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AÇIK KALP CERRAHİSİNDE 72 SAATLİK TRİMETAZİDİN UYGULAMASININ MİYOKARD İSKEMİSİ ÜZERİNE ETKİLERİ

Yıl 2021, Cilt: 23 Sayı: 1, 49 - 58, 30.04.2021

Hüseyin Gemalmaz Yıldırım Gültekin Tuğrul Kural

https://doi.org/10.24938/kutfd.824624
Cited By: 1

Öz

Amaç: Bu çalışmanın amacı açık kalp cerrahisi öncesi 72 saatlik trimetazidin (TMZ) uygulamasının miyokard iskemisi üzerine etkilerini göstermektir.
Gereç ve Yöntemler: Bu çalışma, 2009-2010 tarihleri arasında, Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Kalp ve Damar Cerrahisi Anabilim Dalında prospektif olarak gerçekleştirildi. Çalışmaya elektif koroner arter bypass greft operasyonu planlanan, yaşları 43-76 yıl aralığında olan, 12’si erkek, 8 kadın olmak üzere toplam 20 hasta alındı. Hastalar iki gruba ayrıldı. Birinci gruba 72 saat öncesinden başlayarak preoperatif 3x20 mg, oral TMZ verildi (çalışma grubu). İkinci grup kontrol grubuydu. Son 6 hafta içinde miyokard enfarktüsü geçirmiş olan, koroner arter bypass cerrahisine ek kardiyak cerrahi uygulanan, önceden böbrek hastalığı olan, cerrahiden 24 saat önce kardiyak enzim düzeyleri yüksek olan ve hemodinamik açıdan stabil olmayan hastalar çalışma dışı bırakıldı. Yaş, vücut yüzey alanı, cinsiyet, ejeksiyon fraksiyonu, komorbidite, kardiyopulmoner bypass zamanı, kros-klemp zamanı, hasta damar sayısı ve bypass sayıları kaydedildi. Troponin I (TnI) baz değeri için kan numuneleri hasta uyutulmadan hemen önce alındı. Operasyon sırasında kros-klemp kaldırılınca sağ atriyumdan ikinci örnek alındı. Kross-klemp kaldırıldıktan sonra 6., 12. ve 24. saatlerinde TnI için kan örnekleri alındı.
Bulgular: Hastalar uyutulmadan hemen önce, kros-klemp kaldırıldıktan hemen sonra ve 6. 12. ve 24. saatlerde bakılan TnI değerleri gruplar arasında karşılaştırıldığında istatistiksel olarak anlamlı bir fark saptanmadı. (sırasıyla, p=0.7734, p=0.3390, p=0.5624, p=0.1296, p=0.1796).
Sonuç: Açık kalp cerrahisinde preoperatif kısa süreli TMZ tedavisinin miyokard korunması üzerine bir etkisinin olmadığı tespit edildi.

