Fehim Can SEVİL, Mehmet TORT, Uğur AKSU, Necip BECİT

KORONER ARTER BAYPAS GREFTLEME OPERASYONU SONRASINDA ATRİYAL FİBRİLASYON GELİŞMESİNDE SANTRAL VENÖZ BASINCIN ETKİSİ

AMAÇ: Kardiyak operasyonlar sonrasında gelişen aritmiler mortalite ve morbidite ile sonuçlanabilir. Koroner arter baypas greftleme (KABG) operasyonu sonrasında atriyal fibrilasyon (AF) en sık görülen kardiyak aritmilerdendir. Santral venöz basınç (SVB) sağ atriyum ve sağ ventrikül basınçları ile ilişkili bir para-metredir. Çalışmamızda amacımız sağ atriyum gerginliğine ne-den olabilecek SVB yüksekliğinin KABG operasyonu sonrasında AF gelişmesi üzerine etkisinin araştırılmasıdır.GEREÇ VE YÖNTEM: Ocak 2010 - Haziran 2020 yılları arasında kliniğimizde KABG operasyonu yapılan 278 hastanın verileri retrospektif olarak incelendi. KABG operasyonu sonrasında AF gelişen ve AF gelişmeyen hastalar iki gruba ayrıldı ve demografik özellikleri, eşlik eden hastalıkları, kan tetkikleri ve operasyon sonrası ilk 24 saatteki ortalama SVB değerleri karşılaştırıldı.BULGULAR: KABG operasyonu sonrasında AF gelişen 31 hasta ile AF gelişmeyen 247 hastanın karşılaştırılmasında demografik özelliklerinden yaş (p=0,091), cinsiyet (p=0,595), boy (p=0,368) ve kilonun (p=0,078) iki grupta benzer olduğu görüldü. Eşlik eden risk faktörleri ve Euroskorları iki grup arasında benzer iken sigara kullanımının AF gelişmeyen grupta anlamlı olarak daha yüksek oranda olduğu saptandı (p=0,033). Kan tetkiklerinde fibrinojen seviyesi (p=0,013), brain natriüretik peptit seviyesi (p=0,037) AF gelişen grupta anlamlı olarak yüksek saptanırken trombosit sayısı (p=0,045) AF gelişmeyen grupta anlamlı olarak yüksek saptandı. KABG operasyonu sonrasında AF gelişen grupta ölçülen SVB değerleri AF gelişmeyen Grubun SVB değerlerinden anlamlı olarak yüksek saptandı (p=0,008).SONUÇ: KABG operasyonu sonrasında sağ atriyum basıncını gösteren SVB değerinin yüksek saptanmasının AF gelişiminde etkili olduğu görüldü. Yoğun bakım ünitesinde KABG operasyonu sonrası SVB takibinin yapılması ve uygun seviyelerde tutulmasının gelişebilecek AF ihtimalini azaltacağı görüşündeyiz.

Anahtar Kelimeler:

Koroner, Atriyal, Fibrilasyon, Santral, Basınç

THE EFFECT OF CENTRAL VENOUS PRESSURE ON THE DEVELOPMENT OF ATRIAL FIBRILLATION AFTER CORONARY ARTERY BYPASS GRAFT OPERATION

OBJECTIVE: Arrhythmias that develop after cardiac operations may result in mortality and morbidity. Atrial fibrillation (AF) is one of the most common cardiac arrhythmias after coronary artery bypass grafting (CABG) operation. Central venous pressure (CVP) is a parameter related to the right atrial and right ventricular pressures. In our study, we aim/ed to investigate the effect of CVP elevation that may cause right atrial tension on the development of AF after CABG operation.MATERIAL AND METHODS: Data of 278 patients who underwent CABG operation in our clinic between January 2010 and June 2020 were retrospectively analyzed. Patients who developed and did not develop AF after CABG operation were divided into two groups and their demographic characteristics, accompanying diseases, blood tests and mean CVP values in the first 24 hours after the operation were compared.RESULTS: When the data obtained from 31 patients who developed AF after CABG operation and 247 patients who did not develop AF were compared, demographic characteristics of age (p = 0.091), gender (p = 0.595), height (p = 0.368) and weight (p=0.078) were found to be similar in the two groups. While accompanying risk factors and Euro scores were similar between the two groups, smoking was found to be significantly higher in the group without AF (p = 0.033). In blood tests, fibrinogen level (p = 0.013) and brain natriuretic peptide level (p = 0.037) were found to be significantly higher in the AF-developing group, while the thrombocyte count (p = 0.045) was found to be significantly higher in the group without AF. CVP values measured in the group developing AF after CABG operation were found to be significantly higher than the CVP values of the group without AF (p = 0.008).CONCLUSIONS: It was observed that the high CVP value indicating the right atrial pressure after the CABG operation was effective in the development of AF. We think that CVP follow-up after CABG operation in the intensive care unit and keeping it at appropriate levels will reduce the possibility of AF that may develop.

Keywords:

Coronary, Atrial, Fibrillation, Central, Pressure,

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