부산대학교 도서관

Introduction Platelets are strongly affected by cardiopulmonary bypass (CPB) using a pumpoxygenator (1). Hypothermia, anticoagulant administration and hemorrhage are many of the other risk factors for thrombocytopenia (TP) after cardiac [...]
Objectives: There are various risk factors which make the cardiac surgery patients prone to thrombocytopenia such as the effects of cardiopulmonary bypass procedure, anticoagulant administration, bleeding diathesis, blood product transfusions and hypothermia. However the clinical and prognostic value of early thrombocytopenia soon after cardiac surgery is less studied previously and is the objective of our study. Materials and Methods: In this cross-sectional study we evaluated cardiac surgery patients who were operated within 6 months period in our hospital electively. Thrombocytopenia was defined as a platelet count under 150,000/[micro]L The peroperative variables, prognostic scores according to the Sequential Organ Failure Assesment (SOFA), length of stay, mortality and adverse events during hospital stay were investigated. Results: Thrombocytopenia was observed in 33.05% of all patients. The mean cross-clamping time was prolonged and the total mediastinal drainage volume was excessive in thrombocytopenia group. All-cause infection, pulmonary and renal dysfunction rates were higher, SOFA scores were increasing at 24th and 48th hours, and length of stay in hospital and intensive care unit were prolonged in this group. Conclusion: Thrombocytopenia may be associated with multiple organ dysfunction and further infections; and may be regarded as a remarkable finding of poor prognosis and prolonged length of stay after cardiac surgery in early period. Hemorrhage and prolonged cross clamping time are the significant risk factors associated with thrombocytopenia in our study. Therefore an appropriate hemostatic approach and brief cross clamping time may be considered as preventive strategies to reduce thrombocytopenia following cardiac surgery. Key Words: Thrombocytopenia, Coronary Artery Bypass, Postoperative Thrombocytopenia, Postoperative Prognosis Amac: Kardiyopulmoner baypas prosedurunun etkileri, antikoagulan uygulanmasi, kanama diyatezi, kan urunu transfuzyonu ve hipotermi gibi cesitli risk faktorleri kalp cerrahisi hastalarini trombositopeniye yatkin hale getirmektedir. Kalp cerrahisi sonrasi erken trombositopeninin klinik ve Prognostik onemi ise onceki calismalarda daha az incelenmistir ve calismamizin temel konusunu olusturmaktadir. Gerec ve Yontem: Bu kesitsel calismada 6 ay icerisinde hastanemizde elektif olarak kalp cerrahisi uygulanan hastalar incelendi. Trombosit sayisinin 150.000/[micro]L altinda olmasi trombositopeni olarak kabul edildi. Peroperatif degiskenler, Ardisik Organ Yetmezligi Degerlendirmesi'ne (SOFA) gore Prognostik skorlar, yatis suresi, hastane yatisi sirasindaki mortalite ve ek olaylar incelendi. Bulgular: Hastalarin %33,05'inde trombositopeni goruldu. Trombositopeni grubunda ortalama kros klemp suresi uzamis ve toplam mediastinal drenaj miktari artmisti. Bu grupta tum nedenlere bagli enfeksiyonlar, pulmoner ve renal disfonksiyon oranlari fazla, SOFA skorlari 24. ve 48. saatlerde yuksek, yogun bakim ve hastane yatis sureleri daha uzun olmustu. Sonuc: Kalp cerrahisi sonrasi erken donemde trombositopeninin, multiorgan yetmezligi, gelisebilecek enfeksiyonlar, kotu prognoz ve uzamis yatis suresiyle iliskili olabilecegi gozlenmistir. Calismamizda kanama ve uzamis kros klemp suresinin trombositopeniyle iliskili anlamli risk faktorleri oldugu saptanmistir. Bu nedenle uygun hemostatik yaklasim ve kros klemp suresinin kisa tutulmasinin kalp cerrahisi sonrasi trombositopeniyi azaltabilecek onlemler olabilecegini dusunmekteyiz. Anahtar Kelimeler: Trombositopeni, Koroner Baypas, Postoperatif Trombositopeni, Postoperatif Prognoz