Ender DÜZCAN, Metin AKBULUT, Vefa ÖZCAN, Şeyda KAYA, Ahmet BALTALARLI, İbrahim GÖKŞİN, Mustafa SAÇAR

Normovolemik hemodilüsyonun alt ekstremite iskemi-reperfüzyonu sonrası oluşan akciğer hasarı üzerine olan etkisi

Amaç: Abdominal aortanın geçici olarak klemplenmesi ve alt ekstremitelerin iskemi-reperfüzyona (IR) maruz kalması, akciğerde interstisyel ödem ve enflamasyonla karakterize hasar oluşumunu indükler. Bu çalışmada ringer laktatla (RL) yapılan normovolemik hemodilüsyonun, alt ekstremite IR sonrası oluşan akciğer hasarını azaltıp azaltmadığı saptanmaya çalışıldı. Çalışma planı: Çalışma için 13 wistar albino cinsi erkek sıçan kullanıldı. Deney modeli olarak, her iki alt ekstremitenin arteriyal-venöz dolaşımının turnikeyle iki saat sıkılarak iskemi, ardından çözülerek üç saat reperfüzyon oluşturulmasıyla uygulanan IR modeli kullanıldı. İskemi-reperfüzyon grubunda (grup I, n=6) hemodilüsyon yapılmadan, RL grubunda (grup II, n=7) ise ringer laktatla normovolemik hemodilüsyon yapıldıktan sonra alt ekstremitede IR yapıldı. Deney sonunda, sıçanlar intravenöz yüksek doz pentobarbital sodyumla sakrifiye edildi. Akciğerler histolojik olarak değerlendirildi. Akciğer hasarı; konjesyon, intersitisyel ödem, polimorf nüveli nötrofil (PMN) infiltrasyonu, alveoler hemoraji esas alınarak, 0+ ile 4+ arasında semikantitatif olarak skorlandı. 0+, değişiklik yok; 1+, fokal hafif değişiklikler; 2+, multifokal hafif değişiklikler; 3+, multifokal belirgin değişiklikler; 4+, diffüz belirgin değişiklikler. İstatistiksel değerlendirme Student's t-testi ve Mann-Whitney U-testiyle yapıldı.Bulgular: Ortalama Hct grup I'de %48.2±1.7, grup II'de %35.1±0.9 olarak hesaplandı (p

The effect of normovolemic hemodilution on lung injury after ischemia-reperfusion of lower extremities

Background: Acute transient aortic occlusion with subsequent ischemia/reperfusion (IR) of the lower extremities is known to predispose to the lung injury characterized by inflammation and interstitial edema. In this study, we aimed to investigate whether normovolemic hemodilution by ringer lactate (RL) could have any beneficial effect on the lung injury caused by IR of the lower extremities. Methods: Thirteen wistar albino male rats were used for the study. A rat model in which bilateral lower extremities were tightened by plastic tourniquet for ischemia of 2 hours and then loosened for reperfusion of 3 hours were used as an experimental model. Ischemia/reperfusion of the lower extremities were performed in group of IR (group I, n=6) without hemodilution and in group of RL (group II, n=7) after hemodiluted with ringer lactate solution. At the end of the experiment, the rats were sacrificed by an intravenous overdose of pentobarbital sodium. The lungs were histologically examined. Lung injury was rated with a semiquantitative score based on congestion, interstitial edema, PMN infiltration and airspace hemorrhage, as follows: 0+, no changes; 1+, focal, mild, subtle changes; 2+, multifocal mild changes; 3+, multifocal prominent changes; 4+, extensive prominent changes. Student's t-test and Mann-Whitney U-test were used for statistical analysis.Results: Mean Hct. value were %48.2±1.7 and %35.1±0.9 in group I and II respectively (p

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