Tuğra GENÇPINAR, Volkan YARAR, Eyüp HAZAN, Hasan HEPAĞUŞLAR, Ayşe Pelin GİRGİN, Arif Hikmet ÇIMRIN

Koroner arter baypas greftleme cerrahisi uygulanan kronik obstrüktif akciğer hastalığı tanılı hastalarda respiratuvar kas gücünün araştırılması

Amaç: Bu çalışmada; kronik obstrüktif akciğer hastalığı (KOAH) tanısı konmuş hastalarda koroner arter baypas greftleme (KABG) cerrahisinin solunum fonksiyonları ve respiratuvar kas gücü üzerine olan etkileri araştırıldı. Çalışma planı: Bu klinik, prospektif çalışmada median sternotomi ile kardiyopulmoner baypas altında KABG cerrahisi uygulanan 18 yaş üstü 60 erişkin hasta; Kontrol (n=30) ve KOAH (n=30) grupları olarak ikiye ayrıldı. Ameliyat öncesi ve ameliyat sonrası solunum fonksiyonlarına (FEV 1, FVC) ve respiratuvar kas gücüne (P imax, SNIP, PE max) ait değerler elde edildi. Bulgular: Gruplar arasında FEV1 (p=0.00) dışında ameliyat öncesi solunum fonksiyonları ve respiratuvar kas gücüne ait değerlerde anlamlı fark saptanmadı (p>0.05). Kontrol ve KOAH gruplarında; FEV1 (sırasıyla, p=0.00, p=0.00), FVC (sırasıyla, p=0.00, p=0.00), P imax (sırasıyla, p=0.00, p=0.00), SNIP (sırasıyla, p=0.00, p=0.00), PE max (sırasıyla, p=0.00, p=0.00) değerleri ameliyat sonrası dönemde azaldı. Gruplar arasında ameliyat sonrası 3. günde elde edilen solunum fonksiyonları ve respiratuvar kas gücüne ait değerlerde anlamlı fark saptanmadı (p>0.05). KOAH grubuna kıyasla kontrol grubunda, grup içi FEV1 (p=0.01) ve FVC (p=0.02)deki yüzde azalmalar anlamlı olarak daha fazla saptandı. Grup içi respiratuvar kas gücü değerlerinin yüzde azalmaları gruplar arasında anlamlı fark oluşturmadı (p>0.05). Sonuç: KOAH hastalarında ameliyat öncesi FEV1 düşük saptanırken, FVC ve respiratuvar kas gücüne ait değerler KOAH hastalığı olan ve olmayanlarda benzer bulundu. Cerrahi girişim ile tüm hastalarda solunum fonksiyonları ve respiratuvar kas gücü değerleri azaldı. Eşlik eden akciğer patolojisi olmayanlarda, KOAH hastalarına kıyasla, FEV1 ve FVC daha fazla oranda azaldı. Buna karşın KOAH varlığı, ameliyat öncesi respiratuvar kas gücüne ait değerleri ve bu değerlerde cerrahi ile oluşan değişiklikleri etkilemedi.

Investigation of respiratory muscle strength in patients with chronic obstructive pulmonary disease undergoing coronary artery bypass grafting surgery

Background: This study aims to investigate the effects of coronary artery bypass grafting (CABG) surgery on pulmonary function and respiratory muscle strength in patients with chronic obstructive pulmonary disease (COPD). Methods: Sixty adult patients at >18 years of age undergoing CABG surgery under cardiopulmonary bypass with median sternotomy were assigned into two groups, including Control group (n=30) and COPD group (n=30). Preoperative and postoperative values of pulmonary function (FEV 1 , FVC) and respiratory muscle strength (P i max, SNIP, P E max) were obtained. Results: Preoperative values of pulmonary function and respiratory muscle strength did not differ significantly between groups (p>0.05), except FEV 1 value (p=0.00). The values of FEV 1 (p=0.00, p=0.00, respectively), FVC (p=0.00, p=0.00, respectively), P i max (p=0.00, p=0.00, respectively), SNIP (p=0.00, p=0.00, respectively) and P E max (p=0.00, p=0.00, respectively) decreased postoperatively both in Control and COPD groups. No significant difference was found in the values of pulmonary function and respiratory muscle strength between the groups at the third postoperative day (p>0.05). The percentage decreases of the values of FEV 1 (p=0.01) and FVC (p=0.02) within the control group were significantly higher than those of within the COPD group. No significant difference was found in the percentage decreases of intragroup respiratory muscle strength values between the groups (p>0.05). Conclusion: While low preoperative FEV 1 was obtained in patients with COPD, the values of FVC and respiratory muscle strength were similar in patients with and without COPD. The values of pulmonary function and respiratory muscle strength decreased as a result of the surgical procedure in all patients. The values of FEV1 and FVC decreased more in patients without coexisting pulmonary disease compared to patients with COPD. However, the presence of COPD did not affect the preoperative respiratory muscle strength values and the changes in these values caused by surgery.

