GKD Anest Yoð Bak Dern Derg. 2019; 25(2): 102-112 | DOI: 10.5222/GKDAD.2019.78300

Pediyatrik Kalp Cerrahisinde Transfüzyon: Prospektif, Gözlemsel Çalýþma

Feride Karacaer¹, Ebru Biricik¹, murat türkeün ýlgýnel¹, demet lafli tunay¹, MEHMET ÞAH TOPÇUOÐLU^2
1Çukurova Üniversitesi Týp Fakültesi, Anesteziyoloji Ve Reanimasyon Ana Bilim Dalý, Adana
²Çukurova Üniversitesi Týp Fakültesi, Kalp Ve Damar Cerrahisi Ana Bilim Dalý, Adana

GÝRÝÞ ve AMAÇ: Kalp cerrahisi geçiren pediyatrik hastalarda kan ve kan ürünleri transfüzyonu kaçýnýlmaz olabilmektedir. Çalýþmamýzda, bu hastalarda, kan ve kan ürünlerinin transfüzyonu ile iliþkili faktörlerin ve risklerin belirlenmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Preoperatif demografik veriler, kardiyopulmoner bypass (KPB) ve operasyon süresi, KPB giriþindeki, KPB sýrasýndaki ve ayrýlmadan sonraki, operasyon sonundaki hematokrit ve hemoglobin deðerleri kaydedildi. KPB sýrasýnda ulaþýlan en düþük vücut ýsýsý, intraoperatif dönemde kullanýlan kristalloid, kolloid, eritrosit süspansiyonu (ES), taze donmuþ plazma (TDP), trombosit süspansiyonu (TS), kriyopresipitat miktarý kaydedildi. Postoperatif dönemde; yoðun bakým ünitesinde (YBÜ) verilen kan ve kan ürünleri miktarý, YBÜ’nde ve hastanede kalýþ süreleri, mortalite kaydedildi.
BULGULAR: Çalýþmaya 83 çocuk dahil edildi. ES transfüzyonu RACHS1: 3 olan hastalarda, RACHS1: 2 olan hastalardan yüksekti (p=0,009). Yaþ ile postoperatif ES, intraoperatif ve postoperatif dönemdeki toplam ES ve toplam TDP transfüzyonu arasýnda negatif korelasyon saptandý. KPB süresi ile intraoperatif ES ve TDP, postoperatif ES, TDP, kriyopresipitat tüketimi, toplam ES ve toplam TDP tüketimi arasýnda pozitif korelasyon belirlendi. Siyanotik çocuklarýn intraoperatif ES ve TDP tüketimi asiyanotik çocuklardan yüksekti (ES p=0,002; TDP p=0,002). Postoperatif dönemde siyanotik çocuklarýn kriyopresipitat tüketimi yüksekti (p=0,026). 15 hastanýn eksitus olduðu belirlendi. Eksitus olan hastalarda postoperatif dönemdeki ES ve TDP (ES p=0,004, TDP p=0,003), toplam ES ve TDP miktarýnýn yüksek olduðu saptandý (toplam ES p=0,001, toplam TDP p=0,003).
TARTIÞMA ve SONUÇ: Açýk kalp cerrahisi geçiren çocuklarda intraoperatif ve postoperatif transfüzyon oranlarýnýn hastanýn yaþý, RACHS1 skoru, KPB süresi, vücut ýsýsý ve siyanoz ile iliþkili olduðu belirlenmiþtir. Eksitus olan hastalarda ES ve TDP transfüzyon miktarlarýnýn yüksek olduðu saptanmýþtýr.

Anahtar Kelimeler: : Pediyatrik kalp cerrahisi, kardiyopulmoner bypass, transfüzyon

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Transfusion In Pediatric Heart Surgery: Prospective, Observational Study

Feride Karacaer¹, Ebru Biricik¹, murat türkeün ýlgýnel¹, demet lafli tunay¹, MEHMET ÞAH TOPÇUOÐLU^2
1Department Of Anesthesiology And Reanimation, Çukurova University, Adana, Turkey
²Department Of Cardiovascular Surgery, Çukurova University, Adana, Turkey

INTRODUCTION: Transfusion of blood and blood products may be unavoidable in pediatric patients undergoing cardiac surgery. The aim of this study was to determine the factors and risks associated with transfusion in these patients.
METHODS: Preoperative demographic data, duration of cardiopulmonary bypass (CPB) and operation time were recorded. At the beginning of CPB, during the CPB and at the end of the operation hematocrit and hemoglobin values were recorded. The lowest body temperature during CPB, intraoperative crystalloid, colloid, blood, blood products consumptions were recorded. The consumption of blood and blood products, length of stay intensive care unit (ICU) and hospital, and mortality were recorded during the postoperative period.
RESULTS: 83 children were included in the study. Intraoperative erythrocyte transfusion was higher in patients with RACHS1: 3 than in patients with RACHS1: 2 (p=0.009). There was a negative correlation between age and postoperative erythrocyte, total erythrocyte and total fresh frozen plasma (FFP) transfusion. There was a positive correlation between CPB duration and intraoperative erythrocyte and FFP, postoperative erythrocyte, FFP, cryoprecipitate consumption, total erythrocyte and total FFP consumption. The intraoperative erythrocyte and FFP consumption, the postoperative cryoprecipitate consumption were higher in cyanotic children (Erythrocyte p=0.002; FFP p=0.002, cryoprecipitate p=0.026). 15 patients died. Postoperative erthrocyte and FFP, total erythrocyte and FFP consumption were higher in the patients who died (total erythrocyte p=0.001, total FFP p=0.003).
DISCUSSION AND CONCLUSION: Amount of transfusion were related to age, RACHS1, CPB duration, body temperature, cyanosis in children undergoing open heart surgery. Erthrocyte and FFP transfusions were higher in the patients who died.

Keywords: Pediatric heart surgery, cardiopulmonary bypass, transfusion.

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