Preoperatif hiponatreminin sol ventrikül ejeksiyon fraksiyonu üzerine etkileri ve klinik sonuçlarla ilişkisi
Öz
Amaç: Bu çalışmamızda preoperatif serum
sodyum değeri ile postoperatif klinik durum arasındaki ilişkiyi saptamayı ve
hiponatremik hastaların operasyon sonrasında sol ventrikül ejeksiyon
fraksiyonundaki artışın normonatremik olgularla karşılaştırmayı amaçladık.
Gereç ve Yöntem: Şubat 2014 – 2015 tarihleri arasında
kliniğimize başvuran ve açık kalp cerrahisi operasyonu olan, transplantasyon,
yapay kalp implantasyonu yapılan olgular ve hemodiyaliz gerektiren kronik
böbrek yetmezlik olguları dışındaki tüm hastalar çalışmamıza dahil edildi.
Hastalar kan serum sodyum değerlerine göre operasyon öncesi iki gruba ayrıldı.
Demografik veriler, entübasyon süreleri, yoğun bakım süreleri, inotrop
kullanımı, oluşan komplikasyonlar, sol ventrikül ejeksiyon fraksiyonu değişimi,
intraaortik balon pompası kullanımı, kardiyopulmoner baypas süreleri, kross
klemp süreleri ve klinik sonuçlar arasındaki fark değerlendirildi.
Bulgular: Hiponatreminin
postoperatif EF değişimi üzerine etkisi saptanmamıştır. Olguların serum sodyum değerine göre
NYHA sınıflaması karşılaştırıldığında olguların hiponatremik hastalarda yüksek
NYHA sınıfında olma arasında anlamlı fark saptanmıştır. Hiponatremik grupta
postoperatif dönemde entübasyon süreleri, kullanılan kan ürünü ve postop drenaj
miktarı anlamlı derecede fazladır. Hiponatremik hastalarda postoperatif akut
böbrek yetmezliği görülme sıkılığı artmıştır. Hiponatremik hastalarda
postoperatif mortalite oranları anlamlı derecede yüksektir.
Sonuç: Çalışmamızda preoperatif
hiponatreminin, kalp cerrahisi hastalarında prognostik önemi olduğunu
düşünmekteyiz.
Anahtar Kelimeler
Kaynakça
- Tamizifar B, Kheiry S, Fereidoony F. Hyponatremia and 30 days mortality of patients with acute pulmonary embolism. J Res Med Sci 2015; 20 (8): 777-81.
- Burkhardt K, Kirchberger I, Heier M et al. Hyponatraemia on admission to hospital is associated with increased long-term risk of mortality in survivors of myocardial infarction. Eur J Prev Cardiol 2015; 22 (11): 1419-26.
- Klein L, O'Connor C, Leimberger JD et al. Lower serum sodium is associated with increased short-term mortality in hospitalized patients with worsening heart failure: results from the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study. Circulation 2005; 1118 (19): 2454-60.
- Crestanello JA, Phillips G, Firstenberg MS et al. Preoperative hyponatremia predicts outcomes after cardiac surgery. J Surg Res 2013; 181 (1): 60-6.
- Appoo J, Norris C, Merali S et al. Long-term outcome of isolated coronary artery bypass surgery in patients with severe left ventricular dysfunction. Circulation 2004; 110 (11 Suppl 1): 13-7.
- Polderman KH, Girbes AR. Severe electrolyte disorders following cardiac surgery: a prospective controlled observational study. Crit Care 2004 ;8 (6): 459-66.
- Polderman KH, Peerdeman SM, Girbes AR. Hypophosphatemia and hypomagnesemia induced by cooling in patients with severe head injury. J Neurosurg 2001; 94 (4): 697-705.
- Stelfox HT, Ahmed SB, Zygun D, Khandwala F et al. Characterization of intensive care unit acquired hyponatremia and hypernatremia following cardiac surgery. Can J Anaesth 2010; 57 (7): 650-8.
- Gheorghiade M, Abraham WT, Albert NM et al. OPTIMIZE-HF Investigators and Coordinators. Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J 2007; 28 (8), 980-988.
- Gheorghiade M, Rossi JS, Cotts W et al. Characterization and prognostic value of persistent hyponatremia in patients with severe heart failure in the ESCAPE Trial. Arch Intern Med 2007; 167 (18): 1998-2005.
