İki değişik kardiyoplejik solüsyonun koroner arter baypas cerrahisi geçiren diyabetik hastalarda koroner yataktan salınan nitrik oksit seviyelerine etkileri

Effects of different cardioplegic solutions on nitric oxide release from coronary vasculature in diabetic patients undergoing coronary artery bypass surgery

Tamer AKSOY, Fuat BİLGEN, Yavuz ENÇ, Nurgül YURTSEVEN, Onur SOKULLU, Sevim CANİK, Pelin KARACA

Abstract

Objective: The aim of this study was to compare the effects of two different cardioplegic solutions on nitric oxide (NO) release from coronary vasculature in patients with type II diabetes mellitus undergoing coronary artery bypass grafting (CABG) surgery. Methods: Forty patients undergoing elective CABG surgery were randomized to be given crystalloid (Group 1 ) or blood (Group 2) cardioplegia. Aortic and coronary sinus blood samples were taken at three different time periods and the release of NO from the coronary vasculature was determined by measuring its stable end-products, nitrite and nitrate. The difference between the aortic and coronary sinus concentrations of nitrite and nitrate represents the amount of NO released by coronary vascular bed. Results: Before application of aortic cross-clamp, at T1 period, the levels of nitrite/nitrate from the coronary vasculature were similar in both groups (6.53±1.21 µM vs 6.07±1.24 µM , p> 0.05). However after the removal of cross-clamp, a significant decrease in NO was observed in Group 1 as compared with Group 2 (4.21±0.73 µM vs 4.92±1.02 µM, p< 0.01) . This decrease persisted at T3 period, after 30 minutes of reperfusion in group 1 being significantly different from group 2 (3.86±0.49 vs 4.37±0.72 µM, p

Özet

Amaç: Bu çalışmada kan ve kristalloid kardiyoplejinin tip II diyabeti olan hastalarda koroner yataktan salınan nitrik oksit (NO) düzeylerine etkilerini karşılaştırmayı amaçladık. Yöntemler: Kırk hasta iki gruba ayrılarak Grup 1'de kristalloid; Grup 2'de kan kardiyoplejisi kullanılmıştır. Aort ve koroner sinüs kanları 3 farklı zamanda alınmış ve NO seviyelerindeki fark koroner yataktan salınan NO olarak kabul edilmiştir. Ayrıca indüksiyon öncesi ve kardiyopulmoner baypastan çıktıktan 15 dakika sonra hemodinamik ölçüm yapılmıştır. Bulgular: Aortik kros klempten önce iki grup arasında farka rastlanmazken, kros klempin alınmasını takiben Grup 1'in NO seviyeleri anlamlı olarak düşük bulunmuştur (4.21±0.73 µM; 4.92±1.02 µM, p< 0.01). Bu düşüşün reperfüzyonun 30. dakikasında da sebat ettiği gözlenmiştir (3.86±0.49 µM; 4.37±0.72 µM, p