Laparoskopik kolesistektominin karaciğer üzerine etkisinin noninvaziv karaciğer fonksiyon monitörü ile gösterilmesi
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Dosyalar
Tarih
2010
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Trakya Üniversitesi Tıp Fakültesi ameliyathanesinde yaptığımız bu çalışmanın amacı laparoskopik kolesistektomi operasyonu geçirecek hastalarda batın içine verilen farklı CO2 basınçlarının karaciğer fonksiyonuna etkilerini noninvaziv olarak ölçerek değerlendirmek ve karşılaştırmaktır. Bu çalışma laparoskopik kolesistektomi operasyonu geçiren 18-65 yaş arası toplam 43 hasta üzerinde gerçekleştirildi. Laparoskopik kolesistektomi operasyonu olarak çalışmaya dahil edilen 43 hasta, uygulanan CO2 basınçlarına göre; 10 mmHg (grup I, n=20) ve 14 mmHg (grup II, n=23) olarak iki gruba ayrıldı. Hastalara ait hemodinamik parametreler (Kalp atım hızı,periferik oksijen satürasyonu, ortalama arter basıncı) preoperatif, induksiyon sonrası, insuflasyon öncesi, insuflasyonun 10. dakikası, insuflasyonun 20. dakikası, desuflasyondan 10 dakika sonra, ekstubasyon sırasında olmak üzere toplam 7 farklı zamanda; end-tidal CO2 basıncı değerleri indüksiyon sonrası, insuflasyon öncesi, insuflasyonun 10. dakikası, insuflasyonun 20. dakikası, desuflasyondan 10 dakika sonra olmak üzere toplam 5 farklı zamanda bakılarak kaydedildi. Operasyon öncesi alanin aminotransferaz, aspartat aminotransferaz, total bilirubin değerleri, operasyon sonrası 1. ve 24. saatte tekrar edilerek kayda alındı. Olguların hepatik kan akımının ölçümü de karaciğer fonksiyon monitorizasyon sistemi; LiMON® (Pulsion Medical Systems, Almanya) kullanılarak gerçekleştirildi. İndosiyanin yeşili plazma kayboluş oranı ve indosiyanin yeşili 15 dakika sonra retansiyon oranı ölçümleri indüksiyondan 5 dakika sonra ve operasyon bitiminde cilt sütürleri atıldıktan sonra tekrar edildi. Hastalara ait preoperatif indosiyanin yeşili plazma kayboluş oranı ve postoperatif indosiyanin yeşili plazma kayboluş oranı değerleri karşılaştırıldı. 14 mmHg basınç uygulanan grupII'de postoperatif indosiyanin yeşili plazma kayboluş oranı değerlerinde preoperatif indosiyanin yeşili plazma kayboluş oranı değerlerine göre anlamlı derecede düşme bulundu. (p<0,05). Hastaların postoperatif 1.saatte ölçülen aspartat aminotransferaz ve alanin aminotransferaz değerleri karşılaştırıldığında; 14 mmHg basınç uygulanan grupII'de aspartat aminotransferaz ve alanin aminotransferaz yükselmesi 10 mmHg basınç uygulanan gruptaki aspartat aminotransferaz ve alanin aminotransferaz yükselmesine oranla anlamlı derecede farklı bulundu (p<0,05). Ayrıca preoperatif aspartat aminotransferaz ve alanin aminotransferaz değerleri, postoperatif aspartat aminotransferaz ve alanin aminotransferaz değerleri ile karşılaştırıldığında 14 mmHg basınç uygulanan grup II'de postoperatif 1. saatte bakılan aspartat aminotransferaz ve alanin aminotransferaz değerleri preoperatif aspartat aminotransferaz ve alanin aminotransferaz değerlerine göre anlamlı derecede yüksek bulundu. (p<0,05). Sonuç olarak; bizim bulgularımız laparoskopik kolesistektomi operasyonu uygulanan hastalarda batın içine verilen CO2 basıncı arttıkça karaciğer kan akımı ve fonksiyonu olumsuz yönde etkilediğini düşündürmektedir. Anahtar kelimeler: Laparoskopik kolesistektomi, Alanin aminotransferaz, Aspartat aminotransferaz, indosiyanin yeşili plazma kaybolma oranı, noninvaziv karaciğer fonksiyon monitörü.
