Koroner arter bypass cerrahisi uygulanan hastalarda kan ürünü kullanımı ve postoperatif hemoglobin düzeylerinin atriyal fibrilasyonla ilişkisi
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Date
2014
Authors
Yüksel, Ahmet
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Atriyal fibrilasyon (AF) kardiyak cerrahi sonrasında en sık karşılaşılan ritm bozukluğudur. Postoperatif atriyal fibrilasyon (POAF) zararsız bir problemmiş gibi görünmesine rağmen artmış mortalite ve morbidite ile ilişkilidir. POAF artmış serebrovasküler olay, kalp yetmezliği ve sol ventrikül hemodinamik performansında azalma ile seyreden, uzamış yoğun bakım ve hastanede kalış sürelerine neden olan önemli bir komplikasyondur. Atriyal fibrilasyonun etyolojisi, risk faktörleri, önlenmesi ve tedavisi halen tartışmalıdır. Literatürde POAF gelişimi için birçok risk faktörü tanımlanmış olsa da ileri yaş literatürlerde belirtilen ortak risk faktörüdür. Bu çalışmanın amacı koroner arter hastalığı nedeniyle koroner arter bypass cerrahisi (KABC) uygulanan erişkin hastalarda gelişen atrial fibrilasyon ile kan ürünü kullanımı ve postoperatif hemoglobin düzeylerinin ilişkisini değerlendirmektir. Kliniğimizde Haziran 2013 ile Aralık 2013 tarihleri arasında izole koroner bypass ameliyatı yapılan 80 erişkin hasta postoperatif hemoglobin düzeylerine göre 40'ar hastadan oluşan iki gruba ayrılarak prospektif olarak çalışmaya alındı. Birinci grup takipleri boyunca postoperatif hemoglobin düzeyleri 10 g/dl'nin altında olan hastalar (Grup 1), ikinci grup ise postoperatif hemoglobin düzeyleri 10 g/dl ve üzerinde olan hastalar (Grup 2) alınarak oluşturuldu. Her iki gruptaki hastalar kan ürünü kullanımı ve postoperatif atriyal fibrilasyon gelişimi açısından birbirleriyle karşılaştırıldı, sonuçta kan hemoglobin düzeyleri ve kan ürünü kullanımı ile atrial fibrilasyon gelişimi arasındaki ilişki değerlendirildi. Ayrıca postoperatif atriyal fibrilasyon gelişen ve gelişmeyen hastalar da birbirleriyle karşılaştırıldı. Böylelikle postoperatif atriyal fibrilasyon için risk faktörlerinin analizi de yapıldı ve postoperatif takip sonuçları karşılaştırıldı. Grup 1'de Grup 2'ye göre daha fazla sayıdaki hastada postoperatif atriyal fibrilasyon geliştiği ancak bu farkın istatistiksel olarak anlamlı olmadığı görüldü. POAF gelişen ve gelişmeyen hastalar kan ürünü kullanılan hasta sayıları açısından karşılaştırıldığında, POAF gelişen hastalarda daha fazla sayıdaki hastada kan ürünü kullanıldığı ancak bu farkın istatistiksel olarak anlamlı olmadığı bulundu. POAF gelişen ve gelişmeyen hastaların karşılaştırılmasıyla yapılan risk faktörü analizinde ileri yaş, düşük ejeksiyon fraksiyonu, obesite ve preoperatif beta bloker kullanılmaması POAF gelişimi açısından risk faktörü olarak bulundu ve POAF gelişen hastalarda yoğun bakımda kalış süresi ve hastanede kalış süresi POAF gelişmeyen hastalara göre daha uzun saptandı. Bu çalışmaya göre koroner arter bypass cerrahisi uygulanan erişkin hastalarda gelişen atriyal fibrilasyonun kan ürünü kullanımı ve postoperatif hemoglobin düzeyleri ile ilişkili olduğu ortaya konulamamıştır.
Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery. Although postoperative atrial fibrillation (POAF) looks like a harmless problem, it is associated with increased mortality and morbidity. POAF is an important complication which causes increased cerebrovascular accident, heart failure, a decrease in left ventricular hemodynamic performance, prolonged intensive care unit and hospital length of stay. The etiology, risk factors, prevention and treatment of atrial fibrillation is still debatable. Although identified many risk factors for the development of POAF, advanced age is the common risk factor which consistently stated in the literature. The aim of this study is to evaluate the relationship of POAF with the use of blood product and levels of postoperative hemoglobin in adult patients who underwent coronary artery bypass surgery for coronary artery disease. Between June 2013 and December 2013, 80 adult patients who underwent isolated coronary artery bypass surgery in our institution splitted up two groups that contain 40 patients according to the level of their postoperative hemoglobin and they were taken to study prospectively. In group 1, there are patients that whose level of postoperative hemoglobin is below 10 g/dl. In group 2, there are also patients that whose level of postoperative hemoglobin is above 10 g/dl. Patients in both groups are compared with each other according to the use of blood product and the devolopment postoperative atrial fibrillation (POAF) and then the relationship between the use of blood product and the development of atrial fibrillation is analyzed. In addition, the patients that develop postoperative atrial fibrillation and the patients that do not develop postoperative atrial fibrillation are compared with each other. Thus, risk factor analysis for postoperative atrial fibrillation have been made and the postoperative follow-up results were compared. In Group 1 with respect to Group 2, postoperative atrial fibrillation is developed in much more patients but this difference is seen meaningless statistically. When the patients that develop POAF and do not develop POAF are compared according to the number of patients that use blood product, much more blood product is used in the patients that develop POAF but this difference is also seen meaningless statistically. In risk factor analysis that is made by comparison with the patients that develop POAF and do not develop POAF; advanced age, low ejection fraction, obesity and the non-use of preoperative beta blocker are seen as risk factors according to the development of POAF. And according to staying in intensive care unit and staying in hospital, the duration is much longer in the patients that develop POAF with respect to the patients that do not develop POAF. In consequence of this study, atrial fibrillation that develops in adult patients who are implemented a coronary artery bypass surgery is not related with the use of blood product and the level of postoperative haemoglobin.
Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery. Although postoperative atrial fibrillation (POAF) looks like a harmless problem, it is associated with increased mortality and morbidity. POAF is an important complication which causes increased cerebrovascular accident, heart failure, a decrease in left ventricular hemodynamic performance, prolonged intensive care unit and hospital length of stay. The etiology, risk factors, prevention and treatment of atrial fibrillation is still debatable. Although identified many risk factors for the development of POAF, advanced age is the common risk factor which consistently stated in the literature. The aim of this study is to evaluate the relationship of POAF with the use of blood product and levels of postoperative hemoglobin in adult patients who underwent coronary artery bypass surgery for coronary artery disease. Between June 2013 and December 2013, 80 adult patients who underwent isolated coronary artery bypass surgery in our institution splitted up two groups that contain 40 patients according to the level of their postoperative hemoglobin and they were taken to study prospectively. In group 1, there are patients that whose level of postoperative hemoglobin is below 10 g/dl. In group 2, there are also patients that whose level of postoperative hemoglobin is above 10 g/dl. Patients in both groups are compared with each other according to the use of blood product and the devolopment postoperative atrial fibrillation (POAF) and then the relationship between the use of blood product and the development of atrial fibrillation is analyzed. In addition, the patients that develop postoperative atrial fibrillation and the patients that do not develop postoperative atrial fibrillation are compared with each other. Thus, risk factor analysis for postoperative atrial fibrillation have been made and the postoperative follow-up results were compared. In Group 1 with respect to Group 2, postoperative atrial fibrillation is developed in much more patients but this difference is seen meaningless statistically. When the patients that develop POAF and do not develop POAF are compared according to the number of patients that use blood product, much more blood product is used in the patients that develop POAF but this difference is also seen meaningless statistically. In risk factor analysis that is made by comparison with the patients that develop POAF and do not develop POAF; advanced age, low ejection fraction, obesity and the non-use of preoperative beta blocker are seen as risk factors according to the development of POAF. And according to staying in intensive care unit and staying in hospital, the duration is much longer in the patients that develop POAF with respect to the patients that do not develop POAF. In consequence of this study, atrial fibrillation that develops in adult patients who are implemented a coronary artery bypass surgery is not related with the use of blood product and the level of postoperative haemoglobin.
Description
Keywords
Postoperatif atriyal fibrilasyon, Kan ürünü kullanımı, Hemoglobin düzeyleri, Koroner arter bypass cerrahisi, Postoperative atrial fibrillation, Blood product use, Hemoglobin levels, Coronary artery bypass surgery
Citation
Yüksel, A. (2014). Koroner arter bypass cerrahisi uygulanan hastalarda kan ürünü kullanımı ve postoperatif hemoglobin düzeylerinin atriyal fibrilasyonla ilişkisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.