Nursel ŞAHİN, Cengiz TÜRKAY, Atalay METE, Ömer BAYEZİD, İlhan GÖLBAŞI, Ercan AKBULUT, Ömer ÖZBUDAK

Koroner bypass cerrahisi uygulanan hastalarda kronik obstrüktif akciğer hastalığının mortalite ve morbiditeye etkisi

Amaç: Koroner bypass cerrahisi yapılan hastalarda kronik obstrüktif akciğer hastalığının mortalite ve morbiditeye etkisini değerlendirmekdir. Materyal ve Metod: Kronik obstrüktif akciğer hastalığı olan 20 hasta Grup-1, akciğer hastalığı olmayan 20 hasta ise kontrol grubu (Grup-2) olmak üzere 40 hasta çalışmaya dahil edildi. Postoperatif dönemde hastalar reentübasyon, uzun süren entübasyon (48 saatten fazla), atrial fibrilasyon, intraaortik balon kullanımı, mediastinit, yara yeri enfeksiyonu, pnömoni, steroid ve bronkodilatör ilaç kullanımı, diafragma elevasyonu, ventriküler fibrilasyon, trakeotomi, düşük kardiyak output, yoğun bakım ve klinikte yatış sürelerine göre karşılaştırıldılar. Bulgular: Operasyondan sonra, Grup 1'deki hastalar yoğun bakımda (5.90 $pm$ 2.68'e karşı 2.3 $pm$ 1.8 gün; p = 0.003) ve hasttanede (15.85 $pm$ 3.28'e karşı 7.97 $pm$ 1.86 gün ; p = 0.003) daha uzun süre kaldılar. Grup 1'de daha fazla hastanın uzun entübasyona (4'e karşı 0, p = 0.106) ve reentübasyon (4 'e karşı 0, p = 0.106) ihtiyacı oldu. Grup 1'de daha fazla hasta aritmi (5'e karşı 0, p = 0.106), intraaortik balon pompa kullanımı (2'e karşı 0, p = 0.487), mediastinit (1'e karşı 0, p = 0.487), pnömoni (2'e karşı 0, p = 0.487), trakeotomi (2'e karşı 0, p = 0.487 ), düşük kardiyak output (4'e karşı 0, p = 0.106), steroid ve bronkodilatör kullanımına (4'e karşı 1, p = 0.342) sahipti. Grup 1'de 2 hasta öldü, buna karşın grup 2' de hiç hasta ölmedi (p = 0.487). Sonuç: Günümüzde, açık kalp cerrahisinde ve yoğun bakım ünitelerindeki gelişmelerin sonucu kronik obstrüktif akciğer hastalığına sahip hastalara kabul edilebilir bir morbidite ve mortalite ile koroner bypass cerrahisi uygulanabilir.

The effect of chronic obstructive pulmonary disease on mortality and morbidity in patients undergoing coronary bypass surgery

Background: To evaluate the effect of chronic obstructive pulmonary disease on patients undergoing coronary bypass surgery. Methods: Forty patients who were undergone CABG in our department were enrolled, 20 patients with chromic obstructive pulmonary disease (Group 1) and 20 patients without pulmonary disease preoperatively as a control group (Group 2). Comparison of the groups was made with regard to postoperative reintubation, prolonged intubation (longer than 48 hours), atrial fibrillation, using of intraaortic balloon pump, mediastinitis, wound infection, pneumonia, steroid and bronchodilator use, elevation of diaphragm, ventricular fibrillation, trakeotomy, low cardiac output, length of intensive care unit and hospital stay. Results: After operation, patients in Group 1 had a longer intensive care unit (5.90 $pm$2.68 versus 2.3 $pm$1.8, days p = 0.003) and hospital stay (15.85 $pm$ 3.28 versus 7.97 $pm$ 1.86 days, p = 0.003). More patients in Group 1 required prolonged intubation (4 versus 0, p = 0.106) and reintubation (4 versus 0, p = 0.106). More patients in group 1 had arrhythmias (5 versus 0, p=0.106), using intraaortic balloon pump (2 versus 0, p = 0.487), mediastinitis (1 versus 0, p = 0.487), pneumonia (2 versus 0, p = 0.487), tracheotomy (2 versus 0, p = 0.487), low cardiac output (4 versus 0, p = 0.106) steroid and bronchodilator use (4 versus 1, p = 0.342). Two patients in group 1 died, whereas no patient in Group 2 died (p = 0.487). Conclusions: Nowadays, as a result of improvements in open heart surgery and intensive care unit, coronary bypass surgery in patients with chronic obstructive pulmonary disease can be performed with acceptable mortality and morbidity.