Anahtar Kelimeler

Koroner bypass trimetazidin troponin I miyokard hasarı

Destekleyen Kurum

YOK

Kaynakça

  • 1. Ascione R, Lloyd CT, Underwood MJ, Lotto AA, Pitsis AA, Angelini GD. Inflammatory response after coronary revascularization with or without cardiopulmonary bypass. Ann Thorac Surg. 2000;69(4):1198–204.
  • 2. Parissis T, Adamopoulos S, Farmakis D, Flippatos G, Paraskevaidis I, Kremastinos TH et al. Effect of serial levosimendan infusions on left ventricular performance and plasma biomarkers of myocardial injury and neurohormonal and immune activation in patients with advanced heart failure. Heart. 2006;92(1):1768-72.
  • 3. Buckberg GD, Brazier JR, Nelson RL, Goldstein SM, McConnell DH, Cooper N. Studies of the effects of hypotermia on regional myocardial flow and metabolism during cardiopulmonary bypass. The adequately perfused beating, fibrilating and arrested heart. J Thorac Cardiovas Surg. 1977;73(1):87-94.
  • 4. Akgün S. Erişkin kalp cerrahisinde miyokard korunması. In: Duran E, ed. Kalp ve Damar Cerrahisi. 1st ed. İstanbul. Çapa Tıp Kitabevi, 2004:1091-106.
  • 5. Buckberg GD. The duality of cardiac surgery: mechanical and metabolic objctive. In: Salerno TA, Ricci M, eds. Myocardial Protection. 1st ed. New Jersey. Blackwell Publishing, 2004:13-7.
  • 6. Carden DL, Granger DN. Pathophysiology of ischemia reperfusion injury. J Pathol. 2000;190(6):255-66.
  • 7. Dhalla NS, Elmoselhi AB, Hata T, Makino N. Status of myocardial antioxidants in ischemia-reperfusion injury. Cardivasc Res. 2000;47(3):446-56.
  • 8. Reiter RJ, Tan DX. Melatonin: A novel protective agent against oxidative injury of the ischemic-reperfused heart. Cardiovascular Research. 2003;58(1):10-9.
  • 9. Gross GJ, Kersten JR, Warltier DC. Mechanisms of postischemic contractile dysfunction. Ann Thorac Surg. 1999;68(5):1898-904.
  • 10. Jordan JE, Zhao ZQ, Vinten-Johansen J. The role of neutrophils in myocardial ischemia- reperfusion injury. Cardiovasc Res. 1999;43(4):860-78.
  • 11. Reiter RJ. The aging pineal and its physiological consequences. BioEssays. 1992;14(3):169-75.
  • 12. Efthimiadis A, Cheiridou M, Lefkos N, Doumalas A, Arampatzis P, Tsapas G. The predictive value of TnT in patients who underwent an extracardiac surgery operation. Acta Cardiol. 1995;50(4):309-13.
  • 13. Hamm CW, Katus HA. New biochemical markers for myocardial cell injury. Curr Opin Cardiol. 1995;10(4):355-60.
  • 14. Bertinchont JP, Larue C, Pernel I, Ledermann B, Fabbro-Peray P, Beck L et al. Release kinetics of serum cardiac troponin I in ischemic myocardial injury. Clin Biochem. 1996;29(6):587-94.
  • 15. Collinson PO. Troponin T or troponin I or CK-MB (or none?). Eur Heart J. 1998;19(4):16-24.
  • 16. Carrier M, Pellerin M, Perrault LP, Solymoss BC, Pelletier LC. Troponin levels in patients with myocardial infarction after coronory artery bypass graftting. Ann Thorac Surg. 2000;96(2):435-40.
  • 17. Adams JE, Sicard GA, Allen BT, Bridwell KH, Lenke LG, Dávila-Román VG et al. Diagnosis of perioperative myocardial infarction with measurement of cardiac troponin I N Engl J Med. 1994;330(10):670-4.
  • 18. Timour Q, Harpey C, Durr F, Faucon G. Is the antianginal action of trimetazidine independent of hemodynamic changes? Cardiovase Dugs Ther. 1991;5(6):1043-44.
  • 19. Chierchia SL, Fragasso G. Protective effects of trimetazidine on ischaemic myocardial dysfunction. European Heart Journal. 1999;1(0):24-27.
  • 20. Chocron S, Alwan K, Toubin G, Clement F, Kaili D, Taberlet C et al. Crystalloid cardioplegia route of delivery and cardiac troponin T release. Ann Thorac Surg. 1996;62(2):481-5.
  • 21. Harpey C, Clauser P, Labrid C, Freyria JL, Jean‐Pierre PJP. Trimetazidin, a cellular anti ischemic agent. Cadiovasc. Drugs Rev. 1989;6(4):292-312.
  • 22. Lopaschuk GD, Barr R, Thomas PD, Dyck JRB. Beneficial effects of trimetazidine in ex vivo working ıschemic hearts are due to a stimulation of glucose oxidation secondary to ınhibition of long-chain 3-ketoacyl coenzyme a thiolase. Circulation Research. 2003;93(3):33–7.
  • 23. Carr JA, Haithcokk BE, Paone G. Long term out come after coronary artery bypass garfting in patients with severe left ventrikular dysfonction: Ann Thorac Surg. 2002;74(5):1531-36.
  • 24. Barber DA, Harris SR. Oxygen free radicals and antioxidants: a review The use of antioxidant vitamin supplements to scavenge free radicals could decrease the risk of disease. Am Pharm. 1994;34(9):26-35.
  • 25. Allman K.C. Shaw LJ, Hachamovitch D. Myocardial viability testing and impact of revascularization on prognosis in patients with coronary arter disease and left ventrikular dysfonction: A meta analysis. JACC. 2002;39(7):1151-58.
  • 26. Kılınç K, Kılınç A. Oksijen toksisitesinin aracı molekülleri olarak oksijen radikalleri. Hacettepe Tıp Dergisi. 2002;33(2):110-8.
  • 27. Yekeler İ, Abanoz M, Akçay F, Varoğlu E, Ege E, Ateş A ve ark. Kalp kapak replasmanı ve koroner bypass cerrahisi uygulanan hastalarda ekstrakorporeal dolaşımın endotelin-1 ve atriyal natriüretik peptid düzeyleri üzerine etkisi. Türk Göğüs Kalp Damar Cer Derg. 1997;5(3):104-11.
  • 28. Mehta JL, Nichols WW, Saldeen TG, Chandna VK, Nicolini FA, Lawson DL et al. Superoxide dismutase decreases reperfusion arrhythmias and preserves myocardial function during thrombolysis with tissue plasminogen activator. J Cardiovasc Pharmacol. 1990;16(1):112-20.
  • 29. Fabiani JN, Ponzio O, Emerit I, Massonet-Caste S, Paris M, Chevalier P et al. Cardioprotective effect of trimetazidine during coronary artery graft surgery. J Cardiovasc Surg. 1992;33(4):486-91.
  • 30. Aussedat J, Ray A, Kay L, Verdys M, Harpey C, Rossi A. Improvement of long-term preservation of isolated arrested rat heart: beneficial effect of the antiischemic agent trimetazidine. J Cardiovasc Pharmacol. 1993;21(1):128-35.
  • 31. El Banani H, Bernard M, Baetz D, Cabanes E, Cozzone P, Lucien A et al. Changes in intracellular sodium and pH during ischaemia-reperfusion are attenuated by trimetazidine. Comparison between low- and zero-flow ischaemia. Cardiovasc Res. 2000;47(4):688-96.
  • 32. Vedrinne JM, Vedrinne C, Bompard D, Lehot JJ, Boisell JP, Champsaui G. Myocardial production during coronary bypass graft surgery:a randomized, double blind, placebo controlled study with Trimetazidine. Anest Analg. 1996;82(4):712-8.
  • 33. Koçarslan A, Hazar A, Aydın MS, Aksoy N, Göz M The impact of preoperative trimetazidine use on oxidative parameters in patients undergoing coronary bypass surgery. Dicle Tıp Dergisi. 2013;40(4):589-96.
  • 34. Zhang N, Lei J, Liu Q, Huang W, Xiao H, Lei H. The effectiveness of preoperative trimetazidine on myocardial preservation in coronary artery bypass graft patients: a systematic review and meta-analysis. Cardiology. 2015;131(2):86-96.
  • 35. Tünerir B, Colak O, Alata¬ O, Besogul Y, Kural T, Aslan R. Measurement of troponin T to detect cardioprotective effect of trimetazidine during coronary artery bypass grafting. Ann Thorac Surg. 1999;68(6):2173-6.
  • 36. Xu P, Wen B, Jiao Z, Liu C, Zhao W: The cardioprotective effects of trimetazidine during off-pump coronary artery bypass grafting. Henan Med Res. 2014;23(3):29-31.
  • 37. Sher-i-Murtaza M, Zubair M, Jalal A. Is there any benefit of preoperative oral trimetazidine in coronary artery bypass graft? J Pak Med Assoc. 2012;62(12):1271-6.
  • 38. Parsomet V, Dean D, Bernstein AD. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart diasease. Circulation. 1989;79(6 [Suppl. 2]):13-22.
  • 39. Lee TH, Thomas EJ, Ludwing LE, Sacks DB, Johnson PA, Donaldson MC et al. TnT as a marker for myocardial ischemia in patients undergoing major cardiac surgery. Am. J. Cardiol. 1996;77(12):1031-6.
  • 40. Aksun M, Aksun S, Kestelli M, Kuru V, Tanyeli HF, Girgin S et al. The postoperatıve effects of use of trimetazidine before the coronary artery bypass graft surgery. Niger J Clin Pract. 2019;22(7):997-1001.

