부산대학교 도서관

A Relationship between Changes in Organ Markers Levels and the Postoperative Outcomes in Adult Cardiac Surgery with Cardiopulmonary Bypass Sung-Chul LeeDepartment of Clinical Laboratory Science,Graduate School of Life Sciences,Catholic University of Pusan Director : Professor Seok-Cheol Choi Ph. D.Background: Open heart surgery with cardiopulmonary bypass (CPB) is associated with systemic inflammatory reactions that may induce postoperative multi-organ dysfunctions. Such complications are causative of postoperative morbidity and mortality. Factors affecting postoperative recovery are multifactorial and there have been arguments among several studies. Objective: The present study was peformed to define changes of organ markers and factors affecting the postoperative outcome in adult cardiac surgery with CPB. Methods: Thirty-two adult patients scheduled for elective cardiac surgery participated in this study. On Pre-CPB (before initiation of CPB), CPB-10m (10 min after initiation of CPB) and CPM-off (immediately after the end of CPB), hematological (leukocytes, platelets, D-dimer, and protein-S and protein-C activity), liver [glutamic oxaloacetic transaminase (GOT) and glutamic pyrubic transaminase (GPT)], renal [blood urea nitrogen (BUN) and creatinine], cardiac [troponin-I (cTNI)], inflammatory [interleukin-6 (IL-6)], brain [neuron-specific enolase (NSE)] and vascular [endothelin-1 (ET-1)] markers were measured. At postoperative period, aortic cross-clamping time (ACC), total CPB time (TCPB), 24 hrs-bleeding and total bleeding volumes, mechanical ventilatory assist time (MVAT), ICU (intensive care unit) stay time and length of hospitalization were recorded and considered as postoperative outcomes. A relationship between organ markers and postoperative outcomes was analyzed.Results: Levels of leukocyte, GOT, cTNI, IL-6, D-dimer and NSE on CPB-off were significantly elevated, whereas platelet count, protein-C and protein-S activities declined in CPB-off compared with Pre-CPB. GPT, BUN and creatinine levels at CPB-off were not statistically different with each that of Pre-CPB. GOT and D-dimer levels at CPB-off showed significantly positive correlation with 24 hrs-bleeding, total bleeding, mechanical ventilatory assist time, ICU stay time or length of hospitalization, respectively. BUN levels at CPB-off were directly related to total bleeding, mechanical ventilatory assist time, ICU stay time and length of hospitalization. Platelet count at CPB-off was inversely related to mechanical ventilatory assist time, ICU stay time and length of hospitalization. Creatinine concentration at CPB-off interrelated positively with mechanical ventilatory assist time and ICU stay time. NSE levels at CPB-off had a positive relationship with postoperative 24 hrs-bleeding. The length of hospitalization was prolonged proportionally to the elevation of cTNI levels in cardiac surgery. ACC and TCPB were also related with GOT, GPT, increased 24 hrs-bleeding and total bleeding volumes and the length of hospitalization. Prolonged MVAT was positively associated with the length of ICU stay and hospitalization. IL-6, ET-1, protein-C and protein-S had no mutual relationship with any postoperative outcomes. Conclusion: These data suggest that GOT, BUN, creatinine, D-dimer and platelet levels, ACC and TCPB are the most important factors affecting postoperative outcomes and patient's recovery in adult cardiac surgery with CPB. Key words: Adult cardiac surgery, Cardiopulmonary bypass, Organ marker, Postoperative outcomes.