Atakan ERKILINÇ, Korhan ERKANLI, Füsun GÜZELMERİÇ, Tuncer KOÇAK, Meliha Zeynep KAHRAMAN KARATAŞ, Pınar KARACA BAYSAL, Hayat CARUS, Bedrettin YILDIZELİ

Pulmoner tromboendarterektomi ameliyatlarında kullanılan inhale nitrik oksidin hemodinamik etkileri

Amaç: Bu çalışmada kronik tromboembolik pulmoner hipertansiyonu olan ve pulmoner tromboendarterektomi ameliyatı geçiren hastalarda inhale nitrik oksit (iNO) kullanımının hemodinamik etkileri araştırıldı.Çalışma planı: Kronik tromboembolik pulmoner hipertansiyon nedeni ile ameliyat planlanan toplam 25 hasta (ASA I-II) çalışmaya dahil edildi. Hastalar iki gruba ayrıldı (grup 1 ve grup 2). Grup 1 (n=13) ve grup 2'deki (n=12) hastalara indüksiyon sonrası 20 ppm iNO verildi. Onuncu (T1) ve 30. dakikalarda (T2), perfüzyon sonrası (T3) ve sternum kapatılır iken (T4) pulmoner arter (PA) basıncı, santral venöz basınç, kalp hızı, sistolik arter basıncı, PA tıkanma basıncı, kardiyak indeks, pulmoner vasküler direnç (PVD) incelemeleri kayıt edildi.Bul gu lar: Grup 1 ve grup 2'de PA ortalama sistolik ve diyastolik basınçlar ile PVD başlangıç dönemine (T0) göre anlamlı olarak düşük idi (p< 0.05). Grup 1'de kardiyak indeks T1, T2, T3 ve T'te, T0'a göre anlamlı olarak yüksek idi (p< 0.05). Ortalama PA basıncı her iki grupta da başlangıç değerine göre istatistiksel olarak anlamlı şekilde düşük idi. İki grupta T0 ve T1 dönemleri arasında farklılık gözlenmez iken, diğer dönemlerde ortalama PA basıncı grup 1'de istatistiksel olarak anlamlı şekilde düşük idi (p=0.008). Grup 1'de T1, T2, T3 ve T4 döneminde başlangıç değerine göre ortalama PA basıncı anlamlı olarak düşük idi. Grup 2'de T1 döneminde başlangıç değerine göre anlamlı azalma saptanır iken, T3 ve T4 dönemlerinde T1 dönemine göre anlamlı azalma saptandı (p=0.04). T0 ve T1 dönemlerinde gruplar arası PVD'de anlamlı farklılık gözlenmez iken, T2, T3 ve T4 dönemlerinde grup 1'de PVD istatistiksel olarak anlamlı şekilde düşük idi (p=0.03).So nuç: Kronik tromboendarterektomi ameliyatlarında iNO'nun farmakolojik özellikleri ile olumsuz hemodinamik değişikliklere yol açmadan en uygun pulmoner vazodilatör ajanlardan biri olduğunu düşünmekteyiz.

Hemodynamic effects of inhaled nitric oxide used in pulmonary thromboendarterectomy operations

Background: This study aims to evaluate the hemodynamic effects of inhaled nitric oxide (iNO) in patients with chronic thromboembolic pulmonary hypertension who are undergoing pulmonary endarterectomy. Methods: A total of 25 patients (ASA I-II) who were planned to undergo operation due to chronic thromboembolic pulmonary hypertension were included in the study. Patients were divided into two groups (group 1 and group 2). Inhaled nitric oxide at 20 ppm was given to patients in group 1 (n=13) and group 2 (n=12) after induction. Pulmonary artery (PA) pressure, central venous pressure, heart rate, systolic arterial pressure, PA wedge pressure, cardiac index, and pulmonary vascular resistance (PVR) were recorded at minutes 10 (T1) and 30 (T2), after perfusion (T3), and while sternal closure (T4). Results: In group 1 and group 2, PA mean systolic and diastolic pressures, and PVR were significantly lower compared to the initial period (T0) (p < 0.05). In group 1, cardiac index was significantly higher in T1, T2, T3, and T4 compared to T0 (p< 0.05). Mean PA pressure in both groups was statistically significantly lower than the initial value. While no difference was observed in both groups between T0 and T1 periods, mean PA pressure was statistically significantly lower in other periods in group 1 (p=0.008). In group 1, mean PA pressure was significantly lower in T1, T2, T3, and T4 periods with respect to baseline value. In group 2, while a significant reduction was detected in T1 period compared to baseline value, a significant reduction was detected in T3 and T4 periods compared to T1 period (p=0.04). Although no significant differences were observed in PVR between the groups during T0 and T1 periods, PVR was significantly lower in group 1 in T2, T3, and T4 periods (p=0.03). Conclusion: We suggest that iNO is one of the most appropriate pulmonary vasodilator agents due to its pharmacological properties without causing adverse hemodynamic changes in thrombendarterectomy operations for chronic pulmonary hypertension patients.

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