İzole Koroner Arter Baypas Operasyonu Sonrasında Ciddi Plevral Efüzyon Gelişen Hastaların Değerlendirilmesi

Amaç: Yapmış olduğumuz bu çalışmada, izole koroner baypas operasyonu yapılan ve erken postoperatif dönemde ciddi plevral efüzyon gelişen hastalarda, preoperatif ve operatif faktörlerin postoperatif plevral efüzyon ile ilişkisinin belirlenmesi amaçlandı. Yöntemler: Bu çalışmamızda, Şubat 2001 ile Temmuz 2013 tarihleri arasındaki çalıştığımız kliniklerdeki opere edilen 7862 izole koroner arter bypass cerrahisi olgusu retrospektif olarak incelendi. Bulgular: Çalışmaya dahil edilen hastalardan 175 (%2.2) olguda erken-ciddi plevral efüzyon gelişti. Bu olguların yaş ortalaması 66.3±9.5 (55-76) idi. Olguların 149 (%85.1)’u elektif şartlarda, 26 (%14.9)’sı ise acil şartlarda operasyona alındı. Olguların ortalama kardiyopulmoner bypass zamanı, 70±28 (40-100) dakikaydı. Olgulardan 161 (%92)‘inde sol internal torasik arter (LİTA) ve safen ven greft (SVG) birlikte kullanıldı. Olguların 126 (%72)’sı nefes darlığı, 115 (%65.7)’si kuru öksürük, 28 (%16)’i prodüktif öksürük, 50 (%28.6)’si takipne, 22 (%12.5)’i ise göğüs ağrısı şikayeti ile tekrar başvurdu. Olguların 154 (%88)’ünde sol hemitoraksta erken ciddi plevral efüzyon gelişti. Bu olguların 148 (%84.6)’inde LİTA+SVG, 6 (%3.4)’sında ise sadece SVG kullanıldı. Olguların 14 (%8)’ünde sağ hemitoraksta erken ciddi plevral efüzyon gelişti. Bu olguların ise 10 (%5.7)’unda LİTA+SVG, 4 (%2.3)’ünde ise sadece SVG kullanıldı. Bilateral erken ciddi plevral efüzyon gelişen olgular ise 7 (%4) idi. Bu olguların 3 (%1.7)’ünde LİTA+SVG, 4 (%2.3)’ünde ise sadece SVG kullanıldı. Sonuç: Koroner arter bypass cerrahisinin postoperatif pulmoner fonksiyonun bozulmasına neden olduğu bilinmektedir. Koroner arter bypass cerrahisinin en sık görülen komplikasyonlarından biri de plevral efüzyondur. Postoperatif oluşan bu tablonun hastanede kalış süresinin artması ve operasyon sonrası yüksek morbidite ile ilişkili olduğu bilinmektedir. Postoperatif hasta yönetimi ve morbidite değerlendirilmesi açısından preoperatif risklerin belirlenmesi önem arz etmektedir.

Anahtar Kelimeler:

kardiyak cerrahi, koroner arter bypass greft cerrahisi, plevral efüzyon

Evaluation of the Patients Developing Severe Pleural Effusion After Isolated Coronary Artery Bypass Operation

Objective: In this study, we aim to determine the causal relationship between isolated coronary bypass surgery development of severe pleural effusion in the early postoperative period. Methods: In this study, 7862 isolated coronary artery bypass surgery cases conducted in our hospital between February 2001 and July 2013 were analyzed retrospectively. Results: Early-severe pleural effusion developed in 175 (2.2%) patients included in the study. The mean age of these cases was 66.3±9.5 (55-76). 149 (85.1%) of the cases were operated under elective conditions and 26 (14.9%) of them were operated under emergency conditions. The mean cardiopulmonary bypass time of the cases was 70±28 (40-100) minutes. Left internal thoracic artery (LITA) and saphenous vein graft (SVG) were used together in 161 (92%) cases. Of the cases, 126 (72%) had shortness of breath, 115 (65.7%) dry cough, 28 (16%) productive cough, 50 (28.6%) tachypnea, 22 (12.5%) chest pain. Early severe pleural effusion developed in the left hemithorax in 154 (88%) of the cases. LITA+SVG was used in 148 (84.6%) of these cases, and only SVG was used in 6 (3.4%) cases. Early severe pleural effusion developed in the right hemithorax in 14 (8%) of the cases. LITA+SVG was used in 10 (5.7%) of these cases, and only SVG was used in 4 (2.3%) cases. The cases with bilateral early severe pleural effusion were 7 (4%). LITA+SVG was used in 3 (1.7%) of these cases, and only SVG was used in 4 (2.3%) cases. Conclusion: It is known that coronary artery bypass surgery causes deterioration of postoperative pulmonary function. One of the most common complications of coronary artery bypass surgery is pleural effusion. It is known that this postoperative picture is associated with increased hospital stay and high postoperative morbidity. It is important to determine preoperative risks in terms of postoperative patient management and morbidity assessment.

Keywords:

cardiac surgery, coronary artery bypass graft surgery, pleural effusion,

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