Hipotermik kardiyopulmoner bypassa karşı normotermik kardiyopulmoner bypassın postoperatif laktat seviyesine etkisi
Ypothermic cardiopulmonary bypass versus normothermic cardiopulmonary bypass effects on the postoperative lactate level
Yazar: MERT ÜRKÜP
Danışman: DOÇ. DR. MUSTAFA GÖZ
Harran Üniversitesi / Tıp Fakültesi / Kalp ve Damar Cerrahisi Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2017
Konu: Göğüs Kalp ve Damar Cerrahisi = Thoracic and Cardiovascular Surgery
Dizin: Cerrahi = Surgery ; Cerrahi-kardiyovasküler = Surgery-cardiovascular ; Kalp hastalıkları = Heart diseases ; Kardiyopulmoner bypass = Cardiopulmonary bypass ; Laktatlar = Lactates ; Postoperatif dönem = Postoperative period

Özet:
Amaç: Bu çalışmamızda normotermik kardiyopulmoner bypass ve hipotermik kardiyopulmoner bypass yöntemlerinin hastalardaki laktat seviyelerine olan etkilerinin karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem: Bu çalışmaya Harran Üniversitesi Tıp Fakültesi Kalp ve Damar Cerrahisi Anabilim Dalında Ocak 2014 ve Aralık 2015 tarihleri arasında kardiyopulmoner bypass ile izole koroner arter bypass cerrahisi uygulanan 60 hasta dahil edildi. Çalışmaya dahil edilen hastalar hipotermik kardiyopulmoner bypass uygulanan 30 hasta, normotermik kardiyopulmoner bypass uygulanan 30 hasta olacak şeklinde 2 grup halinde incelendi. Her iki gruptan ameliyat öncesi, pompa çıkışı, ameliyat sonrası 1.saat, ameliyat sonrası 12.saatte alınan arteryal kan örneklerinden Laktat seviyelerine bakıldı. Ölçülen serum laktat değerlerinin kros klemp süresi, total kardiyoulmoner bypass süresi, hipotermik ve normotermik kardiyopulmoner bypass uygulanan gruplar ile olan korelasyonu incelendi.
Bulgular: Bakılan tüm laktat seviyeleri normotermik kardiyopulmoner bypass uygulanan grupta daha düşük bulunup, özellikle pompa çıkışı bakılan değerde pozitif yönde ilişki saptanmıştır. Ayrıca normotermik kardiyopulmoner bypass uygulanan grupta kros klemp ve total kardiyopulmoner bypass süreleri istatistiksel olarak anlamlı olacak şekilde kısa bulunmuştur. 
Sonuç: Hipotermik kardiyopulmoner bypass, uzamış total kardiyopulmoner bypass ve kros klemp süreleri laktat seviyelerini arttırmaktadır. Ek cerrahi prosedür gerekmeyen izole koroner bypass cerrahisi uygulanan hastalarda normotermik kardiyopulmoner bypass güvenle uygulanabilecek avantajlı bir yöntemdir.

Anahtar Kelimeler: Hipotermik, normotermik, kardiyopulmoner bypass, laktat

Abstract:
Objective: It has been aimed in this study to compare the impacts of normothermic cardiopulmonary bypass and hypothermic cardiopulmonarty bypass on the lactate levels of the patients.
Material and Method: In this study 60 patients who underwent isolated coronary artery bypass surgery with cardiopulmonary bypass in Harran University Faculty of Medicine Department of Cardiovascular Surgery between January 2014 and December 2015 were involved. The patients who were involved in the study were divided into two groups such as 30 patients who underwent hypothermic cardiopulmonary bypass and 30 patients who underwent normothermic cardiopulmonary bypass and they were examined. The lactate levels in the blood samples taken from each group preoperatively, after pump discharge, in the first hour postoperatively and in the twelth hour postoperatively were analysed. The correlation between the serum lactate levels and the duration of cross-clamp, duration of total cardiopulmonary bypass and the groups that underwent hypothermic and normothermic cardopulmonary bypass were examined.
Outcomes: The lactate levels that were examined were found to be lower in the group that underwent normothermic cardiopulmonary bypass, especially a positive correlation was determined in the level measured after pump discharge. Besides, cross-clamp and total cardiopulmonary durations in the group that underwent normothermic cardiopulmonary bypass were found to be short meaning a statistical significance. 
Result: Hypothermic cardiopulmonary bypass, extended total cardiopulmonary bypass and cross-clamp durations increase the lactate levels. The normothermic cardiopulmonary bypass is an advantageous method that can be safely performed on the patients who underwent isolated coronary bypass that did not need any additional surgical procedures. 

Keywords: Hypothermic, normothermic, cardiopulmonary bypass, lactate