D vitamini yetersizliği ve eksikliğinin koroner bypass cerrahisi geçiren hastalarda postoperatif kognitif fonksiyonlara etkisinin değerlendirilmesi
Evaluation of vitamin D deficiency - insufficiency and its effects on postoperative cognitive functions in patients undergoing coronary bypass surgery
- Tez No: 761225
- Danışmanlar: PROF. DR. ZEKİ ERTUĞ
- Tez Türü: Tıpta Uzmanlık
- Konular: Anestezi ve Reanimasyon, Anesthesiology and Reanimation
- Anahtar Kelimeler: D Vitamini Yetersizliği, Postoperatif Kognitif Disfonksiyon, Koroner Arter Bypass Cerrahisi, Montreal Bilişsel Değerlendirme Ölçeği, Biyokimyasal Belirteçler, Near Infrared Spektroskopi, Vitamin D Insufficiency, Postoperative Cognitive Dysfunction, Coronary Artery Bypass Surgery, Montreal Cognitive Assessment Scale, Biochemical Markers, Near Infrared Spectroscopy
- Yıl: 2022
- Dil: Türkçe
- Üniversite: Akdeniz Üniversitesi
- Enstitü: Tıp Fakültesi
- Ana Bilim Dalı: Anesteziyoloji Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 118
Özet
Giriş: Postoperatif kognitif disfonksiyon (POKD); anestezi ve cerrahi sonrası, dikkat, konsantrasyon ve hafızada bozulma ile karakterize uzun vadeli etkileri olabilen bir serebral bilişsel değişiklik durumu olarak tanımlanır ve tam bir psikiyatrik tanı olmayıp, hafif düzeyde nörokognitif bozukluk olarak değerlendirilmektedir. Koroner arter bypass cerrahisi sonrası nörokognitif gerileme başlıca nörolojik komplikasyonlar olarak gözlenebilmektedir. D vitamini, nörotrofik faktörlerin düzenlenmesinde, nörogenezde, kalsiyum homeostazında, detoksifikasyonda ve β-amiloid klirensinde önemli bir rol oynadığı için nörodejenerasyonu önlemeye yardımcı olabilir. Çalışmamızın amacı; KABG cerrahisi geçirecek hastaların preoperatif vitamin-D düzeylerinin postoperatif nörokognitif fonksiyonlar üzerinde etkisinin olup olmadığını değerlendirmektir. Gereç ve Yöntemler: Çalışmaya Akdeniz Üniversitesi Tıp Fakültesi Hastanesi Anesteziyoloji ve Reanimasyon Kliniği'nde Mayıs 2021-Kasım 2022 tarihleri arasında kalp ve damar cerrahisi servisinde elektif KABG cerrahisi planlanan Amerikan Anestezistler Derneği (ASA) skoru 1-3 olan 18-70 yaş aralığında 100 hasta dahil edildi. 70 hasta serum 25(OH)D3 düzeyi 0,05). Yapılan analizlere göre postop CXCL 10 değeri ile postoperatif MOCA değeri arasında ters yönde (negatif) korelasyon tespit edilmiştir (r=-0,312; p=0,004) Sonuç: D vitamini yetersizlik/eksiklik olan izole KABG cerrahisi geçiren olgularda; özellikle eksik olanlarda daha çok olmak üzere ileri yaş, HT, DM gibi POKD risk faktörlerinin literatürle uyumlu olduğunu gördük. Serebral biyokimyasal belirteçlerin postoperatif dönemde POKD gelişen olgularda yükseldiğini saptadık. Kardiyak cerrahi geçirecek olgularda risk faktörlerinin tespitinin yanında preoperatif D vitamini düzeyinin de optimize edilmesi ve perioperatif dönemde nöromonitörizasyonun uygulanmasının hem POKD gelişimini azaltacağını hem de olguların yoğun bakım ünitesi ve hastanede kalış süreleri dolayısıyla maliyeti azaltacağını ve daha büyük vaka serileriyle yapılacak çalışmalarla da bunun destekleneceği düşüncesindeyiz.
