Koroner arter bypass cerrahisinde l-karnitinin myokard fonksiyonları üzerine etkisi
Loading...
Date
2007-02-09
Authors
Furat, Cevdet
Uçar, Halil İbrahim
Tok, Mustafa
Öç, Mustafa
Farsak, Bora
Güvener, Murat
Yorgancıoğlu, A. Cem
Doğan, Rıza
Demırcın, Metin
Paşaoğlu, İlhan
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Karnitin yağ asit metabolizması için gerekli bir ko-faktördür ve normal aerobik kalpte ATP’nin öncelikli kaynaklarındandır. Miyokard iskemisi sırasında yağ asit metabolizması bozulur ve doku karnitin seviyeleri azalır. Kalp karnitin sentezleyemediğinden reperfüzyon sırasında karnitin varlığı miyokard fonksiyonu için önemli bir rol oynar. Bu çalışmada, koroner arter bypass cerrahisi uygulanacak olan hastalarda, karnitin ile zenginleştirilmiş kan kardiyoplejisinin miyokard üzerine olan etkisi ve myokardı postiskemik reperfüzyon hasarın dan korumadaki etkinliğinin araştırılması amaçlanmıştır. Çalışmaya Hacettepe Üniversitesi Tıp Fakültesi Kalp ve Damar Cerrahisi Anabilim Dalında, Nisan 2005-Haziran 2005 tarihleri arasında, elektif koroner by-pass cerrahisi uygulanan 20 hasta alınmıştır. Hastalar 2 gruba ayrıldı. Grup I (kontrol grubu) ve grup II (çalışma grubu) olmak üzere 10’ar kişi içeriyordu. Grup I’de standart soğuk kan kardiyoplejisi ve grup II’de karnitin içeren kan kardiyoplejisi kullanıldı. Hastalarda preoperatif dönemde ve postoperatif dönemde kardiyak verilerin ölçüm leri yapıldı. Kardiak output (CO), çalışma grubunda postoperatif 1. saatte anlamlı derecede yüksekti (kontrol grubu; 4,94 ± 0.09 L/dk ve çalışma grubu; 5.32 ± 0,43 L/dk; p<0,005), CPB sonrası da anlamlı fark bulundu kontrol grubunda 2,99 ± 0,09 L/dk ve çalışma grubu 3,18 ± 0,12 L/dk. Postoperatif 6.saatten sonraki ölçümlerde anlamlı fark bulunmadı. Kardiyak indeks (CI) değerleri açısından gruplar arasında istatiksel fark yoktu. Hastaların sol ventrikül iş gücü (LVSW) Grup 1’de kardiyopulmoner bypass (CPB) sonrası 45,62±0,56 (g.m), Grup 2’de 69,7±28,2 (g.m) idi (p<0,05). Postoperatif 1.saat sol ventrikül iş gücü (LVSW) değerleri Grup 1’de 55,06±0,98 (g.m), Grup 2’de 69,8±27,8 (g.m) olarak ölçüldü (p<0,05). Sağ ventrikül iş gücü (RVSW) Grup 1’de postoperatif 1. saat 11,09±0,86 (g.m), Grup 2’de 13,4±4,5 (g.m) bulundu (p< 0,05). Bu çalışma L-Karnitin içeren kan kardiyoplejisinin normal sol ventrikül fonksiyonlarına sahip hastada etkisi olmadığı ancak, preoperatif dönemde iskemisi bulunan, uzun aortik klemp gerektiren, reoperasyon veya kompleks cerrahi uygulanacak hastalarla, kritik ejeksiyon fraksiyonlu (EF) hastalarda kullanılmasının faydalı olacağı sonucuna varılmıştır.