Effects of 72-Hour Trimethazidine in Open Heart Surgery on Myocardial Ischemia

Yıl 2021, Cilt: 23 Sayı: 1, 49 - 58, 30.04.2021

Hüseyin Gemalmaz Yıldırım Gültekin Tuğrul Kural

https://doi.org/10.24938/kutfd.824624
Cited By: 1

Öz

Objective: The aim of this study is to show the effects of 72-hour long trimethazidine (TMZ) administration on myocardial ischemia before open heart surgery.
Material and Methods: This prospective study was carried out between 2009 and 2010 in Eskişehir Osmangazi University Faculty of Medicine, Department of Cardiovascular Surgery. A total of 20 patients, 12 male and 8 females, aged between 43-76 years, who were scheduled for elective coronary artery bypass graft operation were included in the study. The patients were divided into two groups. 3 × 20 mg oral TMZ was given to the first group 72 hours before the preoperative period (study group). Group 2 was the control group. Patients who had myocardial infarction within the last 6 weeks, who underwent additional cardiac surgery to coronary artery bypass surgery, who had previous kidney disease, who had high cardiac enzyme levels 24 hours before surgery, and who were hemodynamically unstable were excluded from the study. Age, body surface area, gender, ejection fraction, comorbidity, cardiopulmonary bypass time, cross-clamp time, patient vessel number and bypass numbers were recorded. Blood samples for the troponin-I (TnI) base value were taken just before the patient was anesthetized. When the cross-clamp was removed during the operation, a second sample was taken from the right atrium. Blood samples for TnI were taken at 6, 12 and 24 hours after the cross-clamp was removed.
Results: When the TnI values were measured just before the patients were anesthesized, immediately after the cross-clamp was removed, and at the 6th, 12th and 24th hours, there was no statistically significant difference between the groups (p=0.7734, p=0.3390, p=0.5624, p=0.1296, p=0.1796, respectively).
Conclusion: It was found that preoperative short-term TMZ treatment had no effect on myocardial protection in open heart surgery.

