Handan İNÖNÜ, İlker ETİKAN, Ahmet Cemal PAZARLI, Serhat ÇELİKEL, Erdinç NASERİ

Kalp cerrahisinin erken ve geç pulmoner fonksiyonlar üzerine etkisi: Üç yıllık takip sonuçları

Amaç: Bu çalışmada, kalp cerrahisinden üç ay ve üç yıl sonra pulmoner fonksiyonların değerlendirilmesi amaçlandı. Çalışma planı: Hastanemiz Kalp Damar Cerrahisi Kliniği'nde Ağustos 2005 - Mart 2006 tarihleri arasında elektif açık kalp cerrahisi uygulanan 25 hasta (19 erkek, 6 kadın; ort. yaş 55.5±13.4 yıl; dağılım 17-77 yıl) ileriye dönük olarak değerlendirildi. Solunum fonksiyon testleri (SFT) ve arter kan gazı (AKG) analizleri, ameliyat öncesinde ve ameliyat sonrası 3. ay ve 3. yılda yapıldı.Bulgular: Yirmi beş hastanın %64'üne koroner arter bypass greftleme (KABG) ameliyatı, %20'sine kapak replasmanı ameliyatı (KRA), %16'sına ise hem KABG hem de KRA uygulandı. New York Heart Association (NYHA) kalp yetmezliği sınıflamasına göre ameliyat öncesi kalp yetmezliği düzeyi hastaların %68'inde sınıf III, %24'ünde sınıf II ve %8'inde sınıf IV idi. Solunum fonksiyon testi parametrelerinden VC, FEV1, FVC, FEF25, FEF50, FEF75 ve MMEF'nin ameliyat öncesi değerleri ve ameliyat sonrası 3. ay ve 3. yıl değerleri karşılaştırıldığında fark anlamlı iken (p=0.0001), FEV1/FVC oranı ve PEF açısından fark anlamlı değildi (p>0.05). Ameliyat öncesi ve ameliyat sonrası AKG değerleri arasında fark yoktu (p>0.05).Sonuç: Bu çalışmanın en önemli sonucu, SFT parametrelerinin üç yıl sonra, ameliyat öncesi değerlere göre anlamlı derecede düşük tespit edilmesidir. Bu sonuç ameliyat sonrası oluşan fonksiyonel değişikliklerin 3. yılın sonunda bile devam ettiğini göstermesi açısından dikkate değerdir.

The effects of heart surgery on early and late pulmonary functions: the results of three-year follow-up

Background: In this study, we evaluated the pulmonary functions three months and three years after heart surgery. Methods: Twenty-five patients (19 males, 6 females; mean age 55.5±13.4 years; range 17 to 77 years) who underwent elective open heart surgery between August 2005 and March 2006 in the Cardiovascular Surgery Clinic of our hospital were prospectively evaluated. Pulmonary function tests (PFT) and arterial blood gas (ABG) analyses were performed before the operation and in the 3rd month and 3rd year after the operation.Results: Sixty four percent of 25 patients had coronary artery bypass graft (CABG) surgery, 20% of them had valve replacement surgery (VRS), while 16% of them had both CABG and VRS. The stage of heart failure before the surgery, was class III in 68% of patients, class II in 24%, and class IV in 8% according to the New York Heart Association (NYHA) heart failure classification. When compared to preoperative values, the difference in the postoperative 3rd month a nd 3rd year values of the PFT parameters VC, FEV1, FVC, FEF25, FEF50, FEF75 and MMEF was statistically significant (p=0.0001), whereas the difference was not significant in terms of FEV1/FVC ratio and PEF (p>0.05). There was no difference between the preoperative and postoperative ABG values (p>0.05).Conclusion: The most important result of this study is that the PFT parameters after three years were significantly lower than the preoperative values. This result is remarkable since it shows that the functional changes that develop after the operation persist at the end of 3rd year.

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