Carnitine is an essential cofactor for fatty acid (FA) metabolism and the predominant source of ATP in the normal aerobic heart. During myocardial ischemia, FA metabolism is impaired and tissue carnitine levels are depleted. Since the heart cannot synthesize carnitine, carnitine could play an important role for myocardıal functıon during reperfusion. In this study we aimed to investigate the effects of L carnitine enriched blood cardioplegia on myocardial tissue and protective effect on myocardial repefusion injury. From April 2005 to June 2005 twenty patients were selected who underwent elective coronary artery bypass surgery Hacettepe University Department of Cardiovascular Surgery. Patients were divided into two groups. Group I (controlled group) included 10 patients and Grup II (study group) included 10 patients in group I, with standart cold blood cardioplegia was used and in group II, L-carnitine enriched cold blood was use. The patient were assessed for cardiac output, cardiac index, left and right cardiac work. Cardiac output (CO) was found to be significantly high in the study group at the postoperative 1st hour control group; 4,94 ± 0.09 L/min and study group 5.32 ± 0,43 L/min; p<0,005, after CPB control group 2,99 ± 0,09 L/min and study group 3,18 ± 0,12 L/dk. After the six hour this significance was dissappeared between the groups. No statistical difference was found between the two groups considering the Cardiac index (CI) values. Patients left ventricular stroke works (LVSW) were 45,62±0,56 (g.m) in Grup 1 after cardiopulmonary bypass (CPB) and 69,7±28,2 (g.m) in Grup 2 (p<0,05). Postoperative 1st hour LVSW values were 55,06±0,98 (g.m) in Grup 1 and 69,8±27,8 (g.m) in Grup 2 (p<0,05). Right ventricular stroke works (RVSW) were 11,09±0,86 (g.m) postoperative 1st hour in Grup 1 and 13,4±4,5 (g.m) in Grup 2 (p< 0,05). This study showed that L-carnitine enriched blood cardioplegia has no effect on normal left ventricular function. However L-carnitine has limited beneficial effect on the patients with poor left ventricular function who has preoperatively low EF, with longer cross clamp time, the patients who need complex surgery and for reoperations.
Carnitine is an essential cofactor for fatty acid (FA) metabolism and the predominant source of ATP in the normal aerobic heart. During myocardial ischemia, FA metabolism is impaired and tissue carnitine levels are depleted. Since the heart cannot synthesize carnitine, carnitine could play an important role for myocardıal functıon during reperfusion. In this study we aimed to investigate the effects of L carnitine enriched blood cardioplegia on myocardial tissue and protective effect on myocardial repefusion injury. From April 2005 to June 2005 twenty patients were selected who underwent elective coronary artery bypass surgery Hacettepe University Department of Cardiovascular Surgery. Patients were divided into two groups. Group I (controlled group) included 10 patients and Grup II (study group) included 10 patients in group I, with standart cold blood cardioplegia was used and in group II, L-carnitine enriched cold blood was use. The patient were assessed for cardiac output, cardiac index, left and right cardiac work. Cardiac output (CO) was found to be significantly high in the study group at the postoperative 1st hour control group; 4,94 ± 0.09 L/min and study group 5.32 ± 0,43 L/min; p<0,005, after CPB control group 2,99 ± 0,09 L/min and study group 3,18 ± 0,12 L/dk. After the six hour this significance was dissappeared between the groups. No statistical difference was found between the two groups considering the Cardiac index (CI) values. Patients left ventricular stroke works (LVSW) were 45,62±0,56 (g.m) in Grup 1 after cardiopulmonary bypass (CPB) and 69,7±28,2 (g.m) in Grup 2 (p<0,05). Postoperative 1st hour LVSW values were 55,06±0,98 (g.m) in Grup 1 and 69,8±27,8 (g.m) in Grup 2 (p<0,05). Right ventricular stroke works (RVSW) were 11,09±0,86 (g.m) postoperative 1st hour in Grup 1 and 13,4±4,5 (g.m) in Grup 2 (p< 0,05). This study showed that L-carnitine enriched blood cardioplegia has no effect on normal left ventricular function. However L-carnitine has limited beneficial effect on the patients with poor left ventricular function who has preoperatively low EF, with longer cross clamp time, the patients who need complex surgery and for reoperations.
Description
Keywords
Açık kalp cerrahisi, Kardiyopulmoner bypass, Karnitin, Open heart surgery, Cardiopulmonary bypass, Carnitine
Citation
Furat, C. vd. (2006). "Koroner arter bypass cerrahisinde l-karnitinin myokard fonksiyonları üzerine etkisi". Uludağ Üniversitesi Tıp Fakültesi Dergisi, 32(3), 93-97.