BAŞAK AKÇA, Meral KANBAK, BANU KILIÇASLAN, Bilge ÇELEBİOĞLU, Ülkü AYPAR

THE EFFECTS OF HYDROXYETHYL STARCH (130/0.4) VERSUS LACTATED RINGER SOLUTION ON COAGULATION PARAMETERS IN CYANOTIC CHILDREN UNDERGOING CARDIOPULMONARY BYPASS: A RANDOMIZED TRIAL

Amaç: Prospekti f randomize çalıflmamızda, standart Ringer Laktat (RL) solüsyonu ile yeni jenerasyon hidroksietil niflasta (HES) solüsyonunun (130/0.4) standart koagülasyon parametreleri üzerine etkileri karflılafltırıldı. Yöntem: Siyanotik kalp hastalığı olan 6 ay-10 yafl arası 20 hasta çalıflmaya dahil edildi. Bafllangıç solüsyonu olarak grup Ide RL, Grup IIde HES (130/0.4) kullanıldı. Demografik ve klinik özellikler (yafl, cinsiyet, ağırlık, operasyon süresi, kardiyopulmoner baypas süresi ve aort kros-klemp süresi), yoğun bakımda ve hastanede kalıfl süreleri kaydedildi. Anestezi indüksiyonu sonrası (T1), heparinizasyondan 5 dk sonra (T2), KPB bafllangıcından 10 dk sonra (T3), KPB sonlandırılması ve protamin uygulamasını takiben (T4), postoperati f 24.saatte (T5), postoperati f 48. saatte tüm hastalardan kan örnekleri alındı. T1-6 zamanlarında hematokrit, hemoglobin ve trombosit değerlerine bakıldı. T1 ve T4-6 zamanlarında koagülasyon parametreleri (INR, aPTT) ve karaciğer fonksiyon testlerine bakıldı. Tüm hastalarda operasyon bitiminde ve postoperati f 24. ve 48. saatlerde hastaya verilen toplam sıvı miktarı, idrar çıkıflı, kullanılan taze donmufl plazma ve eritrosit süspansiyonu miktarı, inotrop ve diüretik ihtiyacı, göğüs tüpü drenaj miktarı kaydedildi. Bulgular: Gruplar arasında hemoglobin ve hematokrit değerleri, trombosit sayısı ve aPTT değerleri açısından anlamlı fark yoktu. Ayrıca inotrop ve diüretik ajan kullanımı, göğüs tüpünden postoperati f drenaj miktarı, idrar çıkıflı, verilen sıvı, kan ürünü ve taze donmufl plazma miktarı açısından da anlamlı fark yoktu. Her iki grupta da farklı zamanlarda bakılan INR değerlerinde bazal değerlere (T1) oranla artıfl olsa da (p

HDROKS ETL NfiASTA (130/0.4) VEYA RNGER LAKTAT SOLÜSYONUNUN KARDYOPULMONER BYPASS UYGULANAN SYANOTK ÇOCUKLARDA KOAGÜLASYON PARAMETRELERNE ETKLER: RANDOMZE ÇALIfiMA

Objective: In this prospective, randomized study, we compared the effects on standard coagulation parameters of the standard Lactated Ringer (LR) priming solution with the latest generation of hydroxyethyl starch solutions, HES (130/0.4). Method: Twenty patients with cyanotic heart disease aged between 6 months and 10 years were included. A LR solution was used as a priming solution in group I, and in group II, a HES (130/0.4) solution was used. Demographic and clinical data (age, sex, weight, duration of operation, cardiopulmonary bypass (CPB), and aortic cross-clamping time), duration of ICU stay, and hospitalization time were also recorded. Laboratory parameters of blood samples were collected after anesthesia induction (T1), five minutes after heparinization (T2), ten minutes after the initiation of CPB (T3), after weaning from CPB and protamine administration (T4), at 24 hours postoperatively (T5), and at 48 hours postoperatively (T6) in all patients. Hematocrit, hemoglobin, and platelet counts were recorded at T1-6. Coagulation parameters (international normalized ratio, activated partial thromboplastin time) and liver function tests were analyzed at T1 and T4-6. Total fluid administration, urine output, fresh frozen plasma and erythrocyte suspension amount, inotropic and diuretic requirements, and chest tube drainage amount were recorded at the end of the operation and 24 and 48 hours postoperatively in all patients. Results: Hemoglobin (g/dL) and hematocrit levels, platelet count and activated partial thromboplastin time values did not di ffer signi ficantly between groups. There was also no statistically signi ficant di fference in usage of inotropic and diuretic agents, postoperative drainage from chest tube, total urine output, fluid administration, or amount of red blood cells or fresh frozen plasma used. Although international normalized ratio values increased in both groups at di fferent times compared to the baseline levels (T1) (p<0.05), there was no signi ficant di fference between two groups. Conclusion: We concluded that HES (130/0.4) solution does not affect the standard coagulation parameters of children with cyanotic heart diseases undergoing CPB

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