GKD Anest Yoð Bak Dern Derg. 2019; 25(2): 113-118 | DOI: 10.5222/GKDAD.2019.18291

Açýk Kalp Cerrahisi Sonrasýnda Yeni Geliþen Major Nörolojik Hasarlanma

Þerife Gökbulut Bektaþ, Mine Altýnkaya Çavuþ, Aslý Demir
Türkiye Yüksek Ýhtisas Eðitim Ve Araþtýrma Hastanesi,Sýhhýye, Ankara, Turkey

GÝRÝÞ ve AMAÇ: Nörolojik hasarlanma kalp cerrahisinin en ciddi komplikasyonlarýndan biridir. Bu yazýda açýk kalp cerrahisi yapýlan merkezimizde son iki yýlda postoperatif tip 1 nörolojik hasar geliþmiþ hastalarý deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Hastanemizde son 2 yýlda 2689 hastanýn açýk kalp cerrahisi geçirdiði saptandý. Bunlarýn içinde postoperatif dönemde aþikar nörolojik hasar geliþen 50 hasta tespit edildi. Bu hastalarýn verilerine elektronik veri tabanýndan ve arþivden dosya taramasý yapýlarak ulaþýldý.
BULGULAR: Verilerine ulaþýlan 50 hasta deðerlendirildi. Hastalarýn yaþ ortalamasý 60,4 ± 10,2 yýl olarak bulundu. Hastalarýn % 61,2’sine hipertansiyon, % 22,4’üne diyabet eþlik etmekteydi.Hastalara uygulanan prosedürler sýklýk sýrasýna göre %54 koroner baypas cerrahisi, %20 çoklu cerrahi prosedürler ve %14 aort cerrahisiydi. Ortalama KPB süresi 131,1 ± 58,6 dk idi. Buna göre serebrovasküler olay etyolojisinde %90 oranýnda embolinin neden olduðu iskemik inme gözlenirken, %10 hastada hipoperfüzyona baðlý inme görülmüþtür.SVO sonrasý kalýcý hasar %56 hastada bulundu. Mortalite ise 17 hastada (%34) mevcuttu.
TARTIÞMA ve SONUÇ: Araþtýrma sonucunda hastanemizde açýk kalp cerrahisi sonrasýnda aþikar nörolojik hasarlanma oraný %1,9 bulundu. Literatürde bununla ilgili olarak %0,5-5,4 gibi geniþ bir aralýk verilmiþtir. Hastalarýmýzdaki nörolojik hasarlanmanýn etyolojisinde daha çok intraoperatif embolik faktörlerin yer aldýðýný düþünmekteyiz.

Anahtar Kelimeler: Postoperatif inme, kardiyak anestezi, postoperatif nörolojik komplikasyon, postoperatif morbidite, postoperatif mortalite, serebrovasküler olay

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Newly Developed Major Neurological Injury After Open Heart Surgery

Þerife Gökbulut Bektaþ, Mine Altýnkaya Çavuþ, Aslý Demir
Turkey Yüksek Ýhtisas Training and Research Hospital, Sýhhýye, Ankara, Turkey

INTRODUCTION: Neurological injury is one of the most serious complications of cardiac surgery. In this study, we aimed to evaluate patients who had postoperative type 1 neurological injury after open heart surgery in the last two years in our center.
METHODS: In our hospital, 2689 patients underwent open heart surgery in the last two years 50 patients with obvious neurological damage were detected postoperatively. The data of these patients were obtained from by electronic database and files scanning from the archive.
RESULTS: Fifty patients who achieved the data were evaluated. The mean age of the patients was 60,4 ± 10,2 years. 61,2% of the patients had hypertension and 22,4% had accompanied by diabetes. Procedures applied to the patients were 54% coronary bypass surgery, 20% multiple surgical procedures and 14% aortic surgery. The mean duration of CPB was 131,1 ± 58,6 min. Accordingly, in the etiology cerebrovascular event,while ischemic stroke caused by emboli was observed in 90%, hypoperfusion related stroke was observed in 10% patients. Permanent damage after SVO occurred in 56% of patients. Mortalite was observed in 17 patients(34%).
DISCUSSION AND CONCLUSION: In our study, the rate of obvious neurological injury after open heart surgery was 1,9% in our hospital. A large range of 0,5-5,4% is given in the literature. We think that intraoperative embolic factors are more involved in the etiology of neurological injury in our patients.

Keywords: Postoperative stroke, cardiac anaesthesia, postoperative neurological complication, postoperative morbidity, postoperative mortality, cerebrovascular event

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