Konjenital kalp cerrahisi sonrası yoğun bakım yatış süresinde uzama ile ilişkili faktörlerin araştırılması
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmada, konjenital kalp cerrahisi geçiren olgularda, yoğun bakımda yatış süresinde uzamaya neden olabilecek preoperatif, intraoperatif ve postoperatif faktörleri değerlendirerek saptamayı amaçladık. Gereç ve Yöntem: Ege Üniversitesi Rektörlüğü Tıp Fakültesi Dekanlığı Tıbbi Araştırmalar Etik Kurulu 10/06/2021 tarih ve 21-6T/54 nolu etik kurul onayı alındıktan sonra 1 Ocak 2018- 31 Aralık 2020 tarihleri arasında Ege Üniversitesi Tıp Fakültesi Kalp ve Damar Cerrahisi ameliyathanesinde konjenital kalp cerrahisi uygulanan hastaların retrospektif olarak incelenmesi planlandı. Çalışmamıza 18 yaş üstü konjenital kalp cerrahisi geçiren hastalar ve peroperatif verilerine tam olarak ulaşılamayan hastalar dahil edilmedi. Hastaların preoperatif, intraoperatif ve postoperatif verileri retrospektif olarak dosya bilgileri ve elektronik kayıtlar üzerinden kaydedildi. Bulgular: Çalışmaya 321 hasta dahil edildi ve 176(%54,8) hastanın kadın, 145(%45,2) hastanın erkek olduğu saptandı. Hastaların yaşları 3 gün ila 194 ay arasında değişmekte olup, medyan yaş 24 ay ve neonatal hasta sayısı 14(%4,4) olarak saptandı. Hastaların, boy uzunluğu 47 ila 165 cm arasında değişmekte olup medyan boy uzunluğu 84 cm, vücut ağırlığı 2,8 ila 62 kg arasında değişmekte olup medyan ağırlık 11 kg, vücut yüzey alanı 0,2 ila 1,6 m2 arasında değişmekte olup medyan alan 0,5 m2 olarak bulundu. Hastaların anestezi süreleri 55 ila 370 dakika arasında olup medyan anestezi süresinin 126 dakika, kardiyopulmoner baypas süresinin 1 ila 260 dakika arasında olup medyan kardiyopulmoner baypas süresinin 68 dakika ve kros klemp süresinin de 9 ila 234 dakika arasında olup medyan kros klemp süresinin 56 dakika olduğu belirlendi. Hastaların intraoperatif laktat düzeyleri 0,8 ila 12,7 mmol/L arasında olup, medyan laktat değeri 2,4 mmol/L olarak bulundu. Daha düşük vücut ağırlığı, daha düşük boy, daha düşük yaşa sahip olan hastaların yoğun bakım yatış sürelerinin daha uzun olduğu saptandı (p<0,001). Preoperatif anemi, mekanik ventilasyon ihtiyacı, inotropik ajan ihtiyacı ve yoğun bakım ünitesi ihtiyacı olmasının daha uzun yatış süreleri ile ilişkili olduğu saptandı (p<0,001). Anestezi, cerrahi, kardiyopulmoner baypas ve kros klemp sürelerinde uzama ile yoğun bakım yatış süresinde uzama arasında korelasyon olduğu saptandı (p<0,001). İntraoperatif yüksek laktat değerleri ve intraoperatif inotropik ajan ihtiyacının olması istatiksel açıdan anlamlı bulundu (p<0,001). Postoperatif renal disfonksiyon, nörolojik ve pulmoner komplikasyonların gelişmesi ile yoğun bakım yatış sürelerinde uzama olması anlamlı bulundu (p<0,001). Postoperatif inotropik ajan ihtiyacının olması, pacemaker ihtiyacının olması, mekanik ventilasyon süresinin uzaması, ateş/enfeksiyon gelişmesi daha uzun yoğun bakım yatış süreleri ile anlamlı bulundu (p<0,001). STAT mortalite skoru yüksek hastaların daha uzun yoğun bakım yatış sürelerine sahip olduğunu saptadık (p<0,001). Yoğun bakım yatış süresi ?48 saat olan olgularda hastane içi mortalite anlamlı yüksek bulunmuştur (p<0,001). Tek değişkenli modelde anlamlı bulunan değişkenler çok değişkenli modelde geriye dönük Wald yöntemiyle tekrar değerlendirildiğinde vücut yüzey alanı, anemi, intraoperatif laktat seviyesi ve kros klemp süresi istatistiksel açıdan anlamlı bulunmuştur (p<0,05). Vücut yüzey alanı arttıkça yoğun bakımda 48 saatten daha uzun süre yatış azalırken, diğer anlamlı bulunan değişkenler arttırıcı etkiye neden olmuştur. Sonuç: Hastaların operasyona hazırlanırken, preoperatif dönemden itibaren hastalığın patofizyolojisine göre uygun anestezi modelinin planlanarak yapılmasının peroperatif koruyucu önlemlerin alınmasının, sıkı laktat değerleri takibi yapılmasının, postoperatif iyi bir yoğun bakım takibi yapılmasının hastalarda daha az mortalite ve morbiditeye sebep olacağı ve daha iyi sonuçların alınacağı görüşündeyiz.