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1.Grover FL, Hammermeister KE, Burchfiel C. Initial reportof the veterans administration prepoperative risk assesmentstudy for cardiac surgery. Ann Thorac Surg 1990;50:12-28.
2.Kotloff RM. Acute respiratory failure in the surgical patient. In Fishman AP, Elias JA, Fishman JA, Grippi MA,Kaiser LR, Senior RM, eds Fishman’s PulmonaryDiseases and Disorders. New York: McGraw - Hill,1998.
3.Berrizbeitia LD, Tessler S, Jacobowitz IJ,et al. Effect of sternotomy and coronary bypass surgery on postoperative pulmonary mechanics: Comparison, of internal mammary and saphenous vein bypass grafts.Chest 1989:96;873-6.
4.Braun SR, Birnbaum ML,Chopra PS. Pre and postopera-tive pulmonary function abnormalities in coronary arteryrevascularization surgery. Chest1978;73:316-20.
5.Taggart DP, El-Fiky M, Carter R, et al. Respiratorydysfunction after uncomplicated cardiopulmonary bypass.Ann Thorac Surg 1993;56:1123-8.
6.Singh NP, Vargas FS, Cukier A, et al. Arterial blood gasesafter coronary artery bypass surgery. Chest 1992;102:1337-41.
7.Gracey DR, Divertie MB, Didier EP. Preoperativepulmonary preparation of patients with chronic obstructivepulmonary disease: A prospective study. Chest 1979;76:123-9.
8.Warner MA, Divertie MB, Tinker JH. Preoperativecessation smoking and pulmonary complications coronary artery bypass patients. Anesthesiology 1984;60: 380-3.
9.Duncan S, Negrin RS, Mihm FG, et al. Nasal continuous positive airway pressure in atelectasis. Chest 1987;92:621-4.
10.Marini JJ, Pierson DJ, Hudson LD. Acute lobaratelectasis: A prospective comparison of fiberopticbronchoscopy and respiratory therapy. Am Rev Respir Dis1979;119:971-8.
11.Driks MR, Craven DE, Celli BR, et al. Nasocomialpneumonia in intubated patients given sucralfate ascompared with antacids or histamine type 2 blockers. NewEngl J Med 1987;317:1376-82.
12.Suttorp MJ, Kingma H, Gin RMTJ, et al. Efficiacy andsafety of low and high dose sotalol versus propranolol in the prevention of supraventricular tachyarrhytmias early after coronary artery bypass operations. J.ThoracCardiovas Surg 1990;100:921-6.
13.Incalzi RA, Pistelli R, Fuso L, et al. Cardiac arrhytmias andleft ventricular function in respiratory failure from COPD.Chest 1990;97:1092-7.Vecht RJ,Nicolaides EP, Ikweuke JK, et al. Incidence and prevention of supraventrýcular tachyarrhythmias after CABG. Int. J Cardiology 1986;13:125-34.
14.Leitch JW, Thomson D, Baird DK, et al. Theimportance of age as a predictor of atrial fibrillation and flutter after coronary artery bypass grafting. J Thorac Cardiovasc Surg 1990;100:338-42.
15.Salazar C, Fishman W, Friedman S, et al. Beta-blockade treatment for supraventricular tachyarrhythmias aftercoronary surgery: A propranolol withdrawal syndrome. Angiology 1979;30:816-9.
16.Cohen AJ, Katz MG, Katz R, et al. Phrenic nerve injury after CABG: Is it always benign. Ann Thorac Surg 1997;64:148-53.
17.Neumann LS, Szczukowski LC, Bain RP, et al. Suppura-tive mediastinitis after open heart surgery: A case control study of risk factors. Chest1988;94:546-53.