Journal of Life Science (생명과학회지)

Korean Society of Life Science (한국생명과학회)
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Factors Affecting the Postoperative Outcome in Adult Cardiac Surgery with Cardiopulmonary Bypass

심폐바이패스를 이용한 성인 심장수술 시 환자회복에 영향을 미치는 인자

  • Lee, Sung-Chul (Department of Clinical Laboratory Science, College of Health Sciences, Catholic University of Pusan) ;
  • Kim, Yun-Tae (Seoul Medical Science Institute (SMSI)) ;
  • Moon, Seong-Min (Department of Biomedical Laboratory of Science, College of Smart Foods and Drugs, Inje University) ;
  • Hyun, Kyung-Yae (Department of Biomedical Laboratory of Science, College of Smart Foods and Drugs, Inje University) ;
  • Kim, Dae-Sik (Department of Clinical Laboratory Science, Dongnam health college) ;
  • Choi, Seok-Cheol (Seoul Medical Science Institute (SMSI))
  • 이성철 (부산가톨릭대학교 보건과학대학 임상병리학과) ;
  • 김윤태 (서울의과학 연구소) ;
  • 문성민 (인제대학교 식의학생명공학대학 임상병리학과) ;
  • 현경애 (인제대학교 식의학생명공학대학 임상병리학과) ;
  • 김대식 (동남보건대학 임상병리과) ;
  • 최석철 (서울의과학 연구소)
  • Published : 2008.11.30
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Abstract

We defined factors affecting the postoperative outcome in adult cardiac surgery with cardiopulmonary bypass (CPB). Thirty-two adult patients scheduled for elective cardiac surgery participated in this study. Levels of leukocyte, glutamic oxaloacetic transaminase (GOT), troponin-I (cTNI), interleukin-6 (IL-6), D-dimer and neuron-specific enolase (NSE) were significantly elevated, whereas platelet count declined in cardiac surgery with CPB. GOT and D-dimer levels at CPB-off each had a positive significant correlation significantly with 24 hrs-bleeding, total bleeding, mechanical ventilatory assist time, ICU stay time and length of hospitalization. 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. Aortic cross-clamping and total CPB times also related with increase of 24 hrs and total bleeding volumes and the length of hospitalization. IL-6 and ET-1 had no mutual relation with any postoperative outcome. These data suggest that GOT, BUN, creatinine, D-dimer and platelet levels are the most important factors affecting postoperative outcomes and patient's recovery in adult cardiac surgery with CPB.

본 연구는 심폐바이패스를 이용한 성인 심장수술 시 수술 후 환자의 회복 결과에 영향을 미치는 인자들을 규명하기 위해 시행하였다. 성인 심장수술 환자 32명을 대상으로 하여 연구하였다. 심장수술 시 밸혈구 수, GOT, troponin-I (cTNI), interleukin-6 (IL-6), endothelin-1 (ET-1), D-dimer, neuron-specific enolase (NSE) 등의 혈장농도는 유의하게 증가한데 비해 혈소판 수는 감소하였다. 수술 직후 GOT 및 D-dimer 농도와 24 시간 및 총출혈량, 기계호흡보조 시간, 중환자실 치료기간, 재원일수와 각각 양의 상관성이 있었다. 혈소판 수와 기계호흡보조 시간, 중환자실 치료기간, 재원일수와 각각 음의 상관관계가 있었다. Creatinine 농도와 기계호흡보조 시간, 중환자실 치료기간 사이에 양의 상관성이 있었다. NSE 농도와 24 시간 출혈량 사이에 양의 상관관계를 보였다. cTNI 농도와 재원일수 간에 양의 상관성이 있었다. 대동맥 교차차단 및 총심폐바이패스 실시 시간과 24 시간 및 총 출혈량, 재원일수 사이에 양의 상관관계를 나타내었다. 결론적으로 본 연구의 결과들은 심폐바이패스를 적용한 성인 심장수술 시 수술 후 환자의 결과와 회복에 영향을 미치는 가장 중요한 변수는 수술 종료 직후(CPB-off)의 GOT, BUN, creatinine, D-dimer 등의 농도와 혈소판 수임을 시사하고 있다.

Keywords

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