Kardiyopulmoner Bypass'ın Hemogram Parametreleri Üzerine Etkisi

Year 2021, Volume: 6 Issue: 1, 102 - 111, 05.03.2021

Bişar Amaç , Aydemir Koçarslan , Mehmet Salih Aydın , Nazım Kankılıç , Mahmut Padak , Reşat Dikme

https://doi.org/10.26453/otjhs.811833

Cited By: 1

Abstract

Amaç: Bu çalışmada, kardiyopulmoner bypass yöntemi ile kardiyovasküler cerrahi geçiren hastaların farklı zamanlarda alınan hemogram örneklerinin değerlendirilmesi amaçlanmıştır.
Materyal ve Metot: Prospektif olan çalışmamıza çeşitli sebeplerden dolayı kardiyovasküler cerrahi geçiren 30 hastadan preoperatif, anestezi indüksiyonu sonrası, aortik kross klemp sonrası, KPB çıkışından hemen sonra ve postoperatif 5.gün olmak üzere beş farklı zamanda hemogram tüpüne kan örnekleri alındı. Numuneler tam kan sayım cihazında çalışıldı ve istatistiksel analizleri yapıldı.
Bulgular: Çalışmaya dahil edilen hastaların yaşları 49,57±14,25, boyları 165,33±0,06 cm, kiloları 71,00±12,98 kg, aortik kross klemp süreleri 75,23±28,45 dakika, total perfüzyon süreleri 112,50±46,23 dakika, hastanede kalış süreleri 13,53±10,18 gün, yoğun bakım kalış süreleri 1,9±2,04 gün, vücut yüzey alanları 1,78±0,17 m2, flow değerleri 4177,90±831,91 ml/dk/m2 bulundu. Lökosit, lenfosit, monosit, eoznofil, eritrosit, hematokrit ve platelet düzeylerindeki değişim istatistiksel olarak anlamlı bulundu (p<0,05). Nötrofil, bazofil ve hemoglobin düzeylerinde de ciddi düzeyde değişim vardı ancak istatistiksel olarak anlamlı değildi (p>0,05).
Sonuç: Kardiyopulmoner bypass yöntemi ile kardiyovasküler cerrahisi sırasında uygulanan hemodilüsyon, heparinizasyon ve kanın endotel olmayan yüzeylerle teması neticesinde hasar ve enflamatuar yanıta bağlı olarak hemogram parametrelerinde ciddi düzeyde değişimler oluşmaktadır.

Keywords

Ekstrakorporeal dolaşım, hemogram parametreleri, kardiyopulmoner bypass, perfüzyon

The Effect of Cardiopulmonary Bypass on Hemogram Parameters

Abstract

Objective: This study aims to evaluate the hemogram samples taken at different times from patients who underwent cardiovascular surgery with cardiopulmonary bypass method.
Materials and Methods: In this prospective study, blood samples were taken from 30 patients who underwent cardiovascular surgery for various reasons at five different times: preoperatively, after anesthesia induction, after aortic cross clamp, immediately after CPB, and on the postoperative 5th day. Complete blood count was performed for the samples and statistical analysis was made.
Results: The patients were found to have the following values: age 49.57±14.25 years, height 165.33±0.06 cm, weight 71.00±12.98 kg, aortic cross clamp time 75.23±28.45 minutes, total perfusion time 112.50±46.23 minutes, hospital stay 13.53±10.18 days, intensive care stay 1.9±2.04 days, body surface areas 1.78±0.17 m2, flow values 4177.90±831.91 ml/min/m2. The change in leukocyte, lymphocyte, monocyte, eosinophil, erythrocyte, hematocrit and platelet levels was statistically significant (p<0.05). There was also a significant change in neutrophil, basophil and hemoglobin levels, but it was not statistically significant (p>0.05).
Conclusion: As a result of hemodilution, heparinization and blood contact with non-endothelial surfaces during cardiovascular surgery with cardiopulmonary bypass method, serious changes in hemogram parameters occur due to damage and inflammatory response.

Keywords

Extracorporeal circulation, hemogram parameters, cardiopulmonary bypass, perfusion

