The effect of preoperative circadian blood pressure pattern on early postoperative outcomes in patients with coronary artery bypass graft surgery

GÜLEL, Okan; BAHÇIVAN, Muzaffer; KOLBAKIR, FERŞAT

The effect of preoperative circadian blood pressure pattern on early postoperative outcomes in patients with coronary artery bypass graft surgery

Muzaffer BAHÇIVAN, (Ondokuz Mayıs Üniversitesi, Tıp Fakültesi, Kalp ve Damar Cerrahisi Anabilim Dalı, Samsun, Türkiye)

Okan GÜLEL, (Ondokuz Mayıs Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Samsun, Türkiye)

FERŞAT KOLBAKIR (Ondokuz Mayıs Üniversitesi, Tıp Fakültesi, Kalp ve Damar Cerrahisi Anabilim Dalı, Samsun, Türkiye)

Anadolu Kardiyoloji Dergisi

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Yıl: 2008 Cilt: 8 Sayı: 5 Sayfa Aralığı: 354 - 359 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

The effect of preoperative circadian blood pressure pattern on early postoperative outcomes in patients with coronary artery bypass graft surgery

Öz:

Amaç: Bu prospektif çalışmanın amacı koroner arter baypas greftleme (KABG) operasyonu olan hastalarda, preoperatif sirkadiyan kan basıncı paterninin erken postoperatif seyir üzerindeki etkisini araştırmaktır.Yöntemler: İzole KABG operasyonu planlanan 130 hasta (80 erkek, 50 kadın) çalışmaya dâhil edildi. Bütün hastalarda operasyondan 24 saat önce kan basıncı ölçümleri yapıldı ve hastalar dipper (79 hasta) ve non-dipper (51 hasta) fenomenin varlığına göre 2 gruba ayrıldı. Gecelik sistolik ve diyastolik kan basıncı değerleri %10’dan daha az düşen hasta grubu non-dipper olarak tanımlandı. Her iki grup postoperatif intraaortik balon pompası (IABP) ihtiyacı, inotrop ilaç ihtiyacı, ekstübasyon zamanı, yoğun bakımda ve hastanede kalış süresi, renal yetersizlik, inme, malign ventriküler aritmi, atriyal fibrilasyon, düşük kardiyak debi sendromu, postoperatif miyokard infarktüsü ve mortalite açısından karşılaştırıldı. İstatistiksel değerlendirmede Ki-kare, eşleştirilmemiş t ve Mann Whitney U testleri kullanıldı. Non-dipper fenomeni ile postoperatif komplikasyon riskleri lojistik regresyon analizi yapılarak araştırıldı.Bulgular: Dipper karakter gösteren hastalarla karşılaştırıldığında, non-dipper grupta inotropik ilaç ihtiyacı (%37.5’a %62.5), düşük kardiyak debi sendromu (%30.4’a %69.6), postoperatif miyokard infarktüsü (%28.6’e %71.4) ve malign ventriküler aritmiler (%27.8’e %72.2) daha fazlaydı (p<0.05). Lojistik regresyon analizinde sonuçlar şu şekildeydi; kardiyopulmoner baypas zamanı (OR=1.038, %95GA 1.016-1.060 p=0.001), postoperatif inotropik ajan ihtiyacı (OR=4.014, %95GA 1.235-13.047, p=0.021), düşük kardiyak debi sendromu (OR=4.159, %95GA 0.921-18.775, p=0.064), malign ventriküler aritmi (OR=4.653, %95GA 0.964-22.456, p=0.056) postoperatif IABP ihtiyacı (OR=6.625, p=0.010, %95GA(1.564-28.069), postoperatif miyokard infarktüsü (OR=7.629, %95GA 1.448-40.177, p=0.017).Sonuç: Dipper ve non-dipper fenomen, KABG operasyonu geçirecek hastalarda erken postoperatif mortalite ve morbiditeyi tayin etmede basit bir analiz yöntemi olabilir.

Anahtar Kelime: Koroner arter hastalığı İntra-aortik balon pompası Koroner arter köprüleme Kan basıncı İleriye dönük çalışma Yatış süresi Tedavi sonucu Risk faktörleri Lojistik modeller Günlük ritim Preoperatif bakım Hastalık oranı Ameliyat sonrası komplikasyonlar

Konular: Kalp ve Kalp Damar Sistemi

Koroner arter baypas operasyonlu hastalarda preoperatif sirkadiyan kan basıncı paterninin erken postoperatif seyir üzerindeki etkisi

Öz:

