Mustafa SAÇAR, Gökhan ÖNEM, Fahri ADALI, İbrahim GÖKŞİN, Derviş VERDİ, Ali Vefa ÖZCAN, Ümit Yaşar TEKELİ, Hülya SUNGURTEKİN, Ahmet BALTALARLI

Koroner arter baypas cerrahisi sonrasında gecikmiş ekstübasyonun risk faktörleri

Bu çalışmada koroner arter baypas cerrahisi sonrasında ekstübasyon süresini uzatan risk faktörlerinin belirlenmesi amaçlandı. Koroner arter baypas cerrahisi uygulanan 121 hastanın kayıtları retrospektif olarak incelendi. Hastalar erken (16 saatten kısa sürede) ve uzamış (16 saatten uzun sürede) ekstübasyon grubu olarak ikiye ayrıldı. Entübasyon süresini etkileyen risk faktörleri t-testi ve chisquare testi kullanılarak univaryans analiz yöntem ile değerlendirildi. Ardından extübasyon süresini uzatan faktörler logistic regression modeli ile değerlendirmeye alındı. Kırk yedi hastada uzamış mekanik ventilasyon ihtiyacı tespit edildi. Ekstübasyon süresini uzatan faktörler univaryans analizde yaş, operasyon süresi, minimum vücut ısısı, kros klemp süresi, total perfüzyon süresi, inotropik ajan kullanımı, Yoğun Bakım Ünitesi (YBÜ)’ de verilen kolloid miktarı, kan transfüzyonu, ekstübasyona kadar geçen süredeki saatlik ortalama idrar çıkışı, göğüs drenaj, ekstübasyon da başarısızlık, anesteziklerin doz ve infüzyon süresi, intraaortik balon pompa (IABP), postoperatif nörolojik bozukluk, YBÜ’ ne geldiği sıradaki PaO2 seviyesi ve BUN seviyesi olarak tespit edildi. Ancak yapılan logistic regression analizinde yaş, operasyon esnasındaki en düşük vücut ısısı, IABP kullanımı, remifentanil infüzyon süresi ve PaO2/FiO2 oranının ekstübasyon süresini uzatan en önemli belirleyiciler olduğu gösterilmiştir.YBÜ’nde hastanın kan gazı takipleri ile ventilatör ayarlarının düzenlenmesi, hemodinamik instabilitenin uygun inotropik ajanlarla ve İABP yardımı ile düzeltilmesinin ekstübasyon süresini kısaltabileceğini düşünüyoruz.

Risk factors of delayed extubation after coronary artery bypass graft surgery

The aim of this study was to determine the risk factors of delayed extubation in patients undergoing coronary artery bypass grafting (CABG). The records of 121 patients who underwent CABG surgery were studied retrospectively. The patients were divided into early (intubation time <16h) and delayed extubation (intubation time >16h) groups. Risk factors affecting the intubation time were evaluated with a univariate analysis using the t-test and chi-squared test. A logistic regression model was then used to determine the factors causing delayed extubation. Forty seven patients needed prolonged mechanical ventilation. In univariate analysis, predictors of delayed extubation (p<0.05) were age, operation time, minimal body temperature, cross-clamp time, total perfusion time, inotropic agent usage, amount of colloids infused, blood transfusion, hourly urine output (ml/h) up to extubation, failure in extubation trying, dosage and infusion time of anesthetic agents, the number of patient requiring IABP, the incidence of neurological disorders, PaO2/FiO2 ratio, PaO2 , SaO2 and blood urea nitrogen levels at the extubation time. Logistic regression analysis showed that age, minimal body temperature, duration of ansthesia, the number of patient requiring IABP and PaO2/FiO2 ratio at the extubation time were the most important predictors for delayed extubation. We think that the adjustment of ventilatory according to patients arterial blood gases monitorization, improvement of hemodynamic instability with inotropic agents and IABP would reduce the extubation time after the coronary artery bypass surgery.

Tam Metin

Kaynakça

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