Cardiotrophin 1'in çalışan kalpte ve vücut dışı dolaşım desteği ile yapılan koroner arter bypass cerrahisinde iskeminin değerlendirilmesindeki yeri
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Date
2014
Authors
Tecimer, M. Ergun
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Günümüzde kalp-damar hastalıkları orta ve ileri yaş grubunda en önemli mortalite nedeni olup küresel ölümlerin %30'unu teşkil etmektedir. Koroner arter hastalığının sıklığının artmasına paralel koroner bypass operasyonlarında da artış olmaktadır. Cerrahi uygulamalar çoğunlukla kardiyopulmoner bypass altında yapılmasına karşın cerrahi deneyimin artması ile günümüzde koroner revaskülarizasyon ameliyatlarının %25-30 kadarı çalışan kalpte yapılmaktadır. Koroner arter bypass operasyonu yapılan hastalarda, operasyon sonrasında miyokard hasarı gelişmesi önemli komplikasyonlar arasındadır. Bugün için teşhiste en sık kullanılan kardiyak biyobelirteçler kreatin kinaz-MB (CKMB) ve troponin (cTn)'dir. İskemi ve hipoksi ile salınımı uyarılan kardiotropin-1 (CT-1), Interlökin-6 ailesinin bir üyesidir. Bizim çalışmamızda vücut dışı dolaşım desteği ile çalışan kalpte koroner bypass uygulanan hastalarda gelişen miyokard hasarını göstermede CT-1'in yerini ve diğer kardiyak biyobelirteçler ile olan korelasyonunu araştırdık. Çalışmamızda 20 hasta çalışan kalpte koroner arter bypass operasyonu ve diğer 20 hasta vücut dışı dolaşım (VDD) desteği kullanılarak ve kalbi durdurarak koroner arter bypass yapılan hastalardan oluşturuldu. Biyokimyasal tetkikler, hemogram, üre, kreatinin, Aspartat Aminotransferaz (AST), Alanin Aminotransferaz (ALT), CK, CKMB, cTn-I ve CT-1 düzeyleri preoperatif dönemde ve postoperatif 6.saatte çalışıldı. Tüm hastaların preoperatif ve postoperatif dönem elektrokardiyografileri çekildi. Çalışan kalpte koroner bypass (ÇKKB) grubunda postoperatif CT-1 ile postoperatif CK, CKMB ve cTn-I düzeyleri arasında korelasyon analizi yapıldığında anlamlı olduğu bulunmuştur. Vücut dışı dolaşım desteği ile yapılan koroner arter bypass (VDDKB) grubunda postoperatif CT-1 ile korelasyon analizi yapıldığında ise postoperatif CK, cTn-I düzeyleri anlamlı bulunmuştur.iii Sonuç olarak çalışmamızda, her iki gurupta CT-1'in postoperatif değerlerinin, preoperatif değerlere göre istatistiksel olarak anlamlı şekilde yükseldiği, miyokardiyal hasarı göstermede postoperatif CK, CKMB ve cTn-I ile pozitif korelasyon göstererek alternatif bir biyobelirteç olarak kullanılabileceği gösterilmiştir.
At the present time, cardiovascular diseases are the most primary reason of mortality rates in the middle and advanced age group and they involve %30 of death. Coronary artery disease's rates are increasing, relatedly to that coronary bypass operations are increasing too. Although, surgical operations are operated with cardiopulmonary bypass, nowadays nearly 25-30 percent of coronary revascularization operations are operated on beating heart thanks to increasing surgical experience. After coronary artery bypass graft surgery, myocardium damage is one of the most important complications on patients. Cardiac biomarkers which are creatine kinase-MB (CKMB) and troponin (cTn) are mostly used to make diagnosis. Cardiotropin-1 (CT-1) which is release induced by ischaemia and hypoxia is member of interleukin-6 family. We researched significance of CT-1 to show myocardium damage after coronary artery bypass graft surgery and correlation with other cardiac biomarkers on both of group. We organized two group of patient. Beating Heart Coronary bypass surgery to 20 patients.from Coronary artery bypass with cardiopulmonary bypass to the other 20 patients. Patients' physical examinations were checked. Detailed medical history was taken from patients. Biochemical tests, hemogram, urea, creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), CK, CK-MB, cTnI-I and CT-1 levels were determined preoperatively and postoperatively at 6 hours. All patients' preoperative and postoperative period electrocardiographies were taken. When postoperative CT-1 and correlation analysis was taken from beating heart coronary bypass surgery, postoperative CK, CKMB and cTn-I v levels was significant. When postoperative CT-1 and correlation analysis was taken from coronary arter bypass surgery with cardiopulmonary bypass, postoperative CK and cTn-I levels was significant. Consequently, CT-1's postoperative values significantly increased when compared to preoperative values both of groups. CT-1 can be used to indicate myocardial damage by correlation positively with postoperative CK, CKMB and cTn-I so, it was showed that CT-1 can be used for alternative biomaker.
At the present time, cardiovascular diseases are the most primary reason of mortality rates in the middle and advanced age group and they involve %30 of death. Coronary artery disease's rates are increasing, relatedly to that coronary bypass operations are increasing too. Although, surgical operations are operated with cardiopulmonary bypass, nowadays nearly 25-30 percent of coronary revascularization operations are operated on beating heart thanks to increasing surgical experience. After coronary artery bypass graft surgery, myocardium damage is one of the most important complications on patients. Cardiac biomarkers which are creatine kinase-MB (CKMB) and troponin (cTn) are mostly used to make diagnosis. Cardiotropin-1 (CT-1) which is release induced by ischaemia and hypoxia is member of interleukin-6 family. We researched significance of CT-1 to show myocardium damage after coronary artery bypass graft surgery and correlation with other cardiac biomarkers on both of group. We organized two group of patient. Beating Heart Coronary bypass surgery to 20 patients.from Coronary artery bypass with cardiopulmonary bypass to the other 20 patients. Patients' physical examinations were checked. Detailed medical history was taken from patients. Biochemical tests, hemogram, urea, creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), CK, CK-MB, cTnI-I and CT-1 levels were determined preoperatively and postoperatively at 6 hours. All patients' preoperative and postoperative period electrocardiographies were taken. When postoperative CT-1 and correlation analysis was taken from beating heart coronary bypass surgery, postoperative CK, CKMB and cTn-I v levels was significant. When postoperative CT-1 and correlation analysis was taken from coronary arter bypass surgery with cardiopulmonary bypass, postoperative CK and cTn-I levels was significant. Consequently, CT-1's postoperative values significantly increased when compared to preoperative values both of groups. CT-1 can be used to indicate myocardial damage by correlation positively with postoperative CK, CKMB and cTn-I so, it was showed that CT-1 can be used for alternative biomaker.
Description
Keywords
Kardiotropin-1, Koroner arter hastalığı, Myokard hasarı, Cardiotropin-1, Coronary artery disease, Myocardial damage
Citation
Tecimer, M. E. (2014). Cardiotrophin 1'in çalışan kalpte ve vücut dışı dolaşım desteği ile yapılan koroner arter bypass cerrahisinde iskeminin değerlendirilmesindeki yeri. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.