Özet (Çeviri)
Introduction: Postoperative cognitive dysfunction (POCD); It is defined as a state of cerebral cognitive change that can have long-term effects after anesthesia and surgery, characterized by impaired attention, concentration, and memory. It is not a complete psychiatric diagnosis and is considered as a mild neurocognitive disorder. Neurocognitive regression can be observed as the main neurological complications after coronary artery bypass surgery. Vitamin D may help prevent neurodegeneration as it plays an important role in the regulation of neurotrophic factors, neurogenesis, calcium homeostasis, detoxification and clearance of β-amyloid. In our study we aimed to evaluate whether the preoperative vitamin-D levels of patients who will undergo CABG surgery have an effect on postoperative neurocognitive functions. Materials and Methods: Between May 2021 and November 2022, 100 patients with ASA 1-3 risk score, aged 18-70 who were scheduled for elective CABG surgery at Akdeniz University Medical Faculty Hospital Anesthesiology and Reanimation Clinic, were included in the study. All patient were divided into 2 groups. While Vitamin D insufficiency group has 21-29 ng/ml serum 25(OH)D3 level, Vitamin D deficiency group has less than 20 ng/ml serum 25(OH)D3. Demographic characteristics of the patients, age, gender, BMI, educational status, comorbidities and medications, alcohol abuse, ASA classification, preoperative left ventricular ejection fraction value, preoperative 25 OH vitamin D level, NYHA (New York Heart Association Functional Classification) classification, EuroSCORE 2 values were recorded. MOCA cognitive assessment test was applied to the patients 1 day before the operation and 5-7 days after operation. NIRS monitoring was applied to the patients during the surgery. S100B and CXCL10 Ligand were measured preoperatively and at the postoperative 48th hour. The length of stay of the patients in the intensive care unit and hospital, APACHE2 score in the first 24 hours postoperatively and CASUS score for 5 days postoperatively were also calculated and recorded. While evaluating the findings, they were evaluated using the SPSS 23.0 statistical program for statistical analysis. For statistical significance, the p value was determined to be less than 0.05. Results: Demographic data and perioperative characteristics of the patients in the two groups with vitamin D deficiency (70 case) and insufficiency (30 case) were similar, except for Hypertension (HT). HT was observed significantly higher in patients with preoperative vitamin D deficiency (67.1%) than in patients with insufficiency (43.3%) (p=0.045). POCD was observed in 27.8% of the patients included in the study. 27 cases of POCD; Vitamin D deficiency was detected in 6 of them, and vitamin D deficiency was detected in the remaining 21. When the effect of vitamin D levels on the development of POCD was analyzed; POCD developed in 30% of patients with vitamin D deficiency and in 20% of patients with vitamin D insufficiency. Although a higher rate of POCD was observed in patients with vitamin D deficiency, this difference was not statistically significant (p=0.437). In the subgroup analysis of the data, the ages of 27 patients who developed POCD (66); It was found to be significantly higher than 70 patients (60) who did not develop POCD (p=0.010). 10% of the patients who did not develop POCD and 29.6% of the patients who did develop POCD were female, and the female gender was statistically significantly higher for the development of POCD (p=0.037). A significant correlation was found between the development of POCD and the ASA classification (p=0.032). The rate of ASA 2 is significantly higher in patients who do not develop POCD and the rate of ASA 3 is significantly higher in patients who develop POCD. In 27 cases with POCD; mean MV adherence time [p=0.027], length of stay in the intensive care unit [p=0.015], length of stay in the hospital [p0.05). According to the analyzes performed, a negative correlation was found between the postoperative CXCL 10 value and the postoperative MOCA score (r=-0.312; p=0.004) Conclusion: In patients who underwent isolated CABG surgery with vitamin D deficiency/deficiency; We have seen that POCD risk factors such as advanced age, HT, DM, especially in deficient ones, are compatible with the literature. We found that cerebral biochemical markers were elevated in patients who developed POCD in the postoperative period. We believe that in addition to the detection of risk factors in patients who will undergo cardiac surgery, optimizing the preoperative vitamin D level and applying neuromonitoring in the perioperative period will both reduce the development of POCD and reduce the cost due to the length of stay in the intensive care unit and hospital, and this will be supported by studies with larger case series.
Benzer Tezler
- Böbrek nakli alıcılarında D vitamini eksikliği ve D vitamini eksikliğinin endotel disfonksiyonu üzerine etkisi
Vitamin D defficiency in renal transplant patients and it?s effect on endothelial dysfunction in renal transplant patients
MEHMET ALTAN
Tıpta Uzmanlık
Türkçe
2009
NefrolojiAnkara Üniversitesiİç Hastalıkları Ana Bilim Dalı
DOÇ. DR. KENAN KEVEN
- Anlamlı koroner arter hastalığı olmayan diyabetik ve non diyabetik hastalarda vitamin D düzeyi ile subklinik miyokard hasarı arasındaki ilişki
The relationship between vitamin D levels and subclinic myocardial damage in diabetic and non diabetic patients with no significant coronary artery disease
PELİN KARACA ÖZER
Tıpta Uzmanlık
Türkçe
2014
Kardiyolojiİstanbul ÜniversitesiKardiyoloji Ana Bilim Dalı
PROF. DR. AYTAÇ ÖNCÜL
- D vitamini eksikliği olan hastalarda saf ses odyometri, multifrekans timpanometri, geçici uyarılmış otoakustik emisyon (TEOAE) testleri ile işitmenin değerlendirilmesi
Evaluation of hearing functions in patients with vitamin-Ddeficiency
TUĞÇE ÇAYIRGAN
Yüksek Lisans
Türkçe
2019
Kulak Burun ve BoğazBaşkent ÜniversitesiKulak Burun Boğaz Ana Bilim Dalı
PROF. DR. SELİM SERMED ERBEK
- 2-12 yaş arası sağlıklı çocuklarda D vitamini düzeyleri ve etkileyen faktörler
Vitamin D levels among 2-12 years old healthy children and factors which influence levels of vitamin D levels
İBRAHİM GÜLLÜK
Tıpta Uzmanlık
Türkçe
2017
Çocuk Sağlığı ve HastalıklarıAtatürk ÜniversitesiÇocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
PROF. DR. HANDAN ALP
- Sklerodermalı hastalarda D vitamini eksikliğinin sıklığı ve rodnan cilt skoru ile ilişkisi
Frequency of vitamin D deficiency in patients with scleroderma and its relationship with rodnan skin score
ECE SEVİM
Tıpta Uzmanlık
Türkçe
2019
RomatolojiKocaeli Üniversitesiİç Hastalıkları Ana Bilim Dalı
DOÇ. DR. AYTEN YAZICI