure following cardiac surgery is a very important cause of morbidity and mortality. The risk has been reduced with a variety of some practises. In this study we investigated the effects of two different methods of using N-Acetylcystein (NAC) during cardiac surgery on renal function. Method: 60 patients with normal renal function were randomly allocated to three groups. Group I had 50 mg kg-1 NAC added to pump priming solution; Group II received 50 mg kg-1 NAC i.v. after induction and had an infusion of 20 mg kg-1 h-1 throughout the operation; Group III was the control group. Demographic and perioperative data, fluid balance, urine output and drainage amounts, haemodynamic data, BUN, creatinine, blood and urine electrolytes, and beta-2 globulin, creatinine clearance and fractional sodium excreation (FeNa) were obtained after induction(T1), before CardioPulmonaryBypass (T2), 30th minutes of CardioPulmonary Bypass (T3), after CardioPulmonaryBypass (T4), at the end of the operation (T5), at postoperative 24th h(T6), and at postoperative 48th h (T7). Results: There were no difference among the demographic and perioperative data, total amount of fluid given, urine outputs and drainage. Urinary albumine/creatinine ratios inceased in Group III at T2 (p< 0.05), in Group I at T3, whereas no significant difference was found in Group II. Creatinine values showed a statistically significant increase postoperatively (T6-T7) in all groups (p< 0.05). Beta -2 globuline increased in the control group at T6, whereas in Group I and II at T7. Conclusion: Two different regiments of N-Acetylcystein in coronary artery bypass grafting have some benefical effects, but failed to demonstrate preventive effect after 24 hr operation.

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Anestezi Dergisi-Cover
  • ISSN: 1300-0578
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1993
  • Yayıncı: Betül Kartal
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