Hastalarda Akut Normovolemik Hemodilüsyon Koroner Arter Cerrahisi Geçiren Diyabetik Uygulamasına Kardiyak Yanıtların Transözofageal Ekokardiyografi ile Değerlendirilmesi

Amaç: Çalışmanın amacı, koroner arter cerrahisi geçirecek, diabetik ve düşük kalp debili (EF 40) olguların, akut normovolemik hemodilüsyon uygulamasına kardiyak yanıtlarının transözefageal ekokardiyografik yöntemle değerlendirilmesidirGereç ve Yöntem: Hastalara TÖE 4 gruba ayrıldılar: Grup 1ANH (n: 15): Ejeksiyon fraksiyonu > % 40, ANH uygulanacak grup. Grup 1K (n: 15): Kontrol grubu, Ejeksiyon fraksiyonu > % 40, ANH uygulanmayacak grup. Grup 2ANH (n: 15): Ejeksiyon fraksiyonu

Evaluation of Cardiac Responses to The Application of Acute Normovolemic Hemodilution in Diabetic Patients Undergoing Coronary Surgery with Transoesophageal Echocardiography

Objective: The aim of this study is to evaluate the cardiac responses to acute normovolemic hemodilution (ANH) in diabetic patients with normal (EF > 40) or low (EF <= 40%) cardiac output undergoing coronary artery surgery with transoesophageal echocardiography. Material and Method: The patients were divided into four groups based on TEE findings: Group 1ANH (n: 15): Patients with ejection fraction>%40 who will undergo ANH. Grup 1C (n: 15): Patients with ejection fraction> %40 who will not undergo ANH .Grup 2ANH (n: 15): Patients with ejection fraction<=40 % who will undergo ANH. Grup 2C (n: 15): Control group. Patients with ejection fraction <=40% who will not undergo ANH. The TEE measurements were obtained before ANH and 30 minutes after the application. Using 2D echocardiography systolic (left ventricle end diastolic area (LVEDA), left ventricle end- systolic area (LVESA), fractional area difference (FAD), stroke volume (SV), cardiac index (CI) and diastolic functions; early mitral inflow velocity (Em Vmax), atrial contraction (Am Vmax), ratio (E/A) and deceleration time (DT), isovolumetric relaxation time (IVRT). Results: Hemodynamic and TEE data in Group 1K and Group 1ANH were not different baseline values. However, LVEDA was significantly higher in Group 2ANH after ANH, according to those at the beginning in Group 2ANH (p<0.01). LVESA was not different in these groups. EmVmax. also did not change, but AmVmax. was significantly increased and E/A ratio was significantly decreased in Group 2ANH after ANH, compared to baseline values in Group 2ANH. (p<0.001). Conclusion: In summary, application of moderate degrees of acute normovolemic hemodilution in diabetic patients with normal or low EF was well tolerated without deteriorating left ventricular functions. However, in the presence of atrial fibrillation in diabetic patients with low ejection fractions undergoing cardiac surgery, ANH should be performed carefully, because of the risk of increasing the AmVmax. with ANH.

Kaynakça

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Kaynak Göster

Göğüs Kalp Damar Anestezi ve Yoğun Bakım Derneği Dergisi
  • ISSN: 2548-0669
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1992

2.6b1.6b

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