PDF

___

1.Weiner P, Zeidan F, Zamir D, Pelled B, Waizman J, Beckerman M, et al. Prophylactic inspiratory muscle training in patients undergoing coronary artery bypass graft. World J Surg 1998;22:427-31.
2.Shapiro BA, Lichtenthal PR. Postoperative respiratory management. In: Kaplan JA, editor. Cardiac anesthesia. Philadelphia: W. B Saunders Company; 1999. p. 1215-32.
3.Chetta A, Bobbio A, Aiello M, Del Donno M, Castagnaro A, Comel A, et al. Changes in lung function and respiratory muscle strength after sternotomy vs. laparotomy in patients without ventilatory limitation. Eur Surg Res 2006;38:489-93.
4.Türkay C, Akbulut E, Özbudak Ö, Gölbaşı İ, Şahin N, Mete A ve ark. Koroner bypass cerrahisi uygulanan hastalarda kronik obstrüktif akciğer hastalığının mortalite ve morbiditeye etkisi. Turk Gogus Kalp Dama 2000;8:678-81.
5.Kabitz HJ, Walterspacher S, Walker D, Windisch W. Inspiratory muscle strength in chronic obstructive pulmonary disease depending on disease severity. Clin Sci (Lond) 2007;113:243-9.
6.Steier J, Kaul S, Seymour J, Jolley C, Rafferty G, Man W, et al. The value of multiple tests of respiratory muscle strength. Thorax 2007;62:975-80.
7.American Thoracic Society/European Respiratory Society. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med 2002;166:518-624.
8.Gray-Donald K, Gibbons L, Shapiro SH, Macklem PT, Martin JG. Nutritional status and mortality in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1996;153:961-6.
9.Bégin P, Grassino A. Inspiratory muscle dysfunction and chronic hypercapnia in chronic obstructive pulmonary disease. Am Rev Respir Dis 1991;143:905-12.
10.Zielinski J, MacNee W, Wedzicha J, Ambrosino N, Braghiroli A, Dolensky J, et al. Causes of death in patients with COPD and chronic respiratory failure. Monaldi Arch Chest Dis 1997;52:43 -7.
11.Global initiative for chronic obstructive lung disease. Pocket Guide to COPD Diagnosis, Management, and Prevention. A Guide for physicians and nurses. based on NHLBl/WHO Workshop Report Global Strategy for the diagnosis, management, and prevention of COPD. National Institutes of Health. National Heart, Lung, and Blood Institute. Updated 2003.
12.Morsch KT, Leguisamo CP, Camargo MD, Coronel CC, Mattos W, Ortiz LD, et al. Ventilatory profile of patients undergoing CABG surgery. Rev Bras Cir Cardiovasc 2009;24:180-7.
13.Vargas FS, Cukier A, Terra-Filho M, Hueb W, Teixeira LR, Light RW. Relationship between pleural changes after myocardial revascularization and pulmonary mechanics. Chest 1992;102:1333-6.
14.Worth H, Grundmann C, Goeckenjan G, Smidt U, Irlich G, Loogen F. Electromyographic determination of the fatigability of respiratory and leg muscles before and after aortocoronary bypass operation. Respiration 1984;46:33-44. [Abstract]
15. Coronel CC, Bordignon S, Bueno AD, Lima LL, Nesralla I. Perioperative variables of ventilatory function and physical capacity in heart transplant patients. Rev Bras Cir Cardiovasc 2010;25:190-6