Kardiyovasküler cerrahi yoğun bakım ünitesinde postoperatif gelişen trombositopeninin erken dönem sonuçlar üzerine etkisi
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Dosyalar
Tarih
2014
Yazarlar
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Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Trombositopeni yoğun bakım ünitelerinde sık görülen bir koagülasyon bozukluğudur ve kritik durumdaki hastalarda sık tanımlanan bir komplikasyondur. Kardiyak cerrahi hastaları operasyon sırasında yüksek doz antikoagülan uygulanmış olması, yüksek riskli cerrahi işlem geçirmiş olmaları, kardiyopulmoner bypassın etkileri, çoklu kan transfüzyonları nedeniyle inflamatuvar proseslere yatkınlıkları, diğer cerrahi geçirmiş hastalara göre daha yüksek trombosit sayıları ile yeterli hemostazın sağlanabilmesi ve hemodinamik olarak stabil olmamaları ile diğer yoğun bakım hastalarından ayrılır. Bu çalışmada postoperatif kardiyak cerrahi hastalarında trombositopenin klinik bulgular ile ilişkisinin incelenmesi hedeflenmiştir. Trakya Üniversitesi Tıp Fakültesi Kalp Damar Cerrahisi Kliniği’nde 6 aylık bir dönem içerisinde kardiyak cerrahi uygulanan 78 hastanın bilgilendirilmiş onam formları alınarak dahil edildiği bu kesitsel çalışmamızda hastalardan postoperatif 12, 36 ve 60. saatte alınan kan örneklerinde trombosit sayısı değerlendirildi. Trombositopeninin ilişkili olduğu durumlar ve sonuçlar üzerine etkisi incelendi.Trombositopeni görülen hastalarda kros klemp süresinin anlamlı olarak daha uzun olduğu, akciğer ve böbrek fonksiyon bozukluğu, enfeksiyon gelişimi, plazma transfüzyon miktarları, drenaj miktarları, hastane ve yoğun bakım yatış sürelerinin anlamlı olarak daha fazla olduğunu bulduk. İstatistiksel olarak anlamlı olmasa da trombositopenili hastalarda revizyon, tromboz gelişimi ve mortalitenin arttığı görüldü. SOFA skorları trombositopeni grubunda postoperatif 24 ve 48. saatte kontrol grubuna göre anlamlı olarak daha yüksekti.Kardiyak cerrahi hastalarında uygun hemostatik takip ile koagülopatinin önlenmesi, trombositopeni geliştiğinde ise enfeksiyon, tromboembolik komplikasyonlar ve organ disfonksiyonlarına karşı dikkatli olunması ve gereken destek tedavilerinin erken dönemde uygulanmasının bu hastalardaki morbiditeleri ve mortaliteyi azaltmada etkili olacağı kanaatindeyiz. Trombositopeninin prognostik öneme sahip olduğunu ve kardiyak cerrahi hastaları için tasarlanacak gelecekteki prognostik skorlama sistemlerinde trombosit sayısının yer alması gerektiğini düşünmekteyiz.
Abstract
Thrombocytopenia is a common coagulation disorder in the intensive care unit and is a frequent complication seen in critically ill patients. Cardiac surgery patients are different from the rest of the other intensive care unit patients in many ways because they receive high dosages of anticoagulant agents intraoperatively and high-risk surgery, also they are exposed to the inflammatory processes due to cardiopulmonary bypass and multiple transfusions, they need higher volumes of thrombocytes to provide hemostasis and they are not hemodynamically stable. İn this study we aimed to investigate the correlation between thrombocytopenia and the clinical findings in the cardiovascular surgery patients.In our present cross sectional study in which 78 patients undergoing cardiac surgery who were enrolled with their informed consents in a six month period in Trakya Universitesi Tip Fakultesi Cardiovascular Surgery Institute, the platelet counts were estimated in blood samples which were obtained 12, 36 and 60 hours after surgery. The related clinical events for thrombocytopenia and its effects on the results were studied.We found that the cross clamping time was significantly prolonged, the pulmonary and renal dysfunctions, infection rates, plazma transfusion amounts, drainage volumes are significantly higher and the intensive care unit and hospital stays were significantly longer in thrombocytopenic patients. Revision, mortality and thrombosis rates were higher in thrombocytopenic patients although it was not statistically significant. The SOFA scores measured 24 and 48 hours after surgery were siginficantly higher in thrombocytopenic patients. We believe that shortening the cross clamping time, the prevention of coagulopathy with an adequate hemostatic approach and when thrombocytopenia occurs being aware of infections, thromboembolic complications and organ dysfunctions and applying the essential supportive care in the early period is important to reduce the morbidities and mortality. Also we believe that the thrombocytopenia has a prognostic importance and the platelet count should be involved in the future prognostic scoring systems which will be designed for the cardiac surgery patients.
Abstract
Thrombocytopenia is a common coagulation disorder in the intensive care unit and is a frequent complication seen in critically ill patients. Cardiac surgery patients are different from the rest of the other intensive care unit patients in many ways because they receive high dosages of anticoagulant agents intraoperatively and high-risk surgery, also they are exposed to the inflammatory processes due to cardiopulmonary bypass and multiple transfusions, they need higher volumes of thrombocytes to provide hemostasis and they are not hemodynamically stable. İn this study we aimed to investigate the correlation between thrombocytopenia and the clinical findings in the cardiovascular surgery patients.In our present cross sectional study in which 78 patients undergoing cardiac surgery who were enrolled with their informed consents in a six month period in Trakya Universitesi Tip Fakultesi Cardiovascular Surgery Institute, the platelet counts were estimated in blood samples which were obtained 12, 36 and 60 hours after surgery. The related clinical events for thrombocytopenia and its effects on the results were studied.We found that the cross clamping time was significantly prolonged, the pulmonary and renal dysfunctions, infection rates, plazma transfusion amounts, drainage volumes are significantly higher and the intensive care unit and hospital stays were significantly longer in thrombocytopenic patients. Revision, mortality and thrombosis rates were higher in thrombocytopenic patients although it was not statistically significant. The SOFA scores measured 24 and 48 hours after surgery were siginficantly higher in thrombocytopenic patients. We believe that shortening the cross clamping time, the prevention of coagulopathy with an adequate hemostatic approach and when thrombocytopenia occurs being aware of infections, thromboembolic complications and organ dysfunctions and applying the essential supportive care in the early period is important to reduce the morbidities and mortality. Also we believe that the thrombocytopenia has a prognostic importance and the platelet count should be involved in the future prognostic scoring systems which will be designed for the cardiac surgery patients.
Açıklama
Tıpta Uzmanlık tezi
Anahtar Kelimeler
Trombositopeni, Koagülopati, Kardiyak Cerrahi, Thrombocytopenia, Coagulopathy, Cardiac Surgery
