Erişkin Kalp Cerrahisinde Kardiyopulmoner Baypas Sırasındaki Beyin Perfüzyonu ile Mortalite Skorlarının Etkileşimi
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Giriş: Bu çalışmada
erişkin kalp cerrahisi ameliyatları sırasındaki beyin perfüzyonu ile mortalite
skorlarının etkileşimlerinin araştırılması amaçlandı.
Hastalar ve Yöntem:
Nisan 2018-Ağustos 2018 tarihleri arasında kliniğimizde kardiyopulmoner baypas
(KPB) ile ameliyat edilecek erişkin hastalar çalışmaya dahil edildi (n= 91).
Beyin perfüzyonunu belirlemek için “Near Infrared Spectroscopy (NIRS)” yöntemi
kullanıldı. Ölçümler dört zaman aralığında yapıldı. T0: KPB öncesi, T1: soğuma
periyodu, T2: ısınma periyodu, T3: KPB sonrası. Mortalite skorları olarak
EuroSCORE II ve “Acute Physiology and Chronic Health Evaluation (APACHE)” II
skoru değerleri her bir hasta için kaydedildi.
Bulgular: Ameliyat
verileri, koroner arter baypas cerrahisi (n= 41, %45), kapak ameliyatları (n=
47, %51), koroner arter baypas cerrahisi ve kapak ameliyatlarının birlikte
uygulandığı hastalar (n= 3, %4) olarak saptandı. Ortalama Euroscore II 1.1
(0.7-36.6) ve ortalama APACHE II skoru 6 (0-23) bulundu. Ölüm gelişen dört
hastada EuroSCORE II C indeksi 0.702 (Confidence interval 0.411-0.993, p=
0.048) ve APACHE II score C indeksi 0.871 (Confidence interval 0.660-1, p=
0.010) belirlendi. Ameliyat sırasında T3 dönemindeki NIRS ölçüm değerleri düşük
bulunan ve T0-T3 periyodundaki NIRS değeri değişiklikleri anlamlı olan
hastalarda APACHE II skoru ölçümlerinde anlamlı değişiklik saptandı.
Sonuç: NIRS
ölçümlerindeki değişiklikler, mortalite ve morbidite skorlama yöntemleri
ölçümleriyle paralellik gösterir. Bu nedenle ameliyat öncesi ve sonrası
dönemdeki hasta yönetimi açısından NIRS ölçümü iyi bir belirteçtir.
Relation Between Cerebral Perfusion Changes and Mortality Scores During Cardiopulmonary Bypass at Adult Cardiac Surgery
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Introduction: This
study aims to investigate the correlation between cerebral perfusion changes
and mortality rate in individuals undergoing adult cardiac surgery.
Patients and Methods:
Between April 2018-August 2018, 91 adult individuals who underwent open heart
surgery with cardiopulmonary bypass (CPB) were prospectively evaluated.
Cerebral perfusion was monitored via near-infrared spectroscopy (NIRS). The
NIRS values were recorded at four intervals: T0, just before CPB; T1, cooling
period (time taken to reach targeted hypothermia); T2, warming period (time
taken to reach normal body temperature); and T3, following minutes of
termination of CPB. Euro Score II and Acute Physiology and Chronic Health
Evaluation (APACHE) II scores were recorded for each individual.
Results: The
operations performed include coronary artery bypass surgery (n= 41, 45%),
valvular surgery (n= 47, 51%), and coronary artery bypass combined with
valvular surgery (n= 3, 4%). Median Euro Score II was calculated to be 1.1
(range 0.7-36.6), and median APACHE II score was calculated to be 6 (range
0-23). Mortality occurred in four individuals for whom the Euro Score II C
index was 0.702 (confidence interval, 0.411- 0.993; p= 0.048) and APACHE-II
score C index was 0.871 (confidence interval, 0.660-1; p= 0.010). During the
operative period, cerebral NIRS values decreased during T3 period, and
significant changes occurred at T0-T3 period, consequently leading to an
increase in the APACHE-II scores and the prediction of mortality.
Conclusion: The
changes at NIRS values were related with higher mortality, morbidity, and
predicting scores. It is now suggested that these changes can eventually be a
good guide and predictor for the management of patients during preoperative and
postoperative periods.
___
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