Objective: The aim of this prospective study was to evaluate the relationship between preoperative circadian blood pressure pattern and early postoperative course in patients undergoing coronary artery bypass graft (CABG) surgery.Methods: One hundred and thirty patients planning to undergo isolated CABG operation were included to the study (80 men; 50 women). All patients were studied with ambulatory blood pressure monitoring performed 24 hours before surgery and were divided into 2 groups according with presence (79 patients) or absence (51 patients) of dipper phenomenon. Non-dippers were defined as those with a nocturnal reduction of systolic and diastolic blood pressures of less than 10% of daytime pressures. Both groups were compared with each other from the aspect of postoperative need for intraaortic balloon counterpulsation (IABP), inotropic drug support, extubation time, length of intensive care unit and hospitalization stays, renal failure, stroke, malignant ventricular arrhythmia, atrial fibrillation, postoperative myocardial infarction and cardiac mortality. Statistical analyses were performed using Chi-square, unpaired t and Mann-Whitney U tests. Logistic regression analysis was performed to establish associations of non-dipper phenomenon with the risk of postoperative complications.Results: When compared with the dipper patients, need for inotropic medications (37.5% vs. 62.5%), low cardiac output syndrome (30.4% vs. 69.6%), postoperative myocardial infarction (28.6% vs. 71.4%) and malignant ventricular arrhythmias (27.8% vs. 72.2%) were higher in the non-dipper patients (p<0.05 for all). Logistic regression analysis demonstrated that non-dipper phenomenon after CABG was associated with longer cardiopulmonary bypass time (OR=1.038, 95%CI 1.016-1,060, p=0.001), more need for postoperative inotropic agent (OR=4.014, 95%CI 1.235-13,047, p=0.021) and postoperative IABP (OR=6.625, 95%CI 1.564-28.069, p=0.01) support, higher risk of low cardiac output syndrome (OR=4.159, 95%CI 0.921-18.775, p=0.064), malignant ventricular arrhythmia (OR=4.653, 95%CI 0.964-22,456, p=0.056) and postoperative myocardial infarction (OR=7.629, 95%CI 1.448-40.177, p=0.017).Conclusion: Dipper and non-dipper phenomenon can be used as a simple analysis tool for assessing early postoperative mortality and morbidity.

Anahtar Kelime: Logistic Models Circadian Rhythm Preoperative Care Morbidity Postoperative Complications Coronary Artery Disease Intra-Aortic Balloon Pumping Coronary Artery Bypass Blood Pressure Prospective Studies Length of Stay Treatment Outcome Risk Factors

Konular: Kalp ve Kalp Damar Sistemi

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	BAHÇIVAN M, GÜLEL O, KOLBAKIR F (2008). The effect of preoperative circadian blood pressure pattern on early postoperative outcomes in patients with coronary artery bypass graft surgery. , 354 - 359.
Chicago	BAHÇIVAN Muzaffer,GÜLEL Okan,KOLBAKIR FERŞAT The effect of preoperative circadian blood pressure pattern on early postoperative outcomes in patients with coronary artery bypass graft surgery. (2008): 354 - 359.
MLA	BAHÇIVAN Muzaffer,GÜLEL Okan,KOLBAKIR FERŞAT The effect of preoperative circadian blood pressure pattern on early postoperative outcomes in patients with coronary artery bypass graft surgery. , 2008, ss.354 - 359.
AMA	BAHÇIVAN M,GÜLEL O,KOLBAKIR F The effect of preoperative circadian blood pressure pattern on early postoperative outcomes in patients with coronary artery bypass graft surgery. . 2008; 354 - 359.
Vancouver	BAHÇIVAN M,GÜLEL O,KOLBAKIR F The effect of preoperative circadian blood pressure pattern on early postoperative outcomes in patients with coronary artery bypass graft surgery. . 2008; 354 - 359.
IEEE	BAHÇIVAN M,GÜLEL O,KOLBAKIR F "The effect of preoperative circadian blood pressure pattern on early postoperative outcomes in patients with coronary artery bypass graft surgery." , ss.354 - 359, 2008.
ISNAD	BAHÇIVAN, Muzaffer vd. "The effect of preoperative circadian blood pressure pattern on early postoperative outcomes in patients with coronary artery bypass graft surgery". (2008), 354-359.

APA	BAHÇIVAN M, GÜLEL O, KOLBAKIR F (2008). The effect of preoperative circadian blood pressure pattern on early postoperative outcomes in patients with coronary artery bypass graft surgery. Anadolu Kardiyoloji Dergisi, 8(5), 354 - 359.
Chicago	BAHÇIVAN Muzaffer,GÜLEL Okan,KOLBAKIR FERŞAT The effect of preoperative circadian blood pressure pattern on early postoperative outcomes in patients with coronary artery bypass graft surgery. Anadolu Kardiyoloji Dergisi 8, no.5 (2008): 354 - 359.
MLA	BAHÇIVAN Muzaffer,GÜLEL Okan,KOLBAKIR FERŞAT The effect of preoperative circadian blood pressure pattern on early postoperative outcomes in patients with coronary artery bypass graft surgery. Anadolu Kardiyoloji Dergisi, vol.8, no.5, 2008, ss.354 - 359.
AMA	BAHÇIVAN M,GÜLEL O,KOLBAKIR F The effect of preoperative circadian blood pressure pattern on early postoperative outcomes in patients with coronary artery bypass graft surgery. Anadolu Kardiyoloji Dergisi. 2008; 8(5): 354 - 359.
Vancouver	BAHÇIVAN M,GÜLEL O,KOLBAKIR F The effect of preoperative circadian blood pressure pattern on early postoperative outcomes in patients with coronary artery bypass graft surgery. Anadolu Kardiyoloji Dergisi. 2008; 8(5): 354 - 359.
IEEE	BAHÇIVAN M,GÜLEL O,KOLBAKIR F "The effect of preoperative circadian blood pressure pattern on early postoperative outcomes in patients with coronary artery bypass graft surgery." Anadolu Kardiyoloji Dergisi, 8, ss.354 - 359, 2008.
ISNAD	BAHÇIVAN, Muzaffer vd. "The effect of preoperative circadian blood pressure pattern on early postoperative outcomes in patients with coronary artery bypass graft surgery". Anadolu Kardiyoloji Dergisi 8/5 (2008), 354-359.