Erişkin Kalp Cerrahisinde Ekstrakorporeal Dolaşım Sırasında NIRS Yöntemi ile Hepatik ve Renal somatik Oksijen Saturasyonu Takibi Anlamlı mı?
Öz
Amaç: Erişkin açık kalp cerrahisinde, NIRS yöntemiyle karaciğer ve böbrek dokusu oksijen saturasyonu KSO2 ,BSO2 ölçümünün, sonuç parametreleri üzerine olan etkisinin araştırılması. Hastalar ve Yöntemler: Üniversitemiz etik kurul onayı ve onamları alınan koroner bypass cerrahisi olacak 88 hasta prospektif olarak çalışmaya alındı. Hastalara kliniğimizin rutin açık kalp cerrahisi protokolu dışında preoperatif dönemde, USG ile karaciğer ve sağ böbreğin cilde en yakın yerleri saptanarak operasyon sırasında bu lokalizasyonlara yerleştirilen NIRS problarıyla karaciğer ve böbrek satürasyonlarının takipleri alındı. Ölçümler; indüksiyon öncesi T1 , indüksiyon sonrası T2 , ekstrakorporeal dolaşımın EKD 10. dk.sı T3 , EKD’ın 20. dk.sı T4 , ısınma sonrası T5 , EKD bitiminde T6 tekrarlandı.. Aynı süreçlerde pH, pCO2, pO2, laktat, ortalama arter basıncı ve kalp hızı KH değerleri de kaydedildi. Karaciğer ve böbrek fonksiyonları preoperatif, postoperatif 2. ve 4. günlerde kreatinin, üre, ALT, AST değerleriyle değerlendirildi. Sonuçlar Pearson korelasyonu ile karşılaştırıldı. Bulgular: Karaciğer ve böbrek oksijen saturasyonu değerleri T2 periyodu dışında paralel değişim göstermiş olup Pearson korelasyonu yaklaşık r:0,6 düzeylerinde p
Anahtar Kelimeler
somatik oksijen satürasyonu ekstrakorporeal dolaşım near infrared spektroskopi erişkin açık kalp cerrahisi
Kaynakça
- Pasch T, Zalunardo M. Intraoperatives Monitoring: Notwendiges, Sinnvolles und Überflüssiges. Anaesthetist 2000;49:S2-6.
- ST Tan. Cerebral Oksimetriy In Cardiac Surgery. Hong Kong Med J 2008; 14:220-5.
- Slater JP, Guarino T, Stack J, Vinod K, Bustami RT, Brown JM, Rodriguez AL, Magovern CJ, Zaubler T, Freundlisch K, Parr GV. Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery. Annals of Thoracic Surgery 2009;87:36-44 (discussion 44-35)
- James S. Tweddel, Nancy S Ghanayem, Gergoe M. Hoffman. Seminers in Thoracic, Cardiovascular Surgery, Pediatric Cardiac Surgery Annual 2010; 13:44-50.
- Kaufman, Jon. Correlation of abdominal site near-infrared spectroscopy with gastric tonometry in infants following surgery for congenital heart disease. Pediatric Critical Care Medicine. 2008;9:62-68.
- Ascione R., Talpahewa S., Rajakaruna C, Reeves BC, Lovell AT, Cohen A, Angelini GD Annals Of Thoracic Surgery 2006;81:97-103
- Diaz GC, Moitra V, Sladen RN. Hepatic and renal protection during cardiac surgery . Anesthesiol Clin. 2008;26:565-90.
- Khilji SA, Khan AH. Acute renal failure after cardiopulmonary bypass su rgery. J Ayub Med Coll Abbottabad. 2004;16:25-8.
- Hussein D Kanji, Costas J Schulze, Marilou Hervas-Malo, Peter Wang, David B Ross, Mohamad Zibdawiand ve Sean M Bagshaw Difference between pre-operative and cardiopulmonary bypass mean arterial pressure is independently associated with early cardiac surgery-associated acute kidney injury. Journal of Cardiothoracic Surgery 2010;5:71
- Cruz DN, Bagshaw SM, Ronco C, Ricci Z. Acute kidney injury: classification and staging. Contrib Nephrology. 2010;164:24-32. Epub 2010 Apr 20.