The effects of preoperative hyponatremia on left ventricular ejection fraction and relation with clinical outcomes
Öz
Aim: In this study, we aim to investigate the relation between preoperative
serum sodium levels and postoperative clinical follow-up; moreover, to compare
the left ventricular ejection fraction increment in hyponatremic and
normonatremic cases. Herein, we present one-year results of our clinic in open
cardiac surgery performed patients.
Materials and Methods:
This is a retrospective study of cases who
underwent open cardiac surgery between February 2014-2015 in our clinic. Transplantation
assist device implanted cases and hemodialysis receiving patients by reason of
chronic renal failure were excluded.
Patients were divided into two groups according to blood serum sodium
levels on admission day as normonatremic (135–145 mEq/L) or hyponatremic
<135 mEq/L. The demographic characteristics of the patients, duration of
intubation and length of intensive care unit (ICU) stay, need for inotropic
support, mediastinal drainage amount, alteration in left ventricular ejection
fraction (LVEF), intraaortic balloon pump (IABP) usage ratio, occurrence of
acute renal failure, cardiopulmonary bypass time, cross clamping time and
differences in clinical outcomes were examined.
Results: Hyponatremia was observed in 31,3% of patients and those had higher NYHA
classification score. There was no statistical difference between groups in
LVEF alteration was determined (p=0.756). Postoperative duration of intubation
(p=0.003), need of blood products transfusion(p=0.033), vasoactive inotropic
support (p=0.021) and postoperative amount of drainage was statistically higher
in hyponatremic cases surplus(p=0.018). Peroperatively, both aortic cross
clamping time (p=0.018) and cardiopulmonary bypass durations (p=0.026) were
higher in hyponatremic group. Furthermore, postoperative mortality was also
significantly higher (p=0.001).
Conclusion: We suggest that being hyponatremic has a prognostic importance in
patients who undergo open cardiac surgery.
Anahtar Kelimeler
Kaynakça
- Tamizifar B, Kheiry S, Fereidoony F. Hyponatremia and 30 days mortality of patients with acute pulmonary embolism. J Res Med Sci 2015; 20 (8): 777-81.
- Burkhardt K, Kirchberger I, Heier M et al. Hyponatraemia on admission to hospital is associated with increased long-term risk of mortality in survivors of myocardial infarction. Eur J Prev Cardiol 2015; 22 (11): 1419-26.
- Klein L, O'Connor C, Leimberger JD et al. Lower serum sodium is associated with increased short-term mortality in hospitalized patients with worsening heart failure: results from the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study. Circulation 2005; 1118 (19): 2454-60.
- Crestanello JA, Phillips G, Firstenberg MS et al. Preoperative hyponatremia predicts outcomes after cardiac surgery. J Surg Res 2013; 181 (1): 60-6.
- Appoo J, Norris C, Merali S et al. Long-term outcome of isolated coronary artery bypass surgery in patients with severe left ventricular dysfunction. Circulation 2004; 110 (11 Suppl 1): 13-7.
- Polderman KH, Girbes AR. Severe electrolyte disorders following cardiac surgery: a prospective controlled observational study. Crit Care 2004 ;8 (6): 459-66.
- Polderman KH, Peerdeman SM, Girbes AR. Hypophosphatemia and hypomagnesemia induced by cooling in patients with severe head injury. J Neurosurg 2001; 94 (4): 697-705.
- Stelfox HT, Ahmed SB, Zygun D, Khandwala F et al. Characterization of intensive care unit acquired hyponatremia and hypernatremia following cardiac surgery. Can J Anaesth 2010; 57 (7): 650-8.
- Gheorghiade M, Abraham WT, Albert NM et al. OPTIMIZE-HF Investigators and Coordinators. Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J 2007; 28 (8), 980-988.
- Gheorghiade M, Rossi JS, Cotts W et al. Characterization and prognostic value of persistent hyponatremia in patients with severe heart failure in the ESCAPE Trial. Arch Intern Med 2007; 167 (18): 1998-2005.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 20 Eylül 2019 |
| Gönderilme Tarihi | 18 Mayıs 2019 |
| Yayımlandığı Sayı | Yıl 2019 |