GKD Anest Yoð Bak Dern Derg. 2016; 22(3): 99-104 | DOI: 10.5222/GKDAD.2016.099

On-pump açýk kalp cerrahisinde priming solusyonu olarak kullanýlan kolloidler ve kristaloidlerin sývý dengesi üzerine etkilerinin karþýlaþtýrýlmasý.

Tülay Hoþten¹, Neþe Türkyýlmaz¹, Sevim Cesur¹, Ahmet Arýkan², Hasan Bayram², Önder Topbaþ¹, Mine Solak^1
1Kocaeli Üniversitesi Týp Fakültesi Anesteziyoloji Ve Reanimasyon Anabilim Dalý
²Kocaeli Üniversitesi Týp Fakültesi Kalp Ve Damar Cerrahisi Anabilim Dalý

GÝRÝÞ ve AMAÇ: On pump açýk kalp cerrahisinde priming solusyonu olarak seçilecek sývýlarla ilgili kesin bir öneri bulunmamakta, priming sývýlarýnýn avantaj ve dezavantajlarýný karþýlaþtýran çalýþmalar halen devam etmektedir. Çalýþmamýzda, priming solüsyonu olarak kolloid+kristaloid kullanýmýyla, yalnýzca kristaloid kullanýmýnýn cerrahi sonu sývý dengesi üzerine etkisini karþýlaþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: ASA I-II on-pump elektif açýk kalp cerrahisi geçiren toplam 100 hastaya ait veri hasta dosyasý ve anestezi formlarýndan elde edildi. Priming solusyonu olarak kristalloid+kolloid kullanýlan 50 hasta ile, priming solüyonu olarak yalnýzca kristaloid kullanýlan 50 hastanýn verileri deðerlendirildi.
BULGULAR: KPB sonunda sývý dengesi kristaloid grubunda istatistiksel olarak anlamlý derecede fazla iken, cerrahi sonunda iki grupta da benzer bulundu, (p <0.001, p: 0.80). Cerrahi sonunda kullanýlan kan ürünü miktarý ve idrar çýkýþlarý her iki grupta benzerdi. Kreatinin deðerleri preoparatif ve postoperatif dönemlerde hem gruplar arasýnda hem de grup içinde benzer seyretti.
TARTIÞMA ve SONUÇ: % 6 HES (130,0.4), on-pump açýk kalp cerrahisinde KPB sonucu sývý dengesini azaltmakla birlikte bu etkisi cerrahinin sonuna kadar devam edebilmiþtir. Kanama ve hemostaz üzerine etkisi kristaloidlerle benzer bulunmuþtur. % 6 HES (130, 0.4)’ün böbrek fonksiyonlarý saðlam olan hastalarda kreatinin düzeylerini olumsuz etkisi görülmemekle birlikte, gerçek ilaçlar gibi düþünülüp uygun hastalarda uygun doz ve sürede kullanýlmalýdýr.

Anahtar Kelimeler: açýk kalp cerrahisi, priming sývýlarý, kristaloidler ve kolloidler

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Comparison of the effects of colloid and crystalloid priming solutions on the fluid balance in on-pump open heart surgery.

Tülay Hoþten¹, Neþe Türkyýlmaz¹, Sevim Cesur¹, Ahmet Arýkan², Hasan Bayram², Önder Topbaþ¹, Mine Solak^1
1Department Of Anesthesia And Reanimation Of Kocaeli University
²Department Of Cardiovascular Surgery Of Kocaeli University

INTRODUCTION: There is no definitive suggestion for the content of the priming solution in on pump open hearth surgery, but studies comparing the advantages and disadvantages of priming liquid are still ongoing. In our study, we aim to compare the effects of colloid and crystalloid priming solutions on the final fluid balance in open heart surgery
METHODS: Data from 100 patients with ASA I–II who underwent elective on pump open heart surgery are obtained from anesthesia files and patient records. 100 patients are included to the study; 50 of them had crystalloid + colloid priming solutions and the remaining 50 had only crystalloid priming solutions.
RESULTS: Fluid balance at the end of CPB was significantly higher in crystalloid group, while at the end of surgery it was similar in both groups (p<0.001, p=0.80). Blood products used at the end of surgery and the amount of urine output were similar in both groups. Creatinine levels in the preoperative and postoperative period were similar between and in both groups
DISCUSSION AND CONCLUSION: (HES) % 6 (130/0.4) is reducing fluid balance at the end of CPB in on-pump open hearth surgery and this effect continues until the end of surgery. Effects on hemostasis and bleeding were similar with crystalloids. Although (HES) % 6 (130/0.4) does not impair creatinine levels in patients with normal renal functions, it should be contemplated as real drugs and used in appropriate doses and durations in suitable patients.

Keywords: open heart surgery, priming fluids, crystalloids and colloids

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ATIF KOPYALA