GKD Anest Yoð Bak Dern Derg. 2020; 26(2): 80-84 | DOI: 10.5222/GKDAD.2020.34635

Koroner Arter Cerrahisinde Yoðun Bakýmda Kalýþ Süresini Etkileyen Faktörler

Songül Kocabaþ Güler¹, Nurgul Yurtseven², Ýpek Yakýn Düzyol^3
1Tekirdað Devlet Hastanesi Anestezi ve Reanimasyon
²Saðlýk Bilimleri Üniversitesi Dr. Si̇yami̇ Ersek Göðüs Kalp ve Damar Cerrahi̇si̇ Anestezi ve Reanimasyon Kliniði, Ýstanbul
³Saðlýk Bilimleri Üniversitesi Derince Eðitim Araþtýrma Hastanesi Anestezi ve Reanimasyon, Kocaeli

GÝRÝÞ ve AMAÇ: Koroner arter baypas graft (KABG) cerrahisi sonrasý yoðun bakým kalýþ sürelerinin uzamasý morbidite, mortalite ve hastane maliyetlerinin artmasý ile iliþkilidir. Bu çalýþmanýn amacý KABG operasyonlarý sonrasý postoperatif yoðun bakým kalýþ süresinin (YBKS) uzamasýyla iliþkili risk faktörlerini analiz etmektir.
YÖNTEM ve GEREÇLER: Elektif olarak KABG operasyonu geçirecek 199 hasta çalýþmaya alýndý. Uzamýþ yoðun bakým kalýþ süresi 48 saat olarak belirlendi. Hastalarýn preoperatif demografik verileri, kros-klemp ve pompa süreleri, inotrop kullanýmlarý, 2>ünite kan transfüzyonu, hipotermi, entübasyon süresi, aritmi, alveolo-arteriyel oksijen gradienti (PAO2-PaO2) ve parsiyel arteriyel oksijen/ fraksiyone inspire oksijen (PaO2/FiO2) oranlarý kaydedildi. Yoðun bakýmda kalýþ süresine göre hastalar iki gruba ayrýldý. Grup 1: Yoðun bakým kalýþ süresi 48 saatten kýsa olan hastalar, Grup 2: Yoðun bakýmda kalýþ süresi 48 saatten uzun olan hastalar. Ýstatik yöntemi olarak Mann Whitney U testi ve eþli olmayan t testi kullanýldý. Lineer regresyon analizi ile uzamýþ yoðun bakýmla iliþkili faktörler araþtýrýldý.
BULGULAR: Yoðun bakýmda kalýþ süresi Grup 1‘de 26.4±9.1 iken, Grup 2 hastalarýnda 137.8±72.3 saat olarak bulundu. Ventilasyon süresi ise grup 1’de 11.1±4.1 saat, Grup 2’de 74.5±81.0 olarak hesaplandý. Lineer regresyon analizine göre entübasyon süresi, kronik obstrüktif akciðer hastalýðý (KOAH), yaþ >60, kreatinin > 1.3 mg/dl ve ejeksiyon fraksiyonu (EF) < %45 uzamýþ yoðun bakýmda kalýþ süresi ile iliþkili faktörler olarak bulundu.
TARTIÞMA ve SONUÇ: Tespit edilen risk faktörlerinin varlýðýnda uygun tedavi seçenekleri ile hastalarýn desteklenerek operasyon zamanlamasýnýn iyi belirlenmesi, yoðun bakým kalýþ süresi azaltacaktýr.

Anahtar Kelimeler: Koroner Arter Cerrahisi, Yoðun Bakým Kalýþ Süresi, Risk Faktörü

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Factors Affecting Intensive Care Unit Stay in Coronary Artery Surgery

Songül Kocabaþ Güler¹, Nurgul Yurtseven², Ýpek Yakýn Düzyol^3
1Tekirdað State Hospital
²Deparment of Anesthesiology and Reanimation Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital University of Health Sciences, Turkey
³Deparment of Anesthesiology and Reanimation Derince Training and Research Hospital, University of Health Sciences, Turkey

INTRODUCTION: Prolonged ICU stay after coronary artery bypass surgery(CABG) is associated with increased morbidity, mortality and hospital costs.
The aim of this study is to analyze the risk factors associated with the prolongation of postoperative intensive care stay(ICUS) after CABG operations.

METHODS: 199 patients who would electively undergo CABG operation were included in the study. Prolonged ICU stay was determined as 48 hours. Preoperative demographic data, cross-clamp and pump times, inotropic uses, 2> unit blood transfusion, hypothermia, intubation time, arrhythmia, alveolo-arterial oxygen gradient (PAO2-PaO2) and partial arterial oxygen / fractional inspired oxygen (PaO2 / FiO2) ratios were recorded. Patients were divided into two groups according to the length of stay in the intensive care unit. Group1: Patients with ICU stay shorter than 48 hours, Group2: Patients with ICU stay longer than 48 hours. Mann Whitney U test and unpaired t test were used as statistical method. The factors associated with prolonged intensive care were investigated by linear regression analysis.
RESULTS: Duration of stay in intensive care unit was 26. ±9.1 in Group1, it was 137.8±72.3 hours in Group2 patients. Ventilation time was calculated as 11.1±4.1 hours in group 1 and 74.5±81.0 in group 2. According to the linear regression analysis, intubation time, chronic obstructive pulmonary disease (COPD), age>60, creatinine>1.3 mg/dl and ejection fraction (EF)<45% were found to be factors associated with prolonged ICU stay.
DISCUSSION AND CONCLUSION: In the presence of identified risk factors, the appropriate timing of the operation will be supported by supporting the patients with appropriate treatment options and determining the timing of the operation

Keywords: Coronary Artery Surgery, Intensive Care Unit Stay, Risk Faktors

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ATIF KOPYALA