- Jennifer C. Hirsch, John R. Charpie, Richard G. Ohye, James G. Gurney. Near-infrared spectroscopy: What we know and what we need to know-A systematic review of the congenital heart disease literature. Journal of Cardiothoracic Surgery 2009;137:154-9.
- Austin EH, Edmonds HL, Auden SM, et alBenefit of Neurophysiologic monitoring for pediatric cardiac surgery. Journal of Thoracic and Cardiovascular Surgery 1997; 114:707-715, 717;discussion 715-716.
- Mathias Redlin, Wolfgang Boetcher, Michael Huebler, Felix Berger, Roland Hetzer, Andreas Koster, Wolfgang M. Kuebler. Detection of Lower Torso Ischemia by Near-Infrared Spectroscopy During Cardiopulmonary Bypass in a 6,8-Kg Infant With Complex Aortic Anatomy. Ann Thorac Surg. 2006;82:323-5.
- Dent CL, Spaeth JP, Jones BV, Schwartz SM, Glauser TA, Hallinan B, et al. Brain magnetic resonance imagingabnormalities after Norwood procedure using regional cerebral perfusion. Journal of Thoracic and Cardiovascular Surgery. 2006;131:190-7.
- Gabe E. Owens, Karen Kin, James G. Gurney, John R. Charpie. Low renal Oxymetry Correlates With Acute Kidney Injury After Infant Cardiac Surgery. Pediatric Cardiology 2011, 32:183-188
- Fortune PM, Wagstaff M, Petros AJ (2001). Cerebrosplanchnic oxygenation ratio (CSOR) using near-infrared spectroscopymay be able to predict splanchnic ischemia in neonates. Intensive Care Medicine 27:1401-1407.
- Chakravarti SB, Mittnacht AJ, Katz JC, Nguyen K, Joashi U, Srivastava S . Multisite near-infrared spectroscopy predicts elevated blood lactate level in children after cardiac surgery. Journal of Cardiothoracic And Vascular Anesthesia 2009;23:663-667.
- Saidi N, Murkin JM. Applied neuromonitoring in cardiac surgery, patient specific management. Seminers in Cardiothoracic Vascular Anesthesia 2005;9:17-23.
Is It Efficient To Use Nirs To Calculate Hepatic and Renal Oxygen Saturation During Extracorporeal Circulation?
Öz
Aim: This study was performed to evaluate the effects of hepatic and renal oxygen saturation calculation on the outcome parameters in the adult cardiac surgery. Patients and Methods: Eighty-eight open heart surgery patients were admitted to the study. They had undergone open heart surgery under routine protocol of our clinic.In addition to routine protocol; the nearest localization of the liver and right kidney to the skin was marked with USG, preoperatively. In the operation room the NIRS probes were placed, the saturation measurements were noted before induction T1 , after induction T2 , in the 10th min. of extracorporeal circulation ECS T3 , in the 20th min. of ECS T4 , after rewarming T5 , at the end of ECS T6 as well as pH, pCO2, pO2, lactate, mean arterial pressure/pump pressure and heart rate measurements. Creatinine, urea and ALT-AST values were evaluated in the preoperative day and postoperative day 2 and 4. The results were compared with Pearson correlation. Results: Hepatic and renal saturation levels were in concordance with pO2 levels Pearson correlation p
Anahtar Kelimeler
somatic oxygen saturation extracorporeal circulation near infrared spectroscopy adult open heart surgery
Kaynakça
- Pasch T, Zalunardo M. Intraoperatives Monitoring: Notwendiges, Sinnvolles und Überflüssiges. Anaesthetist 2000;49:S2-6.
- ST Tan. Cerebral Oksimetriy In Cardiac Surgery. Hong Kong Med J 2008; 14:220-5.