Purpose: In this study, we aimed to evaluate and determine the preoperative, intraoperative and postoperative factors that may prolong the length of stay in the intensive care unit in patients undergoing congenital heart surgery. Material and Method: After receiving the approval of the Ethics Committee of Ege University Rectorate Faculty of Medicine, Medical Research Ethics Committee dated 10/06/2021 and numbered 21-6T/54, it was planned to retrospectively examine the patients who underwent congenital heart surgery at Ege University Faculty of Medicine Cardiovascular Surgery operating room between January 1, 2018 and December 31, 2020. Results: 321 patients were included in the study, and it was determined that 176 (54.8%) patients were female and 145 (45.2%) patients were male. The ages of the patients ranged from 3 days to 194 months, the median age was 24 months and the number of neonatal patients was 14 (4.4%). The patients' height ranged from 47 to 165 cm, median height was 84 cm, body weight ranged from 2.8 to 62 kg, and the median weight was 11 kg. The body surface area of the patients ranged from 0.2 to 1.6 m2, and the median area was found to be 0.5 m2. The anesthesia time of the patients was between 55 and 370 minutes, the median anesthesia time was 126 minutes, the cardiopulmonary bypass time was between 1 and 260 minutes, the median cardiopulmonary bypass time was 68 minutes, the cross clamp time was between 9 and 234 minutes, and the median cross clamp time was 56 minutes. Intraoperative lactate levels of the patients were between 0.8 and 12.7 mmol/L, and the median lactate value was 2.4 mmol/L. It was determined that patients with lower body weight, lower height and lower age had longer intensive care unit stays (p<0.001). It was determined that preoperative anemia, need for mechanical ventilation, need for inotropic agent and need for intensive care unit were associated with longer hospital stays (p<0.001). It was found that there was a correlation between prolongation of anesthesia, surgery, cardiopulmonary bypass and cross-clamp times and prolongation of intensive care unit stay (p<0.001). High intraoperative lactate levels and need for intraoperative inotropic agents were found to be statistically significant (p<0.001). The development of postoperative renal dysfunction, neurological and pulmonary complications and the prolongation of intensive care unit stay were found to be significant (p<0.001). The need for postoperative inotropic agent, need for pacemaker, prolongation of mechanical ventilation, development of fever/infection were found to be significant with longer intensive care unit stays (p<0.001). We found that patients with higher STAT mortality scores had longer ICU stays (p<0.001). In-hospital mortality was found to be significantly higher in patients whose intensive care hospital stay was ?48 hours (p<0.001). When the variables that were found to be significant in the univariate model were re-evaluated using the retrospective Wald method in the multivariate model, body surface area, anemia, intraoperative lactate level and cross-clamp time were found to be statistically significant (p<0.05). As the body surface area increased, hospitalization in the intensive care unit for longer than 48 hours decreased, while other significant variables caused an increasing effect. Conclusion: We are of the opinion that planning the appropriate anesthesia model according to the pathophysiology of the disease from the preoperative period, taking peroperative protective measures, following strict lactate values, and a good postoperative intensive care follow-up will cause less mortality and morbidity in the patients and better results will be obtained while preparing the patients for the operation.
Purpose: In this study, we aimed to evaluate and determine the preoperative, intraoperative and postoperative factors that may prolong the length of stay in the intensive care unit in patients undergoing congenital heart surgery. Material and Method: After receiving the approval of the Ethics Committee of Ege University Rectorate Faculty of Medicine, Medical Research Ethics Committee dated 10/06/2021 and numbered 21-6T/54, it was planned to retrospectively examine the patients who underwent congenital heart surgery at Ege University Faculty of Medicine Cardiovascular Surgery operating room between January 1, 2018 and December 31, 2020. Results: 321 patients were included in the study, and it was determined that 176 (54.8%) patients were female and 145 (45.2%) patients were male. The ages of the patients ranged from 3 days to 194 months, the median age was 24 months and the number of neonatal patients was 14 (4.4%). The patients' height ranged from 47 to 165 cm, median height was 84 cm, body weight ranged from 2.8 to 62 kg, and the median weight was 11 kg. The body surface area of the patients ranged from 0.2 to 1.6 m2, and the median area was found to be 0.5 m2. The anesthesia time of the patients was between 55 and 370 minutes, the median anesthesia time was 126 minutes, the cardiopulmonary bypass time was between 1 and 260 minutes, the median cardiopulmonary bypass time was 68 minutes, the cross clamp time was between 9 and 234 minutes, and the median cross clamp time was 56 minutes. Intraoperative lactate levels of the patients were between 0.8 and 12.7 mmol/L, and the median lactate value was 2.4 mmol/L. It was determined that patients with lower body weight, lower height and lower age had longer intensive care unit stays (p<0.001). It was determined that preoperative anemia, need for mechanical ventilation, need for inotropic agent and need for intensive care unit were associated with longer hospital stays (p<0.001). It was found that there was a correlation between prolongation of anesthesia, surgery, cardiopulmonary bypass and cross-clamp times and prolongation of intensive care unit stay (p<0.001). High intraoperative lactate levels and need for intraoperative inotropic agents were found to be statistically significant (p<0.001). The development of postoperative renal dysfunction, neurological and pulmonary complications and the prolongation of intensive care unit stay were found to be significant (p<0.001). The need for postoperative inotropic agent, need for pacemaker, prolongation of mechanical ventilation, development of fever/infection were found to be significant with longer intensive care unit stays (p<0.001). We found that patients with higher STAT mortality scores had longer ICU stays (p<0.001). In-hospital mortality was found to be significantly higher in patients whose intensive care hospital stay was ?48 hours (p<0.001). When the variables that were found to be significant in the univariate model were re-evaluated using the retrospective Wald method in the multivariate model, body surface area, anemia, intraoperative lactate level and cross-clamp time were found to be statistically significant (p<0.05). As the body surface area increased, hospitalization in the intensive care unit for longer than 48 hours decreased, while other significant variables caused an increasing effect. Conclusion: We are of the opinion that planning the appropriate anesthesia model according to the pathophysiology of the disease from the preoperative period, taking peroperative protective measures, following strict lactate values, and a good postoperative intensive care follow-up will cause less mortality and morbidity in the patients and better results will be obtained while preparing the patients for the operation.
Açıklama
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation
