Nevzat Erdil, Nihat Aydın, Tamer Eroğlu, Murat Kaynak, Köksal Dönmez, Fulya Erbaş, Bektaş Battaloğlu, Saim Yoloğlu

Koroner Arter Baypas Cerrahisinde Kullanılan Heparin Kaplı Olan ve Olmayan Oksijenatörlerin Böbrek Fonksiyonları Üzerine Olan Etkisinin Karşılaştırılması

Amaç: Renal hasar ve takiben oluşan akut böbrek yetmezliği kardiyak cerrahiye giden hastalarda görülen en önemli komplikasyonlardan birisidir. Özellikle son on yılda yayınlanan çok merkezli ve binlerce hastayı kapsayan çalışmalarda akut renal yetmezlik için risk faktörleri ortaya konmaktadır. Bu çalışmanın amacı heparin kaplı olan ve olmayan oksijenatörlerin renal fonksiyonlar üzerine etkisini değerlendirmektir. Metod: Kliniğimizde Mart 2006 ile Kasım 2006 tarihleri arasında koroner bypass operasyonuna giden 50 hasta prospektif olarak çalışmaya dahil edilmiştir. Hastalar heparin kaplı olmayan oksijenatör kullanılan (n=25, Grup 1) ve heparin kaplı oksijenatör kullanılan (n=25, Grup 2) olmak üzere iki gruba ayrılmıştır. Kan örnekleri preoperatif ve postoperatif 1, 24 ve 96. saatte alınmıştır. Alınan kan örneklerinden BUN, kreatinin, sodyum, potasyum, kalsiyum, klor ve fosfor; idrar örneklerinden ise protein, klirens, sodyum, kalsiyum ve klor çalışılmıştır. Her iki grupta demografik veriler benzerdir. Sonuçlar: Her iki grupta da erken mortalite yoktu. Operatif ve postoperatif parametreler her iki grupta da benzerdir. Her iki grupta preoperatif periodda değerlendirilen parametreler olan BUN, kreatinin, sodyum, potasyum, kalsiyum, klor, fosfor, idrar proteini, idrar klirensi, idrar sodyumu, idrar kalsiyumu ve idrar kloru açısından istatiksel olarak anlamlı değişiklik yoktu. Hiçbir hastada renal disfonksiyon saptanmadı. Her iki grupta preoperatif ve postoperatif periyotta ölçülen idrar klirensi istatiksel olarak anlamlı değişiklik göstermemektedir. Grup I'de cerrahi sonrası 24. saatte ölçülen kreatinin değeri Grup II'den daha düşük olarak bulunmuştur ve bu değişiklik istatistiksel açıdan anlamlı idi. Her iki grupta postoperatif periyotta renal fonksiyonları değerlendirmek için kullanılan diğer parametrelere bakıldığında anlamlı bir farklılık bulunmadı. Tartışma: Bu çalışmada preoperatif böbrek fonksiyonları normal hastalarda, heparin kaplı olan ve olmayan oksijenatörlerin böbrek fonksiyonları üzerine olan etkilerinde bir farklılık saptanmadı.

Anahtar Kelimeler:

Koroner arter baypas cerrahisi, kardiyopulmoner baypas, oksijenatör, membran, böbrek yetmezliği.

Comparing Heparin-Coated and Non-Coated Oxygenators On Renal Functions in Coronary Artery Bypass Surgery

Background: Renal damage and subsequent acute renal failure is one of the most important complications in patients who had cardiac surgery. Multicenter studies with thousands of patients which exposed the risk factors for acute renal failure has been published especially in the last decade. This study is designed for evaluation of heparin-coated and non-coated oxygenators on the renal functions. Methods: This study has been performed prospectively with 50 patients who had undergone coronary bypass surgery in our clinic from March 2006 to September 2006. The patients have been divided into two groups as non-coated oxygenators (n = 25, Group 1) used and heparin-coated oxygenators (n = 25, Group 2) used. Blood samples were collected at the preoperative, and at 1st, 24th and 96th postoperative hours. The demographic data were similar in two groups. Results: There was no early mortality in both groups. Operative and postoperative parameters were similar in both groups. There were no statistical differences between the evaluated parameters like BUN, creatinine, sodium, potassium, calcium, chloride, phosphorus, urine protein, creatinine clearence, urine sodium, urine calcium and urine chloride tests at preoperative period in both groups. We did not detect renal dysfunction in any patients. There are no statistical differences in the creatinine clearance in preoperative and postoperative periods in both groups. In group one, creatinin levels were lower than group two at 24 hours after surgery and these differences were statistically important in two groups. We found no significant difference between two groups regarding the other parameters for renal function during the postoperative period. Conclusion: In this study, there were not any significant difference between coated and non-coated oxygenators' effects over renal functions of patients whose renal functions were normal preoperatively.

Keywords:

Coronary artery bypass surgery, cardiopulmonary bypass, oxygenators, membrane, kidney failure.,

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ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi