Turhan YAVUZ, Erdoğan İBRİŞİM, Ahmet ÖCAL, Vildan ULUSAN, Cumhur TENEKECİ, Ali KUTSAL, İrfan ALTUNTAŞ, İbrahim KILINÇ

Daflon kardiyopulmoner bypass sırasında oluşan kompleman aktivasyonunu önleyerek reperfüzyon hasarını azaltır

Amaç: Venotropik bir ilaç olan Daflonun kompleman C3'ü inhibe ettiği bilinmektedir. Kompleman C3 alternatif kompleman aktivasyonunun başlangıcıdır. Kardiyopulmoner bypass ile yapılan açık kalp ameliyatlarının tüm vücutta oluşturduğu yaygın inflamatuvar reaksiyonda alternatif kompleman aktivasyonu önemlidir. Bu çalışmada amacımız Daflonun kardiyopulmoner bypass ile yapılan açık kalp ameliyatlarında oluşan reperfüzyon hasarı ve kompleman aktivasyonu üzerine etkilerini belirlemektir. Materyal ve Metod: Çalışmaya kardiyopulmoner bypass ile öpere edilen ardışık 50 hasta Daflon (Grup 1) ve kontrol grubu (Grup 2) olarak 2 gruba ayrıldı. Grup l'in ortalama yaşı 59.6 + 3.3 yıl olup, 10'u kadın, 15'i erkek toplam 25 hastadan oluşmakta idi ve hastalara preoperatif 7 gün boyunca oral 2 tablet/gün Daflon tablet verildi. Grup 2 ise kontrol grubu olup, ortalama yaşı 60.3 + 2.9 yıl olan 11'i kadın 14'ü erkek 25 hastadan oluşmaktaydı. Bulgular: Daflon verilen grupta kardiyopulmoner bypass sırasında kompleman C3 değerlerinin yükseldiği evrede senkronize olarak troponin I ve CK-MB düzeyleri kontrol grubuna göre anlamlı olarak düşüktü (p < 0.001). Sonuç: Daflon kardiyopulmner bypass sırasında oluşan alternatif kompleman aktivasyonunu inhibe ederek reperfüzyon hasarını azaltır.

During cardiopulmonary bypass Daflon decreases reperfusion injury by complement inhibition

Background: Daflon is basically known as a phlebotonic, vasculoprotector agent and an inhibition of complement C3 is involved in the initial part of alternative complement pathway. The inflammatory response during cardiopulmonary bypass is releated with the activation of alternative complement pathway. The aim of the present controlled-clinical study was to evaluate the potential myocardial protective effects of Daflon by measuring the serum levels of complement C3 during open heart surgery. Methods: Fifty patients selected for open heart surgery under cardiopulmonary bypass were randomly assigned to Daflon or control group. Patients were given Daflon tablet orally twice daily tablet per day or placebo 7 days preoperatively. In the Daflon group there were 25 patients (10 women and 15 men) with the mean age 59.6 + 3.2 years. In the control group, there were 11 women and 14 men with, the mean age 60.3 ± 2.9 years. Serial blood samples were collected preoperatively (venous), 20 minutes after cross-clamping (right atrium), 20 minutes after aortic unclamping (right atrium) and 24 hours postoperatively (venous). Results: Serum C3 levels in the Daflon group were significantly higher at 20 minutes after cross-clamping and 20 minutes after unclamping (p < 0.001). But, troponin I levels in the Daflon group were significantly lower than at 20 minutes after cross-clamping, 20 minutes after unclamping and 24 hours postoperatively than those of the control group (p < 0.001). Conclusion: As a result this study confirms the cardioprotective effect of PMFF against reperfusion injury by alternative complement activation inhibition.

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