Tedavi Edilmiş KOAH’lı Hastaların, KOAH Olmayan Hastalara Göre; KABGO Sonrası Akciğer Problemlerin Araştırılması
Öz
Giriş: Koroner arter baypas greftleme operasyonu (KABGO) öncesi
tedavi almış kronik obstrüktif akciğer hastalığı (KOAH) olan bireylerle, KOAH
olmayan bireyler, cerrahi sonrası uzamış mekanik solunum desteği (UMSD) ve alt
solunum yolu infeksiyonu (ASYİ) açısından karşılaştırılmıştır.
Hastalar
ve Yöntemler: Kalp ve Damar Cerrahisi
kliniğinde, valvüler patolojisi ve konnektif doku hastalığı (Marfan sendromu
vb.) bulunmayan, izole on-pump KABGO yapılmış, 233 hasta çalışmaya alındı.
Veriler retrospektif olarak toplandı. Operasyon öncesi dönemde kliniğimizde
standart preoperatif laboratuvar tetkikleri, solunum sistemi sorgusunda veya
muayenesinde patoloji saptanan kişilere solunum fonksiyon testi (Spirobank
Spirometry, MIR Medical International Research Product) yapılmıştır. KOAH olan
hastalarda, KOAH şiddetini belirlemek için GOLD kılavuzu kullanılmıştır. Bütün
hastalar iki gruba ayrılmıştır. KOAH hastalarını içeren grup; grup 1, KOAH
olmayan hastaları içeren grup; grup 2 olarak adlandırılmıştır.
Bulgular: UMSD görülme hızı grup 1’de %4.8, grup 2’de %1.8 olduğu
görülürken; ASYİ oranı grup 1’de %6.3, grup 2’de %1.7 olduğu tespit edildi.
Sonuç: Çalışmamıza göre; operasyon öncesi
tedavi görmüş KOAH hastalarının, KOAH olmayan hastalara göre on-pump KABGO
sonrası, UMSD ve ASYİ açısından hızları yüksek olmakla birlikte istatistiksel
olarak anlamsız olduğunu söyleyebiliriz. (UMSD açısından p= 0.348; ASYİ
açısından p= 0.088).
Anahtar Kelimeler
Koroner arter baypas kalp akciğer makinası akciğer hastalığı kronik obstrüktif mekanik solunum solunum yolu infeksiyonları
Kaynakça
- 1. Ulaşlı SS, Ünlü M. KOAH’ın ağırlık sınıflamasında yeni konsept. Güncel Göğüs Hastalıkları Serisi 2013;1:13-9.
- 2. Dongelmans DA, Hemmes SN, Kudoga AC, Veelo DP, Binnekade JM, Schultz MJ. Positive end expiratory pressure following coronary artery bypass grafting. Inerva Anestesiol 2012;78:790-800.
- 3. Salenger R, Gammie JS, Vander Salm TJ. Postoperative care of cardiac surgical patients. In: Cohn LH, Edmunds LH Jr (eds). Cardiac surgery in the adult. 3th ed. New York: McGraw-Hill, 2003;p439-69.
- 4. Martin CG, Turkelson SL. Nursing care of the patient undergoing coronary artery bypass grafting. J Cardiovasc Nurs 2006;21:109-17.
- 5. Daganou M, Dimopoulou I, Michalopoulos N, Papadopoulos K, Karakatsani A, Geroulanos S, et al. Respiratory complications after coronary artery bypass surgery with unilateral or bilateral internal mammary artery grafting. Chest 1998;113:1285-9.
- 6. Huckabay L, Daderian AD. Effect of choices on breathing exercises post-open heart surgery. Dimens Crit Care Nurs 1990;9:190-201.
- 7. Imperial-Perez F, Rourke DA. Surgical management of heart disease. In: Kinney MR, Packa DR (eds). Andreoli’s comprehensive cardiac care. 8th ed. St. Louis: Mosby 1996:359-74.