References

• As AK, Engin M, Türk T. Early-term results of early coronary artery bypass graft surgery in patients undergoing primary percutaneous coronary intervention due to acute coronary syndrome. Eur Res J. 2020. doi:10.18621/eurj.593369
• Aftabuddin M, Rajbhandhari N, Rahman MZ, Islam N, Khan OS. Cardiopulmonary bypass induced hematological changes in patients undergoing cardiac surgery. Bangladesh Heart Journal. 2015;30(2):53-57. doi:10.3329/bhj.v30i2.28811
• DeSomer F. Optimisation of the perfusion circuit and its possible impact on the inflammatory response. J Extra Corpor Tecnal. 2007;39:285-288.
• 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 Medical Journal. 2013;40(4):589-596.
• Aydınlı B, Demir A, Güçlü ÇY, et al. Hematological predictors and clinical outcomes in cardiac surgery. Journal of Anesthesia. 2016;30:770–778.
• Karataş MB, Çanga Y, İpek G, et al. Association of admission serum laboratory parameters with new-onset atrial fibrillation after a primary percutaneous coronary intervention. Coron Artery Dis. 2016;27(2):128–134.
• Pober JS, Cotran RS. Cytokines and endothelial cell biology. Physiol Rev. 1990;70(2):427-451.
• DeBois WJ, Lee LY, Krieger KH. Safety of low hematocrits during cardiopulmonary bypass. Ann Thorac Surg. 2002;74(1):296-7.
• Engin M. Are Pre and Postoperative Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio Associated with Early Postoperative AKI Following CABG? Braz J Cardiovasc Surg. 2020;35(2):239. doi:10.21470/1678-9741-2019-0482
• Erdolu B, As AK, Engin M. The Relationship between the HATCH Score, Neutrophil to Lymphocyte Ratio and Postoperative Atrial Fibrillation After Off-Pump Coronary Artery Bypass Graft Surgery. Heart Surg Forum. 2020;23(1):E88-E92. doi:10.1532/hsf.2771
• Çalışkan A, Yazıcı S, Karahan O, et al. The investigation of complete blood counting parameters in deep venous thrombosis Dicle Medical Journal. 2014;41(1):118-122
• Larmann J, Handke J, Scholz AS, et al. Preoperative neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are associated with major adverse cardiovascular and cerebrovascular events in coronary heart disease patients undergoing non-cardiac surgery. BMC Cardiovasc Disord. 2020;20(1):230. doi:10.1186/s12872-020-01500-6
• Salles FB, Kalil RAK. Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio May Contribute Little Compared to Standard Preoperative Evaluation. Braz J Cardiovasc Surg. 2018;33(6):644. doi:10.21470/1678-9741-2018-0242
• Ivert T, Dalén M, Ander C, Stålesen R, Lordkipanidzé M, Hjemdahl P. Increased platelet reactivity and platelet-leukocyte aggregation after elective coronary bypass surgery. Platelets. 2019;30(8):975-981. doi:10.1080/09537104.2018.1542122
• Bilal MS, Bayındır O, Erentürk S, et al. Roller ve Santrifugal Pompa Tekniklerinin İmmun Sistem Üzerindeki Etkilerinin Karşılaştırılması. GKD Cer. Derg. 1995;3:17-26.
• Rychly J, Oldag D, Krüger AD. Electrophoretic studies of the composition of peripheral mononuclear cells during operations with extracorporeal circulation. Z Exp Chir Transplant Kunstliche Organe. 1990;23(1):18-22.
• Karkouti K, Wijeysundera DN, Yau TM, et al. The independent association of massive blood loss with mortality in cardiac surgery. Transfusion. 2004;44(10):1453-1462.
• Çağdaş B, Yazıcıoğlu L, Eryılmaz S. Vücut Dışı Yaşam Desteğinde Kan ve Biyomateryel Yüzeylerin Etkileşimi. Turkiye Klinikleri Cardiovascular Surgery-Special Topics. 2017;(9)3:188-191.
• Ganushchak YM, Fransen EJ, Visser C, DeJong DS, Maessen JG. Neurological complications after coronary artery bypass grafting related to the performance of cardiopulmonary bypass. Chest. 2004;125(6):2196-2205.
• Lohrer RM, Trammer AR, Dietrich W, Hagl S, Linderkamp O. The influence of extracorporeal circulation and hemoseparationon red cell deformability and membrane proteins in coronery artery disease. J Thorac Cardiovasc Surg. 1990;99:735-740.
• Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah A. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed? J Thorac Cardiovasc Surg. 2003;125(6):1438-50.
• Balcı E, Aykut A, Sert GS, et al. Kalp Cerrahisinde Bir Yıllık İntraoperatif Kan Ürünü Kullanımı Analizi: Hangi Hastalarda? Hangi Ameliyatlarda? Ne Kadar? GKDA Derg. 2016;22(2):62-69. doi:10.5222/GKDAD.2016.062
• Kalender M, Baysal AN, Dağlı M, Şahsıvar MA, Gökmengil H. Koroner Arter Baypas Cerrahisi Sırasında Yapılan Kan Transfüzyonunun Hastane Mortalitesi Üzerine Etkisi. Koşuyolu Heart J. 2019;22(1):1-6. doi: 10.5578/khj.67426
• Ascione R, Caputo M, Angelini GD. Off-pump coronary artery bypass grafting: Not a flash pan. Ann Thorac Surg. 2003;75:306-313.
• Zindrou D, Taylor KM, Bagger JP. Preoperative haemoglobin concentration and mortality rate after coronary artery bypass surgery. Lancet. 2002;359(9319):1747-1748.
• Kotfis K, Ślozowska J, Safranow K, Szylińska A, Listewnik M. The Practical Use of White Cell Inflammatory Biomarkers in Prediction of Postoperative Delirium after Cardiac Surgery. Brain Sci. 2019;9(11):308. doi:10.3390/brainsci9110308
• Seropian IM, Romeo FJ, Pizarro R, et al. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as predictors of survival after heart transplantation. ESC Heart Fail. 2018;5(1):149-156. doi:10.1002/ehf2.12199
• Koo CH, Eun JD, Park YS, et al. Neutrophil, Lymphocyte, and Platelet Counts and Acute Kidney Injury After Cardiovascular Surgery. J Cardiothorac Vasc Anesth. 2018;32(1):212-222. doi:10.1053/j.jvca.2017.08.033