Abstract
The aim of our study which was made in the operation rooms of the medical faculty of Trakya University, is to evaluate and compare non-invasively, the effects of different CO2 pressures; given to the abdomen; on liver functions with the patients who had a laparoscopic surgery for cholecystectomy between the age of 18-65. These 43 patients were divided into two groups by considering the CO2 pressure. The first group had the pressure of 10 mmHg (group I, n=20) and the second group had the pressure of 14 mmHg (group II, n=23). The hemodynamic parameters of the patients (Heart rate, peripheral oxygen saturation,mean blood pressure), were reconded on seven different times: preoperative, after the induction, before the insuflation, 10th minute of insuflation, 20th minute of insuflation, 10 minutes after desuflation and at the time of extubation. Similar to this; etCO2 pressure values were recorded again in 5 different periods: after the induction, before the insuflation, 10th minute of insuflation, 20th minute of insuflation, after 10 minutes of desuflation. Alanine aminotransferase, aspartate aminotransferase and total bilirubine values were recorded preoperatively; and after the operation on the firsth and 24th hours. Hepatic blood flow of the patients were measured by using Liver-function-monitorisation system- LIMON (Pulsion medical systems, Germany). The values of plasma disappearance rate of indocyanine green and 15 minutes later, the ratio of retantion of indocyanine green were taken once more after 5 minutes of induction and at the end of the operation after sutures were put. We compared that disapperance ratio of indocyanine green between preoperatively and postoperatively. Disapperance ratio of indocyanine green values were statistically significant decreased in the second group had the pressure of 14 mmHg, postoperatively compaired with the preoperatively. We compered that the values of alanine aminotransferase and aspartate aminotransferase at the 1st hour postoperatively; on the increase of alanine aminotransferase and aspartate aminotransferase values. There was statistically significant differance on the second group with the CO2 pressure of 14 mmHg than the first group with the CO2 pressure of 10 mmHg. Besides, when we compared the values of aspartate aminotransferase and alanine aminotransferase preoperatively with the values of them postoperatively, we found that, on the second group with the CO2 pressure of 14 mmHg; the values of alanine aminotransferase and aspartate aminotransferase at the first hour of postoperation were significant much higher than the alanine aminotransferase and aspartate aminotransferase values preoperatively. As a conclusion; we thought that, in the laparascopic cholesistectomy operations, high CO2 pressure given into abdomen, affected the liver blood flow and liver functions in a negative way. Key words: Laparoscopic surgery, alanine aminotransferase, aspartate aminotransferase, indocyanine green plasma disappearance rate, non invasive liver function monitor.
Abstract
The aim of our study which was made in the operation rooms of the medical faculty of Trakya University, is to evaluate and compare non-invasively, the effects of different CO2 pressures; given to the abdomen; on liver functions with the patients who had a laparoscopic surgery for cholecystectomy between the age of 18-65. These 43 patients were divided into two groups by considering the CO2 pressure. The first group had the pressure of 10 mmHg (group I, n=20) and the second group had the pressure of 14 mmHg (group II, n=23). The hemodynamic parameters of the patients (Heart rate, peripheral oxygen saturation,mean blood pressure), were reconded on seven different times: preoperative, after the induction, before the insuflation, 10th minute of insuflation, 20th minute of insuflation, 10 minutes after desuflation and at the time of extubation. Similar to this; etCO2 pressure values were recorded again in 5 different periods: after the induction, before the insuflation, 10th minute of insuflation, 20th minute of insuflation, after 10 minutes of desuflation. Alanine aminotransferase, aspartate aminotransferase and total bilirubine values were recorded preoperatively; and after the operation on the firsth and 24th hours. Hepatic blood flow of the patients were measured by using Liver-function-monitorisation system- LIMON (Pulsion medical systems, Germany). The values of plasma disappearance rate of indocyanine green and 15 minutes later, the ratio of retantion of indocyanine green were taken once more after 5 minutes of induction and at the end of the operation after sutures were put. We compared that disapperance ratio of indocyanine green between preoperatively and postoperatively. Disapperance ratio of indocyanine green values were statistically significant decreased in the second group had the pressure of 14 mmHg, postoperatively compaired with the preoperatively. We compered that the values of alanine aminotransferase and aspartate aminotransferase at the 1st hour postoperatively; on the increase of alanine aminotransferase and aspartate aminotransferase values. There was statistically significant differance on the second group with the CO2 pressure of 14 mmHg than the first group with the CO2 pressure of 10 mmHg. Besides, when we compared the values of aspartate aminotransferase and alanine aminotransferase preoperatively with the values of them postoperatively, we found that, on the second group with the CO2 pressure of 14 mmHg; the values of alanine aminotransferase and aspartate aminotransferase at the first hour of postoperation were significant much higher than the alanine aminotransferase and aspartate aminotransferase values preoperatively. As a conclusion; we thought that, in the laparascopic cholesistectomy operations, high CO2 pressure given into abdomen, affected the liver blood flow and liver functions in a negative way. Key words: Laparoscopic surgery, alanine aminotransferase, aspartate aminotransferase, indocyanine green plasma disappearance rate, non invasive liver function monitor.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Anestezi, Reanimasyon, Anesthesiology, Reanimation, Laparoskopik Kolesistektomi, Alanin Aminotransferaz, Aspartat Aminotransferaz, İndosiyanin Yeşili Plazma Kaybolma Oranı
