Sinan ARSAN, Ali CİVELEK, Selim İSBİR, Serdar AKGÜN, Atike TEKELİ, Nazan AKSOY, Wolf Peter KLÖVEKORN, Matthias ROTH

Pulsatil akım kardiyopulmoner bypass sonrası S100B protein salınımını azaltmıyor

Amaç: S100B proteininin kardiyak operasyon ve kardiyopulmoner bypass sonrası görülebilen serebral hasarın bir göstergesi olduğu düşünülmektedir. Bu çalışmanın amacı serum S100B proteinini kullanarak, kardiyopulmoner bypass sonrasında görülebilen serebral hasara, pulsatil akımlı kardiyopulmoner bypassın etkisini araştırmaktı. Materyal ve Metod: Elektif koroner bypass ameliyatı planlanan 30 hasta randomize olarak iki gruba ayırıldı (Grup A pulsatil akım, Grup B devamlı akım). Bütün hastalarda pulsatil ve devamlı akım sağlayabilen döner başlıklı pompa kullanıldı. Tüm hastalardan ameliyat öncesi, kardiyopulmoner bypass başlangıcında, aort klempi kaldırılmadan, cilt kapatılırken, ameliyat sonrasında 6. ve 12. saatlerde kan örneği alınarak saklandı. Elde edilen serumlardaki S100B seviyesi immunoluminometrik yöntemle ölçüldü. Bulgular: Her iki grup yaş, anastomoz sayısı, kardiyopulmoner bypass ve aort klemp zamanı, ventilasyon zamanı ve yoğun bakımda kalış süreleri açısından karşılaştırıldı. Her iki grupta ameliyat sonrası S100B değerleri ameliyat öncesi değerlere göre önemli ölçüde yükseldi (p < 0.001). Devamlı akım uygulanan gruptaki S100B değerleri, özellikle aort klempi kaldırıldığında ve cilt insizyonu kapatılırken alınan kan örneklerinde diğer gruba oranla yüksek çıkmasına rağmen (1.7'e karşın l ve 2.2'ye karşın 1.74 $mu$g/L; p > 0.05), her iki gruptaki S100B seviyeleri arasındaki fark hiçbir dönemde anlamlı bulunamadı. Sonuç: Kardiyopulmoner bypass sırasında serum S100B değeri anlamlı derecede yükselmektedir. Kardiyopulmoner bypass sırasında uygulanan pulsatil akım devamlı akımla karşılaştırıldığında, pulsatil akımın kardiyopulmoner bypass ve sonrasında S100B salınımma anlamlı etkisi olmadığı görülmüştür. Bu sonuçlar pulsatil akımın serebral hasarı azaltıcı etkisi olmadığını göstermektedir.

Pulsatile blood flow during cardiopulmonary bypass does not reduce the release of S100B

Background: S100B protein has been suggested to be a marker for cerebral injury after cardiac operation and extra-corporeal circulation. The aim of this study was to determine the effect of pulsatile blood flow during cardiopulmonary bypass (CPB) on cerebral injury by using S100B as a marker for cerebral injury. Methods: Thirty patients with elective coronary artery bypass grafting were randomized into two groups (Group A pulsatile, and Group B non-pulsatile). In all cases a roller pump with a pulsatile and non-pulsatile mode was used for CPB. Serial blood samples (preoperative, beginning of CPB, before aortic cross clamp release, during skin closure and 6 and 12 hours postoperatively) were collected. The serum was analyzed for S100B using immunoluminometric assay. Results: Both groups were matched for age, number of grafts, and duration of CPB and aortic cross clamping, the time of ventilation and ICU stay. Postoperative levels of S100B were significantly higher in both groups compared to the preoperative levels (p < 0.001). Although S100B levels were higher at the time of declamping the aorta and during skin closure in the non-pulsatile group (1.7 vs l and 2.2 vs 1.74 $mu$g/L; p > 0.05), there was no significant difference in S100B levels between the groups at any time. Conclusions: Serum levels of S100B increase significantly during CPB. However, pulsatile perfusion does not reduce serum S100B release significantly during CBP compared with non-pulsatile perfusion. These results indicate that pulsatile blood flow does not have a neuroprotective effect.

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