Pediyatrik Kalp Cerrahisinde Transfüzyon: Prospektif, Gözlemsel Çalışma

Amaç: Kalp cerrahisi geçiren pediyatrik hastalarda kan ve kan ürünleri transfüzyonu kaçınılmaz olabilmektedir. Çalışmamızda, bu hastalarda, kan ve kan ürünlerinin transfüzyonu ile ilişkili faktörlerin ve risklerin belirlenmesi amaçlanmıştır. Yöntem: Preoperatif demografik veriler, kardiyopulmoner baypas (KPB) ve operasyon süresi, KPB girişindeki, KPB sırasındaki ve ayrılmadan sonraki, ameliyat sonundaki hematokrit ve hemoglobin değerleri kaydedildi. KPB sırasında ulaşılan en düşük vücut ısısı, intraoperatif dönemde kullanılan kristalloid, kolloid, eritrosit süspansiyonu (ES), taze donmuş plazma (TDP), trombosit süspansiyonu (TS), kriyopresipitat miktarı kaydedildi. Postoperatif dönemde; yoğun bakım ünitesinde (YBÜ) verilen kan ve kan ürünleri miktarı, YBÜ’nde ve hastanede kalış süreleri, mortalite kaydedildi. Bulgular: Çalışmaya 83 çocuk dahil edildi. ES transfüzyonu RACHS1: 3 olan hastalarda, RACHS1: 2 olan hastalardan yüksekti (p=0,009). Yaş ile postoperatif ES, intraoperatif ve postoperatif dönemdeki toplam ES ve toplam TDP transfüzyonu arasında negatif korelasyon saptandı. KPB süresi ile intraoperatif ES ve TDP, postoperatif ES, TDP, kriyopresipitat tüketimi, toplam ES ve toplam TDP tüketimi arasında pozitif korelasyon belirlendi. Siyanotik çocukların intraoperatif ES ve TDP tüketimi asiyanotik çocuklardan yüksekti (ES p=0.002; TDP p=0.002). Postoperatif dönemde siyanotik çocukların kriyopresipitat tüketimi yüksekti (p=0.026). 15 hastanın eksitus olduğu belirlendi. Eksitus olan hastalarda postoperatif dönemdeki ES ve TDP (ES p=0.004, TDP p=0.003), toplam ES ve TDP miktarının yüksek olduğu saptandı (toplam ES p=0.001, toplam TDP p=0.003). Sonuç: Açık kalp cerrahisi geçiren çocuklarda intraoperatif ve postoperatif transfüzyon oranlarının hastanın yaşı, RACHS1 skoru, KPB süresi, vücut ısısı ve siyanoz ile ilişkili olduğu belirlenmiştir. Eksitus olan hastalarda ES ve TDP transfüzyon miktarlarının yüksek olduğu saptanmıştır.

Transfusion in Pediatric Heart Surgery: A Prospective, Observational Study

Objective: Transfusion of blood and blood products may be unavoidable in pediatric patients undergoing cardiac surgery. The aim of this study was to determine the factors and risks associated with transfusion of blood and blood products in these patients. Method: Preoperative demographic data, cardiopulmonary bypass (CPB) and operation times were recorded. Hematocrit and hemoglobin values were recorded at the beginning, during and at the end of CPB. The lowest body temperature during CPB, intraoperative consumptions of crystalloid, colloid, blood, blood products were recorded. The consumption of blood and blood products, length of stay intensive care unit (ICU) and hospital, and mortality were recorded during the postoperative period. Results: Eighty-three children were included in the study. Intraoperative transfusion of erythrocyte suspension (ES) was more frequently applied in patients with RACHS1: 3 when compared with the patients with RACHS1: 2 (p=0.009). A negative correlation was detected between age and postoperative ES, total erythrocyte and total fresh frozen plasma (FFP) transfusions during intraoperative, and postoperative periods. A a positive correlation was determined between CPB duration and intraoperative erythrocyte and FFP, postoperative erythrocyte, FFP, cryoprecipitate, total erythrocyte and total FFP consumptions. The intraoperative ES and FFP consumptions, the postoperative cryoprecipitate consumptions were higher in cyanotic children (ES p=0.002; FFP p=0.002, cryoprecipitate p=0.026) when compared with acyanotic children. Fifteen patients died. Postoperative ES and FFP, total erythrocyte and FFP consumptions were higher in the deceased patients (total ES p=0.001, total FFP p=0.003). Conclusion: A correlation was detected between intraoperative, and postoperative transfusion rates, age, RACHS1 scores, body temperatures of the patients, duration of CPB, and presence of cyanosis in children undergoing open heart surgery. Higher rates of ES and FFP transfusions were detected in exited patients.

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

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