Pulsatil ve Nonpulsatil Kardiyopulmoner Baypas ile Koroner Baypas Cerrahisi Uygulanan Hastalarda Nörokognitif Değişikliklerin Elektroensefalografi ve Minimental Test Kullanılarak Değerlendirilmesi

Giriş: Bu çalışmanın amacı; koroner baypas cerrahisi uygulanan hastalarda pulsatil ve nonpulsatil perfüzyonun nörokognitif etkilerini elektroensefalografi (EEG) ve minimental test kullanılarak karşılaştırmaktır. Hastalar ve Yöntem: Ardışık randomize koroner baypas adayı 11’er hastalık iki grup oluşturuldu. Grup I’de kardiyopulmoner baypas (KPB) pulsatil, grup II’de nonpulsatil olarak yürütüldü. Hastalara ameliyat öncesinde, ameliyat sırasında, kros klemp konduktan 15 dakika sonra ve ameliyat sonrası yedinci günlerde EEG ile birlikte yine ameliyat öncesi ve sonrası yedinci günlerde minimental test çalışıldı. Bulgular: Her iki grupta da ameliyat sırasında patolojik EEG dalgaları tespit edilmiş ancak aralarında fark bulunamamıştır (p> 0.05). Grup I’de ameliyat sonrası birinci günde idrar çıkışı anlamlı yüksek tespit edilmiştir. Toplam drenaj grup I’de yüksek olmasına rağmen anlamlı bulunmamıştır. Diabetes mellitus, hiperkolesterolemi, hipertansiyon, kros klemp ve perfüzyon süresinin patolojik EEG dalgası oluşumuna anlamlı etkisi saptanmamıştır. Ameliyat öncesi ve sonrası minimental test skorları istatistiksel olarak anlamlı bulunmamıştır (p> 0.05). Sonuç: Çalışmamızda KPB pulsatil ve nonpulsatil perfüzyonun birbirine belirgin bir üstünlüğü gösterilemedi. KPB sırasında perfüzyon yöntemlerinin daha fizyolojik hale getirilmesi, organ perfüzyonu açısından daha yüksek risk grubundaki hastalarda çalışmalar yapılması, perfüzyon akım stratejilerini daha iyi ortaya koyacaktır.

Anahtar Kelimeler:

Pulsatil baypas, nonpulsatil baypas, elektroensefalografi, minimental test, nörokognitif değişiklik

Determination of Neurocognitive Changes Using Electroencephalography and the Mini-Mental Test in Coronary Bypass Patients Who Underwent Operation with Pulsatile and Non-Pulsatile Cardiopulmonary Bypass

Introduction: The aim of this study was to compare the neurocognitive effects of pulsatile and non-pulsatile perfusion using electroencephalography and the Mini-Mental State Examination (MMSE) in patients undergoing coronary bypass surgery. Patients and Methods: We created two groups, each containing 11 consecutive randomized patients, who were candidates for coronary bypass surgery. Pulsatile cardiopulmonary bypass (CPB) was conducted in Group I, and non-pulsatile CPB was conducted in Group II. An electroencephalogram (EEG) was performed preoperatively, intraoperatively, 15 minutes after placement of the cross-clamp, and seven days postoperatively. The MMSE was performed preoperatively and on postoperative day seven. Results: In both groups, pathological EEG waves were detected intraoperatively. However, no statistically significant difference was found between the groups (p> 0.05). Urine output was significantly higher at postoperative day1 in Group I. Overall urine drainage was higher in Group I, but the difference was not statistically significant. Diabetes mellitus, hypercholesterolemia, hypertension, cross-clamp, and perfusion time did not have a significant impact on the formation of pathological EEG waves. The difference between pre- and postoperative MMSE scores was not statistically significant (p> 0.05). Conclusion: No remarkable superiority was shown between CPB pulsatile and non-pulsatile perfusion in our study. Improving physiology of perfusion techniques during CPB and performing further studies on patients at high risk for organ perfusion would suggest more comprehensive perfusion flow strategies.

Keywords:

Electroencephalogram, mini-mental state examination, neurocognitive change, non-pulsatile bypass, pulsatile bypass,

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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