Anahtar Kelimeler

Coronary bypass trimethasidine troponin I myocardial damage

Kaynakça

  • 1. Ascione R, Lloyd CT, Underwood MJ, Lotto AA, Pitsis AA, Angelini GD. Inflammatory response after coronary revascularization with or without cardiopulmonary bypass. Ann Thorac Surg. 2000;69(4):1198–204.
  • 2. Parissis T, Adamopoulos S, Farmakis D, Flippatos G, Paraskevaidis I, Kremastinos TH et al. Effect of serial levosimendan infusions on left ventricular performance and plasma biomarkers of myocardial injury and neurohormonal and immune activation in patients with advanced heart failure. Heart. 2006;92(1):1768-72.
  • 3. Buckberg GD, Brazier JR, Nelson RL, Goldstein SM, McConnell DH, Cooper N. Studies of the effects of hypotermia on regional myocardial flow and metabolism during cardiopulmonary bypass. The adequately perfused beating, fibrilating and arrested heart. J Thorac Cardiovas Surg. 1977;73(1):87-94.
  • 4. Akgün S. Erişkin kalp cerrahisinde miyokard korunması. In: Duran E, ed. Kalp ve Damar Cerrahisi. 1st ed. İstanbul. Çapa Tıp Kitabevi, 2004:1091-106.
  • 5. Buckberg GD. The duality of cardiac surgery: mechanical and metabolic objctive. In: Salerno TA, Ricci M, eds. Myocardial Protection. 1st ed. New Jersey. Blackwell Publishing, 2004:13-7.
  • 6. Carden DL, Granger DN. Pathophysiology of ischemia reperfusion injury. J Pathol. 2000;190(6):255-66.
  • 7. Dhalla NS, Elmoselhi AB, Hata T, Makino N. Status of myocardial antioxidants in ischemia-reperfusion injury. Cardivasc Res. 2000;47(3):446-56.
  • 8. Reiter RJ, Tan DX. Melatonin: A novel protective agent against oxidative injury of the ischemic-reperfused heart. Cardiovascular Research. 2003;58(1):10-9.
  • 9. Gross GJ, Kersten JR, Warltier DC. Mechanisms of postischemic contractile dysfunction. Ann Thorac Surg. 1999;68(5):1898-904.
  • 10. Jordan JE, Zhao ZQ, Vinten-Johansen J. The role of neutrophils in myocardial ischemia- reperfusion injury. Cardiovasc Res. 1999;43(4):860-78.
  • 11. Reiter RJ. The aging pineal and its physiological consequences. BioEssays. 1992;14(3):169-75.
  • 12. Efthimiadis A, Cheiridou M, Lefkos N, Doumalas A, Arampatzis P, Tsapas G. The predictive value of TnT in patients who underwent an extracardiac surgery operation. Acta Cardiol. 1995;50(4):309-13.
  • 13. Hamm CW, Katus HA. New biochemical markers for myocardial cell injury. Curr Opin Cardiol. 1995;10(4):355-60.
  • 14. Bertinchont JP, Larue C, Pernel I, Ledermann B, Fabbro-Peray P, Beck L et al. Release kinetics of serum cardiac troponin I in ischemic myocardial injury. Clin Biochem. 1996;29(6):587-94.
  • 15. Collinson PO. Troponin T or troponin I or CK-MB (or none?). Eur Heart J. 1998;19(4):16-24.
  • 16. Carrier M, Pellerin M, Perrault LP, Solymoss BC, Pelletier LC. Troponin levels in patients with myocardial infarction after coronory artery bypass graftting. Ann Thorac Surg. 2000;96(2):435-40.
  • 17. Adams JE, Sicard GA, Allen BT, Bridwell KH, Lenke LG, Dávila-Román VG et al. Diagnosis of perioperative myocardial infarction with measurement of cardiac troponin I N Engl J Med. 1994;330(10):670-4.
  • 18. Timour Q, Harpey C, Durr F, Faucon G. Is the antianginal action of trimetazidine independent of hemodynamic changes? Cardiovase Dugs Ther. 1991;5(6):1043-44.
  • 19. Chierchia SL, Fragasso G. Protective effects of trimetazidine on ischaemic myocardial dysfunction. European Heart Journal. 1999;1(0):24-27.
  • 20. Chocron S, Alwan K, Toubin G, Clement F, Kaili D, Taberlet C et al. Crystalloid cardioplegia route of delivery and cardiac troponin T release. Ann Thorac Surg. 1996;62(2):481-5.
  • 21. Harpey C, Clauser P, Labrid C, Freyria JL, Jean‐Pierre PJP. Trimetazidin, a cellular anti ischemic agent. Cadiovasc. Drugs Rev. 1989;6(4):292-312.
  • 22. Lopaschuk GD, Barr R, Thomas PD, Dyck JRB. Beneficial effects of trimetazidine in ex vivo working ıschemic hearts are due to a stimulation of glucose oxidation secondary to ınhibition of long-chain 3-ketoacyl coenzyme a thiolase. Circulation Research. 2003;93(3):33–7.
