Kapak replasmanı ve koroner bypass yapılan vakalarda ekstrakorporeal dolaşımın atrial natriüretik peptide ve endotelin-1 seviyeleri üzerine etkisi
Başlık çevirisi mevcut değil.
- Tez No: 40238
- Danışmanlar: Belirtilmemiş.
- Tez Türü: Tıpta Uzmanlık
- Konular: Göğüs Kalp ve Damar Cerrahisi, Thoracic and Cardiovascular Surgery
- Anahtar Kelimeler: Atriyal natriüretik faktör, Ekstrakorporeal dolaşım, Endotelinler, Koroner arter bypass, Atrial natriuretic factor, Extracorporeal circulation, Endothelins, Coronary artery bypass
- Yıl: 1995
- Dil: Türkçe
- Üniversite: Atatürk Üniversitesi
- Enstitü: Tıp Fakültesi
- Ana Bilim Dalı: Belirtilmemiş.
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: Belirtilmemiş.
Özet
SUMMARY This study was carried out in Vascular and Cardiothoracic Surgery Department, Research Hospital, Atatürk University, Erzurum. In order to investigate the effects of extracorporeal circulation (ECC) on plasma ANP (p-ANP) and endothelin-1 (ET-1) concentrations of patients with mitral valve disaese (groupe I, n=15) and with coronary artery disaese (group II, n=15). Eight blood samples were taken from internal jugular vein: (1) before induction, (2) just after induction, (3) before 5 minutes of the aortic crossclamping, (4) after 5 minutes of aortic crossclamping, (5) 20 minutes after aortic crossclamping, (6) 4 hours after removing aortic crossclamp, (7) 24 hours after ECC and (8) the postoperative third day. In groups I and II, preoperative p-ANP levels were found to be significantly higher than those of the controls (p<0,01). p-ANP levels decreased significantly after induction and increased after partial ECC and 5 minutes before crossclamping ANP levels were shown to be increased after 5 minutes of CC and reached maximum level at 20th minute p-ANP levels began to decrease after 4 hours of CC, postoperative 24th and 72nd hours. There was not a significant difference between the preoperative ET-1 levels of the controls and baseline values of the group I patients (p<0,05). ET-1 began to increase after induction and during partial ECC. After that, ET-1 reached to maximum levels at 20th minute of CC and tended to decrease at 4th hour after removing CC and decreased at the postoperative 24th hour. In group n, baseline levels of ET-1 were higher than those of the controls (p<0,01). Immediately after induction and partial ECC, ET-1 levels began to rise and reached maximum value at 5th minute of CC removal. Then, ET-1 decreased at the 20th minute of CC, after 4, 24 and 72 hours of CC. According to these results, in etiopathogenesis of cardiac and circulatory system diseases (particulary coronary artery disease) being the most important cause of morbidity and mortality, there are functional disorders associated with endothelium. Additionally, increaesed ET-1 levels in advanced stages of pulmonary hypertension that result from valvular heart disease (mostly seen one is mitral valve disaese) many have diverse effects. That the changes in courses of p-ANP and ET-1 levels may give an idea for evaluating the patients undergoing ECC surgical, valvular diseases and CBPG during ECC and early postoperative period. However, duration of the assay and expensiveness of kits restict the determinations of p-ANP and ET-1 levels in such cases in our country.(p<0.001) düşme eğilimi gösteren ET-1 değerleri, postop. 