Ömer Naci EMİROĞULLARI, Fatih AŞGÜN, Faruk SERHATLIOĞLU, Hakan CEYRAN, Ali ÖZBEK, Kutay TAŞDEMİR, Cemal KAHRAMAN, Reha ARSAN

Kardiyopulmoner bypass sırasında sistemik lökosit filtrasyonunun ameliyat sonrası erken dönem miyokard fonksiyonu üzerine etkisi

Amaç: Bu çalışmada kardiyopulmoner bypass (KPB) ameliyatında sistemik lökosit filtrasyonunun ameliyat sonrası erken dönem kalp fonksiyonları üzerine olan etkisi araştırıldı. Çalışma planı: Elektif koroner arter bypass cerrahisi (KABC) uygulanacak 30 hasta çalışmaya alınarak eşit sayıda iki gruba ayrıldı, gruplardan biri standart arteriyel hat filtresinin kullanıldığı kontrol grubunu, diğeri lökosit filtrasyonu uygulanan çalışma grubunu oluşturdu. Çalışma grubunda standart filtre ile lökosit filtresi paralel olarak KPB sistemine bağlandı ve reperfüzyon aşamasından itibaren lökosit filtrasyonu uygulandı. Elde edilen veriler uygun istatistiksel yöntem kullanılarak kıyaslandı. Bulgul ar: Gruplar arasında ameliyat öncesi ve ameliyat sonrası erken dönem veriler açısından farklılık yoktu. Benzer şekilde tam kan sayımı, miyokardiyal ve renal hasarın biyokimyasal belirleyicileri, sistemik ve koroner sinüs kanında malondialdehit düzeyi, hemodinamik ölçümler, inotropik destek ihtiyacı, mekanik ventilasyon süresi, yoğun bakım ünitesinde ve hastanede yatış süreleri arasında anlamlı farklılık bulunamadı. Periferik kanda nötrofil sayıları ile biyokimyasal miyokard hasar belirleyicileri arasında doğrusal bir ilişkinin bulunduğu saptandı. Sonuç: Elektif KABC uygulanan hastalarda reperfüzyon aşamasında ve sonrasında arteriyel hat üzerinden sistemik lökosit filtrasyonu uygulanması periferik kandaki lökosit sayısını yeterli düzeyde düşürememektedir ve yeterli miyokard koruması sağlamamaktadır. Bu nedenle lökosit filtrasyonunun elektif olgularda rutin kullanımı önerilmemiştir, ancak ameliyat sonrası komplikasyon gelişimine aday hastalarda uygulanması daha yararlı sonuçlar ortaya koyabilir

The influence of leukocyte filtration during cardiopulmonary bypass on early postoperative myocarddial function

Background: We studied the effects of systemic leukocyte filtration during cardiopulmonary bypass (CPB) on early postoperative heart functions. Methods: Thirty patients scheduled for an elective coronary artery bypass grafting (CABG) were registered for study and divided equally into two groups. Conventional arterial line filter was used in the control group while in the leukocyte filtration group, a commercially available leukocyte filter and a conventional arterial line filter were paralelly incorporated into the CPB circuit, and the blood was filtered during reperfusion phase and the rest of CPB duration. Results: Preoperative and intraoperative data did not reveal any differences between two groups. Similarly, no statistically significant difference was present in terms of complete blood count, biochemical markers of myocardial and renal damage, malondialdehyde levels in systemic blood and coronary sinus effluent, hemodynamic measurements, inotropic support requirement, duration of mechanic ventilation, and length of intensive care unit and hospital stay. There was a linear correlation between neutrophil counts and myocardial damage markers in peripheric blood samples. Conclusion: We concluded that, in the elective CABG patients, leukocyte filtration through arterial line during reperfusion period does not reduce enoughly the leukocyte count in peripheric blood, and does not provide enough myocardial protection. Therefore we do not suggest the routine use of such filters in elective cardiac surgery cases, however, it may be more beneficial to use it in patients who are prone to complications.

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