Halil DÜZOVA, Burak Işık, Dinçer ÖZGÖR, Yaşar BAYINDIR, M.sait TEKEREKOĞLU, Sezai YILMAZ

Mekanik Barsak Obstrüksiyonu Nedeniyle Laparotomi Yapılan Hastalarda Flukonazol Proflaksisinin Lipid Peroksidasyonu Ve Nitrik Oksit Üzerine Etkisi+

Amaç: Mekanik barsak obstrüksiyonu nedeni ile opere edilen hastalarda ortaya çıkan enfeksiyonlarda, giderek artan sıklıkta Candida albicans izole edilmektedir. Bu çalışmada, kandidial enfeksiyonlar, nitrik oksit (NO) ve tiobarbiturik asit türevi aktif ürünlerin (TBARS) yapım cevabı üzerine flukonazol profilaksisin, etkisini incelemek için yapıldı. Gereç ve Yöntem: Temmuz 2003 ile Aralık 2004 tarihleri arasında mekanik barsak obstrüksiyonu nedeniyle laparotomi yapılan 52 hasta çalışmaya alındı. Bu randomize (plasebo- kontrol), çift-kör klinik çalışmada, belirtilen hasta grubunda kandidial translokasyon sıklığı ve bu durumun klinik bulgulara etkisi ile rutin antibakteriyel tedavi ile birlikte preopertaif tek doz flukonazol (400 mg) proflaksisinn etkisi araştırıldı. Aynı zamanda, flukonazol proflaksisinin preoperatif, postoperatif 2., 6. ve 24. saatlerde alınan kan örneklerinde kandidial translokasyonda NO ve TBARS düzeyleri üzerine etkisi spektrofotometrik yöntem ile ölçüldü. Sonuçlar: Malign nedenlerden mekanik barsak tıkanması olan hastalarda ameliyat öncesi tek doz flukonazol verildiğinde, postoperatif 2'inci saat plazma NO düzeyinde artış (p<0.003), ameliyat anında alınan kan ve doku kültürlerinde gram negatif üreme gösteren hastaların postoperatif 24'üncü saatinde plazma NO düzeylerinde istatistiksel olarak artış bulundu (p<0.05). Fakat NO plazma seviyesi, postoperatif kültüründe gram negatif üremesi olan hastalarda 6'ıncı. saatte 2'ıncı saatte ki düzeye göre azalma saptandı (p<0,05). Çıkarımlar: Malign nedenlerden dolayı barsak tıkanması olanlarda, fungal translokasyonu engelleme özelliği gösteren flukonazol, aynı zamanda NO metabolizmasını etkiler. Kültürlerinde gram negatif üremesi olan olgularda ise NO metabolizmasının daha geniş kapsamlı araştırılması gerekmektedir. Anahtar kelimeler: Mekanik barsak obstruksiyonu, Flukonazol, Nitrik oksit, TBARS

Anahtar Kelimeler:

Mekanik barsak obstruksiyonu, Flukonazol, Nitrik oksit, TBARS

The Effect of Fluconasole Prophylaxis on Lipid Peroxidation and Nitric Oxide, In Patients Operated For Mechanical Intestinal Obstruction

Objectives: Candida albicans is being isolated with increasing frequency during intraabdominal infection in patients who are operated for mechanical intestinal obstruction (MIO). The value of fluconazole prophylaxis and documented altered patterns of nitric oxide (NO) and (thiobarbituric acid-reactive substances) TBARS production in response to Candida albicans is a subject of discussion. Material and Methods: Between June 2003 and December 2004, 52 patients with MIO requiring a surgical treatment were included in this study. In this prospective, randomized (placebo-controlled), and double-blind clinical trial, we investigated the frequency and clinical significance of fungal translocation and the effect of a single dose of fluconazole (400 mg) prophylaxis administered with routine antibacterial therapy. NO and TBARS levels were determined in blood samples spectrophotometrically preoperatively; on postoperative 2nd, 6th and 24th hours in order to investigate their roles in fungal translocation. Results: NO levels were significantly high in patients with MIO due to malignant causes who received a single dose of fluconazole, two hours after the operation (p<0.003). In patients with positive gram negative bacteria cultures in the tissue and blood samples obtained preoperatively, NO levels were significantly increased 24 hours after the operation (p<0.05). On the other hand, in patients with positive gram negative bacteria cultures postoperatively, NO levels in samples obtained six hours after the operation were lower than the levels obtained after two hours (p<0,05). Conclusions: Fluconazole with protective effect against candidial translocation had influence on metabolism of NO in patients with MIO due to malign causes and more comprehensive studies should be designed and attention should be paid to the cases with positive gram negative bacteria cultures. Key words: Mechanical intestinal obstruction, Fluconazole, Nitric oxide, TBARS

Keywords:

Mechanical intestinal obstruction, Fluconazole, Nitric oxide, TBARS,

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