24. saatte ise düşmeye devam etmiştir (pO.001). Grup H'de ki hastaların ET-1 düzeylerinin baseline değerleri ise Grup I'den farklı olarak, kontrol grubuna göre anlamlı olarak (p<0.01) yüksek bulunmuştur. İndüksiyondan sonra ise ET-1 değerleri anlamlı olarak daha da artmış (p<0.001), parsiyel EKD sırasında bu artış devam etmiş (pO.001) ve KK kalktıktan 5 dk. sonra en yüksek değere ulaşmıştır. KK'in 20. dakikasında ise anlamlı olarak azalma göstermiş (sırasıyla p<0.001, p<0.001) ve KK'den 4, 24 ve 72 saat sonra ET-1 değerlerinde azalma devam etmiştir (sırasıyla p<0.001, p<0.01), p<0.01). Bu sonuçlara göre günümüzde morbidite ve mortalitenin en önemli sebebi olan kalp ve dolaşım sistemi hastalıklarının (özellikle de Koroner Arter Hastalığının) en önemli sebebi olan Aterosklerozun etiyopatogenezinde ise endotele ait fonksiyon bozuklukları bulunmaktadır. Yine romatizmal kalp kapak hastalıklarından en fazla görülen mitral kapak hastalıklarında da geç dönemlerde oluşan Pulmoner HT hastalığı daha da artırmakta ve ileri dönemlerde irreversibl hale gelip, patolojik zeminden salmımı artan ET-1 de çeşitli olumsuz katkılarda bulunmaktadır. Özellikle KAH nedeniyle KBPG yapılan ve MVR yapılan hastalarda EKD sonralarında ET-1 ve p-ANP seviyelerinde oluşan değişimlerin bilinmesi EKD sonrasında ve erken postoperatif dönemde hastalığın düzeltilmesinin değerlendirilmesinde yardımcı kriterler olarak göz önünde bulundurulabilir. Ancak ülkemiz şartlarında özellikle ANP ve ET-1 seviyelerinin tesbitindeki hassas çalışma ve laboratuar ortamları, konunun pratikliğini ve ekonomikliğini güçleştirmektedir. jL>f'/Wttl-&t£t S?Ç*?// e>2_
Özet (Çeviri)
SUMMARY This study was carried out in Vascular and Cardiothoracic Surgery Department, Research Hospital, Atatürk University, Erzurum. In order to investigate the effects of extracorporeal circulation (ECC) on plasma ANP (p-ANP) and endothelin-1 (ET-1) concentrations of patients with mitral valve disaese (groupe I, n=15) and with coronary artery disaese (group II, n=15). Eight blood samples were taken from internal jugular vein: (1) before induction, (2) just after induction, (3) before 5 minutes of the aortic crossclamping, (4) after 5 minutes of aortic crossclamping, (5) 20 minutes after aortic crossclamping, (6) 4 hours after removing aortic crossclamp, (7) 24 hours after ECC and (8) the postoperative third day. In groups I and II, preoperative p-ANP levels were found to be significantly higher than those of the controls (p<0,01). p-ANP levels decreased significantly after induction and increased after partial ECC and 5 minutes before crossclamping ANP levels were shown to be increased after 5 minutes of CC and reached maximum level at 20th minute p-ANP levels began to decrease after 4 hours of CC, postoperative 24th and 72nd hours. There was not a significant difference between the preoperative ET-1 levels of the controls and baseline values of the group I patients (p<0,05). ET-1 began to increase after induction and during partial ECC. After that, ET-1 reached to maximum levels at 20th minute of CC and tended to decrease at 4th hour after removing CC and decreased at the postoperative 24th hour. In group n, baseline levels of ET-1 were higher than those of the controls (p<0,01). Immediately after induction and partial ECC, ET-1 levels began to rise and reached maximum value at 5th minute of CC removal. Then, ET-1 decreased at the 20th minute of CC, after 4, 24 and 72 hours of CC. According to these results, in etiopathogenesis of cardiac and circulatory system diseases (particulary coronary artery disease) being the most important cause of morbidity and mortality, there are functional disorders associated with endothelium. Additionally, increaesed ET-1 levels in advanced stages of pulmonary hypertension that result from valvular heart disease (mostly seen one is mitral valve disaese) many have diverse effects. That the changes in courses of p-ANP and ET-1 levels may give an idea for evaluating the patients undergoing ECC surgical, valvular diseases and CBPG during ECC and early postoperative period. However, duration of the assay and expensiveness of kits restict the determinations of p-ANP and ET-1 levels in such cases in our country.
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