- Slater JP, Guarino T, Stack J, Vinod K, Bustami RT, Brown JM, Rodriguez AL, Magovern CJ, Zaubler T, Freundlisch K, Parr GV. Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery. Annals of Thoracic Surgery 2009;87:36-44 (discussion 44-35)
- James S. Tweddel, Nancy S Ghanayem, Gergoe M. Hoffman. Seminers in Thoracic, Cardiovascular Surgery, Pediatric Cardiac Surgery Annual 2010; 13:44-50.
- Kaufman, Jon. Correlation of abdominal site near-infrared spectroscopy with gastric tonometry in infants following surgery for congenital heart disease. Pediatric Critical Care Medicine. 2008;9:62-68.
- Ascione R., Talpahewa S., Rajakaruna C, Reeves BC, Lovell AT, Cohen A, Angelini GD Annals Of Thoracic Surgery 2006;81:97-103
- Diaz GC, Moitra V, Sladen RN. Hepatic and renal protection during cardiac surgery . Anesthesiol Clin. 2008;26:565-90.
- Khilji SA, Khan AH. Acute renal failure after cardiopulmonary bypass su rgery. J Ayub Med Coll Abbottabad. 2004;16:25-8.
- Hussein D Kanji, Costas J Schulze, Marilou Hervas-Malo, Peter Wang, David B Ross, Mohamad Zibdawiand ve Sean M Bagshaw Difference between pre-operative and cardiopulmonary bypass mean arterial pressure is independently associated with early cardiac surgery-associated acute kidney injury. Journal of Cardiothoracic Surgery 2010;5:71
- Cruz DN, Bagshaw SM, Ronco C, Ricci Z. Acute kidney injury: classification and staging. Contrib Nephrology. 2010;164:24-32. Epub 2010 Apr 20.
- Jennifer C. Hirsch, John R. Charpie, Richard G. Ohye, James G. Gurney. Near-infrared spectroscopy: What we know and what we need to know-A systematic review of the congenital heart disease literature. Journal of Cardiothoracic Surgery 2009;137:154-9.
- Austin EH, Edmonds HL, Auden SM, et alBenefit of Neurophysiologic monitoring for pediatric cardiac surgery. Journal of Thoracic and Cardiovascular Surgery 1997; 114:707-715, 717;discussion 715-716.
- Mathias Redlin, Wolfgang Boetcher, Michael Huebler, Felix Berger, Roland Hetzer, Andreas Koster, Wolfgang M. Kuebler. Detection of Lower Torso Ischemia by Near-Infrared Spectroscopy During Cardiopulmonary Bypass in a 6,8-Kg Infant With Complex Aortic Anatomy. Ann Thorac Surg. 2006;82:323-5.
- Dent CL, Spaeth JP, Jones BV, Schwartz SM, Glauser TA, Hallinan B, et al. Brain magnetic resonance imagingabnormalities after Norwood procedure using regional cerebral perfusion. Journal of Thoracic and Cardiovascular Surgery. 2006;131:190-7.
- Gabe E. Owens, Karen Kin, James G. Gurney, John R. Charpie. Low renal Oxymetry Correlates With Acute Kidney Injury After Infant Cardiac Surgery. Pediatric Cardiology 2011, 32:183-188
- Fortune PM, Wagstaff M, Petros AJ (2001). Cerebrosplanchnic oxygenation ratio (CSOR) using near-infrared spectroscopymay be able to predict splanchnic ischemia in neonates. Intensive Care Medicine 27:1401-1407.
- Chakravarti SB, Mittnacht AJ, Katz JC, Nguyen K, Joashi U, Srivastava S . Multisite near-infrared spectroscopy predicts elevated blood lactate level in children after cardiac surgery. Journal of Cardiothoracic And Vascular Anesthesia 2009;23:663-667.
- Saidi N, Murkin JM. Applied neuromonitoring in cardiac surgery, patient specific management. Seminers in Cardiothoracic Vascular Anesthesia 2005;9:17-23.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Research Article |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Eylül 2012 |
| Yayımlandığı Sayı | Yıl 2012Sayı: 3 |