Hüseyin Ali TÜNEL, Rıza TÜRKÖZ, Öner GÜLCAN, Orhan Saim DEMİRTÜRK, İsa COŞKUN, Yücel ÇÖLKESEN

The effects of perioperative ultrafiltration on postoperative outcomes in dialysis-dependent patients undergoing open heart surgery

Amaç: Bu çalışmada açık kalp cerrahisi yapılan hemo- diyalize bağımlı hastalarda perioperatif ultrafiltrasyo- nun (UF) ameliyat sonrası sonuçları üzerine etkileri araştırıldı. Çalışma planı: Mart 2000 - Mayıs 2008 tarihleri arasında açık kalp ameliyatı yapılan hemodiyalize bağımlı 46 hasta çalışmaya dahil edildi. Hastalar ultrafiltrasyon (UF) kulla- nımına göre iki gruba ayrıldı: UF (+) ve UF (-) grubu. Tüm hastalar ameliyattan bir gün önce ve ameliyattan iki gün sonra hemodiyalize alındı. Kırk altı hastanın 26sına ame- liyat sırasında UF yapıldı (UF (+) grubu). Her iki grubun yoğun bakımda kalış süresi dahil olmak üzere, hastanede kalış süreleri ve morbidite ve mortalite oranları karşılaştı- rıldı. Ameliyat öncesi ve sonrası santral venöz basınçları, kan üre nitrojen (BUN), kreatinin, serum potasyum ve hemoglobin (Hgb) konsantrasyonları incelendi. Bulgular: Yoğun bakımda kalış süresi (sırasıyla 56±28 saat ve 95±93 saat; p= 0.04) ve hastanede kalış süresi (sırasıyla 5.5±1.4 gün ve 8.1±3.4 gün; p= 0.002) gruplar arasında anlamlı olarak farklı idi. Gruplar arasında ame- liyat sonrası ortalama BUN (sırasıyla 50.6±13.5 mg/dl ve 59.8±13.7 mg/dl; p= 0.02) ve hemoglobin düzeylerinde (sırasıyla 9.9±1.0 g/dl ve 8.8±0.9 g/dl; p= 0.001) anlamlı farklılıklar vardı. Sonuç: Diyalize bağımlı hastalarda açık kalp perioperatif UF uygulaması, hastanede kalış süresini kısaltabilir ve biyokimyasal ve hemodinamik parametrelerde iyileşme sağlayabilir.

Perioperatifultrafiltrasyonun açık kalp ameliyatı yapılan diyalizebağımlı hastalarda ameliyat sonrası sonuçları üzerine etkileri

Background: This study aims to investigate the effects of perioperative ultrafiltration (UF) on postoperative outcome in hemodialysis-dependent patients undergoing open heart surgery. Methods: Between March 2000 and May 2008, 46 hemodialysis-dependent patients who underwent open heart surgery were included. Patients were divided into two groups based on utilization of ultrafiltration: UF (+) and UF (-) group. All patients underwent hemodialysis one day before surgery and two days after surgery. Of 46 patients, 26 had UF during surgery (UF (+) group). The length of hospital stay including intensive care unit and morbidity and mortality rates were compared between the groups. Pre- and postoperative central venous pressure, blood urea nitrogen (BUN), creatinine, serum potassium, hemoglobin (Hgb) concentrations were analyzed. Results: The length of intensive care unit stay (56±28 hours vs. 95±93 hours, respectively; p=0.04) and hospital stay (5.5±1.4 days vs. 8.1±3.4 days, respectively; p=0.002) were significantly different between the groups. There were significant differences in postoperative mean values of BUN (50.6±13.5 mg/dl vs. 59.8±13.7 mg/dl, respectively; p=0.02) and hemoglobin (9.9±1.0 g/dl vs. 8.8±0.9 g/dl, respectively; p=0.001) between the groups. Conclusion: Utility of perioperative UF in dialysis- dependent patients during open heart surgery may shorten the length of hospital stay and improve biochemical and hemodynamic parameters.

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