“Hematolojik parametreler yönünden”açık kalp cerrahisinde, heparin kaplı oksijeneratör ve tubing set kullanılmasının yararları
The Use of heparin coated oxygenator and tubing set in open heart surgery, advantage on heamatological parameters
- Tez No: 59422
- Danışmanlar: PROF. DR. REFİK YİĞİT
- Tez Türü: Doktora
- Konular: Fizyoloji, Physiology
- Anahtar Kelimeler: Aprotinin, Heparin, Kardiyopulmoner bypass, Oksijenaratörler, Aprotinin, Heparin, Cardiopulmonary bypass, Oxygenators
- Yıl: 1997
- Dil: Türkçe
- Üniversite: İstanbul Üniversitesi
- Enstitü: Sağlık Bilimleri Enstitüsü
- Ana Bilim Dalı: Fizyoloji Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: Belirtilmemiş.
Özet
SUMMARY The effects of Heparin Coated CPB Systems (HCS) and Uncoated CPB Systems (UCS) on heamatologic parameters during open heart surgery were studied. 30 patients were studied and they were divided into two groups as HCS (n:15) and UCS (n:15). Blood samples were drawn in three periods and evaluated at 8 stages as, before the operation, during the operation (1th, 30 & minute and after the aortic cross clamp was removed) and after the operation (after the protamin infusion was completed, 12, 24 and 48 hours ). After the evaluation of the results of the two groups, these conclusions were attained. The type of the operation performed, sex, age, weight, body surface area, cardiopulmonary bypass, aortic cross clamping times and total diuresis distributions between two groups were not statistically meaningful (p>0.05). The mean heamatocrit percentage, erythrocyte, hemoglobin, leukocyte, neutrophil percentage and thrombocyte values of the heparin coated and uncoated system groups differed in every stages, but the differences were not statistically meaningful (p>0.05). Free plasma hemoglobin (FpHb) levels of the UCS group were found to be statistically significantly higher than the HCS group in every stages other than stage 1 * of the preoperative period (p<0.05). While the Activated Clotting Time (ACT) was meaningful (p<0.05) after the systemic heparinization (stage 2) and during the operation (stages 3, 4, 5, 6, 7 ), the difference between the results of the two groups were not statistically meaningful preoperatively (stage 1) and in all postoperative stages (p<0.05). The mean Prothrombin Time (PT) and Activated Partial Thromboplastin Time (aPTT) value differeces in every stages were not statistically meaningful when the two groups were compared to each other (p<0.05). The mean Fibrinogen values differed in every stages other than postoperative stage 7 (p<0.05). But the differences were not statistically meaningful (p<0.05). 69The patients were mean Total Blood Drainage and Blood Transfusion Quantities of the two groups in the intensive care. These values were found statistically lower in the HCS group compared to the UCS group (p>0.05). The mean Entubation Periods were calculated. The results were found lower in the HCS group than that of the UCS group. Howewer they were not statistically meaningful (p<0.05). The mean body temperature and higest body temperature (armpit) of patients during the intensive care were higher in the UCS group than those of the HCS group.The difference was statistically meaningful (p<0.05). Neither of the cases studied in both groups required intraaortic baloon pump end of the operation and during the intensive care units. In addition to this, nor they had encountered any gastrointestinal system bleeding, infection and neurologic complications. We recommend the use of Heparin Coated CPB Systems that enable low dose heparin and protamin administration not routinely but in cases which the CPB time may have a probablity to exceed 120 and aortic cross clamping time 90 minutes (reoperations, dissections, anevrizmectomy, CABG+valve replasment, double or multiple valve replacement etc.) and in cases which we want CPB related physiopathologic events to be minimal. In addition, in the proceeding cases full dose systemic heparinization administration will not be appropriate; protamin sensitivity, bleeding defect, cerebral and gastrointestinal bleeding risk, seriously liver disfonction, heparin related thrombocytopenia and heparin related thrombosis with thrombocytopenia related long term heparin usage. 70
Özet (Çeviri)
SUMMARY The effects of Heparin Coated CPB Systems (HCS) and Uncoated CPB Systems (UCS) on heamatologic parameters during open heart surgery were studied. 30 patients were studied and they were divided into two groups as HCS (n:15) and UCS (n:15). Blood samples were drawn in three periods and evaluated at 8 stages as, before the operation, during the operation (1th, 30 & minute and after the aortic cross clamp was removed) and after the operation (after the protamin infusion was completed, 12, 24 and 48 hours ). After the evaluation of the results of the two groups, these conclusions were attained. The type of the operation performed, sex, age, weight, body surface area, cardiopulmonary bypass, aortic cross clamping times and total diuresis distributions between two groups were not statistically meaningful (p>0.05). The mean heamatocrit percentage, erythrocyte, hemoglobin, leukocyte, neutrophil percentage and thrombocyte values of the heparin coated and uncoated system groups differed in every stages, but the differences were not statistically meaningful (p>0.05). Free plasma hemoglobin (FpHb) levels of the UCS group were found to be statistically significantly higher than the HCS group in every stages other than stage 1 * of the preoperative period (p<0.05). While the Activated Clotting Time (ACT) was meaningful (p<0.05) after the systemic heparinization (stage 2) and during the operation (stages 3, 4, 5, 6, 7 ), the difference between the results of the two groups were not statistically meaningful preoperatively (stage 1) and in all postoperative stages (p<0.05). The mean Prothrombin Time (PT) and Activated Partial Thromboplastin Time (aPTT) value differeces in every stages were not statistically meaningful when the two groups were compared to each other (p<0.05). The mean Fibrinogen values differed in every stages other than postoperative stage 7 (p<0.05). But the differences were not statistically meaningful (p<0.05). 69The patients were mean Total Blood Drainage and Blood Transfusion Quantities of the two groups in the intensive care. These values were found statistically lower in the HCS group compared to the UCS group (p>0.05). The mean Entubation Periods were calculated. The results were found lower in the HCS group than that of the UCS group. Howewer they were not statistically meaningful (p<0.05). The mean body temperature and higest body temperature (armpit) of patients during the intensive care were higher in the UCS group than those of the HCS group.The difference was statistically meaningful (p<0.05). Neither of the cases studied in both groups required intraaortic baloon pump end of the operation and during the intensive care units. In addition to this, nor they had encountered any gastrointestinal system bleeding, infection and neurologic complications. We recommend the use of Heparin Coated CPB Systems that enable low dose heparin and protamin administration not routinely but in cases which the CPB time may have a probablity to exceed 120 and aortic cross clamping time 90 minutes (reoperations, dissections, anevrizmectomy, CABG+valve replasment, double or multiple valve replacement etc.) and in cases which we want CPB related physiopathologic events to be minimal. In addition, in the proceeding cases full dose systemic heparinization administration will not be appropriate; protamin sensitivity, bleeding defect, cerebral and gastrointestinal bleeding risk, seriously liver disfonction, heparin related thrombocytopenia and heparin related thrombosis with thrombocytopenia related long term heparin usage. 70
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