- 8. Kjaergaard S, Rees SE, Grønlund J, Nielsen EM, Lambert P, Thorgaard P, et al. Hypoxaemia after cardiac surgery: clinical application of a model of pulmonary gas exchange. Eur J Anaesthesiol 2004;21:296-301.
- 9. Liu LL, Gropper MA. Respiratory and hemodynamic management after cardiac surgery. Curr Treat Options Cardiovasc Med 2002;4:161-9.
- 10. Simková I, Kozlovski M, Riecanski I, Fischer V, Kanáliková K, Bilcíková E. Pulmonary complications after heart surgery. Bratisl Lek Listy 1997;98:258-68.
- 11. Spivack SD, Shinozaki T, Albertini JJ, Deane R. Preoperative prediction of postoperative respiratory outcome. Coronary artery bypass grafting. Chest 1996;109:1222-30.
- 12. Wynne R, Botti M. Postoperative pulmonary dysfunction in adults after cardiac surgery with cardiopulmonary bypass: clinical significance and implications for practice. Am J Crit Care 2004;13:384-93.
- 13. Nicholson DJ, Kowalski SE, Hamilton GA, Meyers MP, Serrette C, Duke PC. Postoperative pulmonary function in coronary artery bypass graft surgery patients undergoing early tracheal extubation: a comparison between short-term mechanical ventilation and early extubation. J Cardiothorac Vasc Anesth 2002;16:27-31.
- 14. Weissman C. Pulmonary complications after cardiac surgery. Semin Cardiothorac Vasc Anesth 2004;8:185-211.
- 15. Wynne R, Botti M. Postoperative pulmonary dysfunction in adults after cardiac surgery with cardiopulmonary bypass: clinical significance and implications for practice. Am J Crit Care 2004;13:384-93.
- 16. Yende S, Wunderink R. Causes of prolonged mechanical ventilation after coronary artery bypass surgery. Chest 2002;122:245-52.
- 17. Bartz RR, Ferreira RG, Schoder JN, Davies J, Liu WW, Camara A, et al. Prolonged pulmonary support after cardiac surgery: incidence, risk factors and outcomes: a retrospective cohort study. J Crit Care 2015;30:940-4.
- 18. Canver CC, Chanda J. Intraoperative and postoperative risk factors for respiratory failure after coronary bypass. Ann Thorac Surg 2003;75:853-7.
- 19. Quadrelli SA, Brandani LM. Gas exchange changes in the postoperative period of heart surgery. Medicina (B Aires) 1995;55:300-6.
Öz
Introduction: In our study COPD and non-COPD patients who underwent
CABG were compared in terms of prolonged mechanical ventilation and lower
respiratory tract infektion.
Patients
and Methods: A total of 233 patients
without valvular pathology and connective tissue disorders, such as Marfan
syndrome, who underwent isolated on-pump CABG in the Department of
Cardiovascular Surgery were retrospectively studied. Preoperative laboratory
tests and respiratory system test (Spirobank Spirometry, Medical International
Research Product) were applied in patients who had pathology in respiratory
system query or examination were performed at our clinic during the
preoperative period. The severity of COPD in COPD patients was evaluated
according to the COLD guideline. All patients were divided in two groups. The
group including COPD patients was named group 1 and the other group including non-COPD
patients was named gruop 2.
Results: UMSD rates in groups 1 and 2 were 4.8% and 1.8%,
respectively. Lower respiratory tract infection rates in groups 1 and 2 were
6.3% and 1.7%, respectively.
Conclusion: According to our study, we can say
that the rate of UMSB and lower respiratory tract infection occuring in treated
COPD patients after CABG is statiscally indifferent according to non-COPD
patient. (p= 0.348 for UMSD, p= 0.088 for lower respiratory tract infection).
Anahtar Kelimeler
Coronary artery bypass heart lung machine pulmonary disease chronic obstructive respiration artificial respiratory tract infections
Kaynakça
- 1. Ulaşlı SS, Ünlü M. KOAH’ın ağırlık sınıflamasında yeni konsept. Güncel Göğüs Hastalıkları Serisi 2013;1:13-9.
