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Kronik obstrüktif akciğer hastalığının izole koroner cerrahisi üzerine erken dönem etkileri

The effect of chronic obstructive pulmonary disease on the early postoperative outcome of patients undergoing CABG

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  1. Tez No: 192339
  2. Yazar: İLHAN KORAY AYDEMİR
  3. Danışmanlar: DOÇ. DR. NEVZAT ERDİL
  4. Tez Türü: Tıpta Uzmanlık
  5. Konular: Göğüs Kalp ve Damar Cerrahisi, Thoracic and Cardiovascular Surgery
  6. Anahtar Kelimeler: COPD, coronary artery bypass grafting, surgical outcomes43
  7. Yıl: 2006
  8. Dil: Türkçe
  9. Üniversite: İnönü Üniversitesi
  10. Enstitü: Tıp Fakültesi
  11. Ana Bilim Dalı: Kalp ve Damar Cerrahisi Ana Bilim Dalı
  12. Bilim Dalı: Belirtilmemiş.
  13. Sayfa Sayısı: 60

Özet

KRON K OBSTRÜT F AKC ĞER HASTALIĞININ ZOLE KORONER ARTERCERRAH S ERKEN DÖNEM SONUÇLARINA ETK SVII. ÖZET:Amaç:Koroner arter hastalığı ve kronik obstrüktif akciğer hastalığı ( KOAH ) sıkkarşılaşılan bir birlikteliktir. KOAH, koroner arter cerrahisinde mortalite ve morbiditeaçısından tespit edilen en önemli preoperatif risk faktörlerinden biridir. Bu yazıda, izolekoroner arter cerrahisi uyguladığımız hastalarda KOAH' nın erken dönem cerrahisonuçlar üzerine etkilerini araştırdık.Materyal ve Metod:Eylül 2001-Şubat 2006 tarihleri arasında kliniğimizde izole koroner bypasscerrahisi uygulanan 1032 hasta çalışmaya dahil edildi. Sol ventrikül anevrizma onarımı,karotis endarterektomi yapılanlar ve re-operasyonlar da çalışmaya alınmadı. KOAHnedeniyle yatarak tedavi öyküsü olan veya solunum fonksiyon testlerinde beklenenFEV1 değeri

Özet (Çeviri)

VIII. SUMMARY:Background: Coronary artery disease and chronic obstructive pulmonarydisease (COPD) have been a common association. COPD has been identified as animportant preoperative risk factor for mortality and morbidity in patients undergoingcoronary artery bypass grafting (CABG). The aim of the study was to assess the impactof COPD on the early postoperative outcome of patients undergoing CABG.Methods: Between September 2001 to February 2006, 1032 patientsunderwent CABG at our clinic. Patients underwent carotid endarterectomy, leftventricle aneurysm repair during the CABG session and reoperations were excluded.One hundred fifty-three (15%) of these individuals had required therapy for thetreatment of chronic pulmonary compromise or had an FEV1, 75% of predicted value.These subjects were defined as COPD group, and the remaining 879 were defined ascontrol group.Results: The patients who had COPD were significantly older than those whodid not have this disease (p = 0.001). Compared to the control group, COPD patientshad a significantly higher prevalence rates of hypertension (p = 0.016) and obesity(p = 0.01). The 2 groups were statistically similar with respect to sex distribution,proportion of cases with unstable angina and left main coronary artery disease. Therewere also no significant differences between the groups with respect to prevalence ratesof hyperlipidemia, smoking, diabetes; proportions of patients with previous MI orcerebrovascular accident; or proportions of patients with carotid artery disease or renaldysfunction. There was no significant difference between the mean cross-clamp andmean cardiopulmonary bypass times, mean numbers of grafts per operation, use of leftinternal mammary artery grafts, proportions of patients who required inotropic support,intraaortic balloon pump support, and incidences of perioperative MI and postoperative42atrial fibrillation for the 2 groups. The proportion of patients who received arterialgrafts only, and who had off-pump surgery were significantly higher in control group(p = 0.001, p = 0.012, respectively). The incidence of proximal anastomosis performedduring the cross-clamp period was also significantly higher in control group(p = 0.026). The COPD group had a significantly longer mean mechanical ventilationtime (8.9±4.5 vs. 7.9±3.1 hours for COPD vs. control, respectively; p = 0.0001). TheCOPD group had statistically higher incidences of gastrointestinal complications(bleeding/perforation), and sternal dehiscence (p = 0.01, p = 0.049, respectively). Therewere also no significant differences between with respect to mean intensive care stay,but overall hospital stay was significantly longer in COPD group (6.8±1.8 vs. 7.3±3.9days for COPD vs. control, respectively; p = 0.009). The rates of hospital mortalitywere 2.6 % in the COPD group and 1.9% in the control group (p = 0.589).Conclusion: Our findings indicate that COPD is not associated with increasedmortality in patients undergoing CABG. However, morbidity of patients with COPDafter CABG was significantly high. Morbidity ratios might be lowered by close care,improving preoperative evaluation and by avoiding CPB as possible as.

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