Açık kalp cerrahisi uygulanan siyanotik/nonsiyanotik konjenital kalp hastalarında modifiye ultrafiltrasyonun postoperatif karaciğer ve böbrek fonksiyonları üzerine etkisi (Retrospektif çalışma)

Amac: Pediatrik kardiyopulmoner baypas total vucut sivinda ve damar ecirgenliginde artmaya neden olur. Dokular aralarina sizan bu sivi organ onksiyonlarinda bozulmalara neden olmaktadir. Modifiye ultrafiltrasyon cocuklarda kardiyopulmoner baypasa bagli olusan toplam vucut sivi artisinin neden oldugu organ fonksiyon bozukluklarini onlemek amaciyla gelistirilmistir. Bu calismada amacimiz konjenital kalp hastaligi nedeni ile kardiyopulmoner baypas kullanilarak opere edilen siyanotik ve siyanotik olmayan cocuklarda MUF kullaniminin karaciger ve bobrek fonksiyonlari uzerine etkisini arastirmaktiMateryal ve Metod: Ocak 2009 ile agustos 2011 yillari arasinda Ankara Universitesi Tip Fakultesi Kalp ve damar cerrahisi kliniginde opere edilen modifiye ultrafiltrasyon kullanilan (grup 1) n:63, kullanilmayan (grup 2) n:31 toplam 93 hasta calismaya dahil edildi. Daha onceden bilinen operasyon ve organ fonksiyon bozuklugu olan, acil sartlarda operasyona alinan, sistemik ve otoimmun hastaligi olan ve kompleks kardiyak anomali nedeni ile parsiyel duzeltme yapilan hastalar calismaya dahil edilmedi. Organ fonksiyonlarinin degerlendirilmesi amaciyla operasyon oncesinde ve sonrasinda kan ornekleri alindi. Hastalar operasyon sonrasi ilk 8 ve 24.saat idrar miktari, drenaj miktari, diuretik kullanimi, inotrop kullanimi, kan ve kan urunu kullanimi, diyaliz ihtiyaci ve mortalite acisindan retrospektif olarak incelendi.Bulgular: Preoperatif verileri ve operasyon verileri acisindangruplar benzerdi. Grup1 icin kreatinin duzeyinin operasyon sonrasinda yuzde degisim orani %56,5, grup 2 icin %25,8 olarak hesaplandi. Vucut yuzey alanina gore univaryant analizde anlamli olarak bulundu. (p:0,031 0,05).Sonuc: Pediatrik acik kalp cerrahisinde modifiye ultrafiltrasyonun kullaniminin bobrek yetmezligi gelisimini azalttigi ve karaciger fonksiyonlarini korudugunu dusunmekteyiz.Abstract Aims: Increased total body water and capillary permeabilty in pediatric cardiopulmonary bypass can cause organ disfunction. Modified ulltrafiltration is developed for decrease total body water and attenuate organ disfunction. The purpose of this study, is to investigate retrospective effects of modified ultrafiltration on postoperative hepatic and renal functions of pediatric patients with congenital siyanotic/nonsiyanotic heart defect who underwent open heart surgery.Materials and methods: In this study, we assessed 93 children who underwent pediatric cardiac surgery with cardiopulmonary bypass from January 2009 to August 2011.Patients were divided into two groups. Group 1 (n=62) patiens, to whom modified ultrafiltration was performed, compared with 31control patients(group 2). Patients who had redo cardiac surgery, preoperative organ disfunction, otoimmune disease, genetic disorders, shunt and emergency operations were excluded. Preand postoperative biochemical parameters, postoperativeurine output, chest tube drenaige, diuretic usage, blood and bloodproduct transfusion, dialysis requirement and mortality were compared.Results: Age, weight, body surface area, congenital defect type and number, preoperative and intraoperative blood samples measurement, cross clamp time, cardiopulmonary bypass time were similar between 2 groups (p\u003e0,05).The difference in percent increase in creatinine leves of 2 group was statistically significant by univariant analysis (p 0,05) (4of 62 patients died in group 1, while only 1 of 31 in group 2).Conclusions: Hemodynamic, pulmonary, hematologic and immunologic effects of modified ultrafiltration are well known. Although our study group was not big enough to get a conclusion, we believe that modified ultrafiltration can be an effective method in preservation of renal and hepatic function of the patients whounderwent total reconstructive congenital heart surgery.