- 2. Dongelmans DA, Hemmes SN, Kudoga AC, Veelo DP, Binnekade JM, Schultz MJ. Positive end expiratory pressure following coronary artery bypass grafting. Inerva Anestesiol 2012;78:790-800.
- 3. Salenger R, Gammie JS, Vander Salm TJ. Postoperative care of cardiac surgical patients. In: Cohn LH, Edmunds LH Jr (eds). Cardiac surgery in the adult. 3th ed. New York: McGraw-Hill, 2003;p439-69.
- 4. Martin CG, Turkelson SL. Nursing care of the patient undergoing coronary artery bypass grafting. J Cardiovasc Nurs 2006;21:109-17.
- 5. Daganou M, Dimopoulou I, Michalopoulos N, Papadopoulos K, Karakatsani A, Geroulanos S, et al. Respiratory complications after coronary artery bypass surgery with unilateral or bilateral internal mammary artery grafting. Chest 1998;113:1285-9.
- 6. Huckabay L, Daderian AD. Effect of choices on breathing exercises post-open heart surgery. Dimens Crit Care Nurs 1990;9:190-201.
- 7. Imperial-Perez F, Rourke DA. Surgical management of heart disease. In: Kinney MR, Packa DR (eds). Andreoli’s comprehensive cardiac care. 8th ed. St. Louis: Mosby 1996:359-74.
- 8. Kjaergaard S, Rees SE, Grønlund J, Nielsen EM, Lambert P, Thorgaard P, et al. Hypoxaemia after cardiac surgery: clinical application of a model of pulmonary gas exchange. Eur J Anaesthesiol 2004;21:296-301.
- 9. Liu LL, Gropper MA. Respiratory and hemodynamic management after cardiac surgery. Curr Treat Options Cardiovasc Med 2002;4:161-9.
- 10. Simková I, Kozlovski M, Riecanski I, Fischer V, Kanáliková K, Bilcíková E. Pulmonary complications after heart surgery. Bratisl Lek Listy 1997;98:258-68.
- 11. Spivack SD, Shinozaki T, Albertini JJ, Deane R. Preoperative prediction of postoperative respiratory outcome. Coronary artery bypass grafting. Chest 1996;109:1222-30.
- 12. Wynne R, Botti M. Postoperative pulmonary dysfunction in adults after cardiac surgery with cardiopulmonary bypass: clinical significance and implications for practice. Am J Crit Care 2004;13:384-93.
- 13. Nicholson DJ, Kowalski SE, Hamilton GA, Meyers MP, Serrette C, Duke PC. Postoperative pulmonary function in coronary artery bypass graft surgery patients undergoing early tracheal extubation: a comparison between short-term mechanical ventilation and early extubation. J Cardiothorac Vasc Anesth 2002;16:27-31.
- 14. Weissman C. Pulmonary complications after cardiac surgery. Semin Cardiothorac Vasc Anesth 2004;8:185-211.
- 15. Wynne R, Botti M. Postoperative pulmonary dysfunction in adults after cardiac surgery with cardiopulmonary bypass: clinical significance and implications for practice. Am J Crit Care 2004;13:384-93.
- 16. Yende S, Wunderink R. Causes of prolonged mechanical ventilation after coronary artery bypass surgery. Chest 2002;122:245-52.
- 17. Bartz RR, Ferreira RG, Schoder JN, Davies J, Liu WW, Camara A, et al. Prolonged pulmonary support after cardiac surgery: incidence, risk factors and outcomes: a retrospective cohort study. J Crit Care 2015;30:940-4.
- 18. Canver CC, Chanda J. Intraoperative and postoperative risk factors for respiratory failure after coronary bypass. Ann Thorac Surg 2003;75:853-7.
- 19. Quadrelli SA, Brandani LM. Gas exchange changes in the postoperative period of heart surgery. Medicina (B Aires) 1995;55:300-6.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Orijinal Araştırmalar |
| Yazarlar | |
| Yayımlanma Tarihi | 4 Nisan 2016 |
| Yayımlandığı Sayı | Yıl 2016 Cilt: 19 Sayı: 1 |