  • 23. Carr JA, Haithcokk BE, Paone G. Long term out come after coronary artery bypass garfting in patients with severe left ventrikular dysfonction: Ann Thorac Surg. 2002;74(5):1531-36.
  • 24. Barber DA, Harris SR. Oxygen free radicals and antioxidants: a review The use of antioxidant vitamin supplements to scavenge free radicals could decrease the risk of disease. Am Pharm. 1994;34(9):26-35.
  • 25. Allman K.C. Shaw LJ, Hachamovitch D. Myocardial viability testing and impact of revascularization on prognosis in patients with coronary arter disease and left ventrikular dysfonction: A meta analysis. JACC. 2002;39(7):1151-58.
  • 26. Kılınç K, Kılınç A. Oksijen toksisitesinin aracı molekülleri olarak oksijen radikalleri. Hacettepe Tıp Dergisi. 2002;33(2):110-8.
  • 27. Yekeler İ, Abanoz M, Akçay F, Varoğlu E, Ege E, Ateş A ve ark. Kalp kapak replasmanı ve koroner bypass cerrahisi uygulanan hastalarda ekstrakorporeal dolaşımın endotelin-1 ve atriyal natriüretik peptid düzeyleri üzerine etkisi. Türk Göğüs Kalp Damar Cer Derg. 1997;5(3):104-11.
  • 28. Mehta JL, Nichols WW, Saldeen TG, Chandna VK, Nicolini FA, Lawson DL et al. Superoxide dismutase decreases reperfusion arrhythmias and preserves myocardial function during thrombolysis with tissue plasminogen activator. J Cardiovasc Pharmacol. 1990;16(1):112-20.
  • 29. Fabiani JN, Ponzio O, Emerit I, Massonet-Caste S, Paris M, Chevalier P et al. Cardioprotective effect of trimetazidine during coronary artery graft surgery. J Cardiovasc Surg. 1992;33(4):486-91.
  • 30. Aussedat J, Ray A, Kay L, Verdys M, Harpey C, Rossi A. Improvement of long-term preservation of isolated arrested rat heart: beneficial effect of the antiischemic agent trimetazidine. J Cardiovasc Pharmacol. 1993;21(1):128-35.
  • 31. El Banani H, Bernard M, Baetz D, Cabanes E, Cozzone P, Lucien A et al. Changes in intracellular sodium and pH during ischaemia-reperfusion are attenuated by trimetazidine. Comparison between low- and zero-flow ischaemia. Cardiovasc Res. 2000;47(4):688-96.
  • 32. Vedrinne JM, Vedrinne C, Bompard D, Lehot JJ, Boisell JP, Champsaui G. Myocardial production during coronary bypass graft surgery:a randomized, double blind, placebo controlled study with Trimetazidine. Anest Analg. 1996;82(4):712-8.
  • 33. Koçarslan A, Hazar A, Aydın MS, Aksoy N, Göz M The impact of preoperative trimetazidine use on oxidative parameters in patients undergoing coronary bypass surgery. Dicle Tıp Dergisi. 2013;40(4):589-96.
  • 34. Zhang N, Lei J, Liu Q, Huang W, Xiao H, Lei H. The effectiveness of preoperative trimetazidine on myocardial preservation in coronary artery bypass graft patients: a systematic review and meta-analysis. Cardiology. 2015;131(2):86-96.
  • 35. Tünerir B, Colak O, Alata¬ O, Besogul Y, Kural T, Aslan R. Measurement of troponin T to detect cardioprotective effect of trimetazidine during coronary artery bypass grafting. Ann Thorac Surg. 1999;68(6):2173-6.
  • 36. Xu P, Wen B, Jiao Z, Liu C, Zhao W: The cardioprotective effects of trimetazidine during off-pump coronary artery bypass grafting. Henan Med Res. 2014;23(3):29-31.
  • 37. Sher-i-Murtaza M, Zubair M, Jalal A. Is there any benefit of preoperative oral trimetazidine in coronary artery bypass graft? J Pak Med Assoc. 2012;62(12):1271-6.
  • 38. Parsomet V, Dean D, Bernstein AD. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart diasease. Circulation. 1989;79(6 [Suppl. 2]):13-22.
  • 39. Lee TH, Thomas EJ, Ludwing LE, Sacks DB, Johnson PA, Donaldson MC et al. TnT as a marker for myocardial ischemia in patients undergoing major cardiac surgery. Am. J. Cardiol. 1996;77(12):1031-6.
  • 40. Aksun M, Aksun S, Kestelli M, Kuru V, Tanyeli HF, Girgin S et al. The postoperatıve effects of use of trimetazidine before the coronary artery bypass graft surgery. Niger J Clin Pract. 2019;22(7):997-1001.
Toplam 40 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Hüseyin Gemalmaz 0000-0003-3995-3557

Yıldırım Gültekin 0000-0002-9384-0556

Tuğrul Kural Bu kişi benim 0000-0003-3499-4915

Yayımlanma Tarihi 30 Nisan 2021
Gönderilme Tarihi 12 Kasım 2020
Yayımlandığı Sayı Yıl 2021 Cilt: 23 Sayı: 1

Kaynak Göster

APA Gemalmaz, H., Gültekin, Y., & Kural, T. (2021). AÇIK KALP CERRAHİSİNDE 72 SAATLİK TRİMETAZİDİN UYGULAMASININ MİYOKARD İSKEMİSİ ÜZERİNE ETKİLERİ. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, 23(1), 49-58. https://doi.org/10.24938/kutfd.824624
AMA Gemalmaz H, Gültekin Y, Kural T. AÇIK KALP CERRAHİSİNDE 72 SAATLİK TRİMETAZİDİN UYGULAMASININ MİYOKARD İSKEMİSİ ÜZERİNE ETKİLERİ. Kırıkkale Üni Tıp Derg. Nisan 2021;23(1):49-58. doi:10.24938/kutfd.824624
Chicago Gemalmaz, Hüseyin, Yıldırım Gültekin, ve Tuğrul Kural. “AÇIK KALP CERRAHİSİNDE 72 SAATLİK TRİMETAZİDİN UYGULAMASININ MİYOKARD İSKEMİSİ ÜZERİNE ETKİLERİ”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 23, sy. 1 (Nisan 2021): 49-58. https://doi.org/10.24938/kutfd.824624.
EndNote Gemalmaz H, Gültekin Y, Kural T (01 Nisan 2021) AÇIK KALP CERRAHİSİNDE 72 SAATLİK TRİMETAZİDİN UYGULAMASININ MİYOKARD İSKEMİSİ ÜZERİNE ETKİLERİ. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 23 1 49–58.
IEEE H. Gemalmaz, Y. Gültekin, ve T. Kural, “AÇIK KALP CERRAHİSİNDE 72 SAATLİK TRİMETAZİDİN UYGULAMASININ MİYOKARD İSKEMİSİ ÜZERİNE ETKİLERİ”, Kırıkkale Üni Tıp Derg, c. 23, sy. 1, ss. 49–58, 2021, doi: 10.24938/kutfd.824624.
ISNAD Gemalmaz, Hüseyin vd. “AÇIK KALP CERRAHİSİNDE 72 SAATLİK TRİMETAZİDİN UYGULAMASININ MİYOKARD İSKEMİSİ ÜZERİNE ETKİLERİ”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 23/1 (Nisan 2021), 49-58. https://doi.org/10.24938/kutfd.824624.
JAMA Gemalmaz H, Gültekin Y, Kural T. AÇIK KALP CERRAHİSİNDE 72 SAATLİK TRİMETAZİDİN UYGULAMASININ MİYOKARD İSKEMİSİ ÜZERİNE ETKİLERİ. Kırıkkale Üni Tıp Derg. 2021;23:49–58.
MLA Gemalmaz, Hüseyin vd. “AÇIK KALP CERRAHİSİNDE 72 SAATLİK TRİMETAZİDİN UYGULAMASININ MİYOKARD İSKEMİSİ ÜZERİNE ETKİLERİ”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, c. 23, sy. 1, 2021, ss. 49-58, doi:10.24938/kutfd.824624.
Vancouver Gemalmaz H, Gültekin Y, Kural T. AÇIK KALP CERRAHİSİNDE 72 SAATLİK TRİMETAZİDİN UYGULAMASININ MİYOKARD İSKEMİSİ ÜZERİNE ETKİLERİ. Kırıkkale Üni Tıp Derg. 2021;23(1):49-58.

Cited By

Effect of troponin I and coagulation parameters on mortality in COVID-19 patients
Marmara Medical Journal
https://doi.org/10.5472/marumj.1235703
 Kapak Resmi İndir

Bu Dergi, Kırıkkale Üniversitesi Tıp Fakültesi Yayınıdır.