Effects of hydroxyethyl starch %6 130/0.4 (voluven), hes%10 200/0.5 ve ringer usage for priming solutıon on inflammatuary responce and morbıdıty in extracorporeal cırculatıon

2.SUMMARY:EFFECTS OF HYDROXYETHYL STARCH %6 130/0.4 (VOLUVEN), HES%10200/0.5 VE RİNGER USAGE FOR PRİMİNG SOLUTION ON INFLAMMATUARYRESPONCE AND MORBIDITY IN EXTRACORPOREAL CIRCULATIONDr.Goksel Kilci, Dokuz Eylül University Faculty of Medicine Department ofCardiovascular Surgery, Izmir, Turkey.(goksel.kilci@deu.edu.tr)OBJECTIVES: Extracorporeal circulation is one of the most important invention ofmodern medicine which induce open heart surgery possible. In extracorporeal circulationblood and ingredients of blood contact with given solution and artificial surfaces. Afterextracorporeal circulation coagulapathies and important pathological changes in cardiac,pulmonary, renal and cerebral functions. Also systemic diferentiations as fever, increasedcapillary permeability, increased interstitial fluid collection and leucocytosis reported. Inthis study Ringer, HES %10 200/0.5 and HES %6 130/0.4 solutions with differentosmolarity used in priming solution to search their effect on renal function, post operativebleeding, blood replacement and PT, aPTT, INR, Complement and CRP levels. All threesolutions were used safely as priming solution in worldwide.METHODS: We studied on 45 patients undergoing coronary artery bypass surgery atDokuz Eylül University Faculty of Medicine Department of Cardiovascular Surgerybetween dates 07.09.2005-17.04.2006. Patients divided into three groups. Priming solutionin control group prepared with Ringer solution and in experimental groups with 100ccHES 10% 200/0.5 AND HES 6% 130/0.4 solutions. Also priming solutions consisted ofmannitol 20% 3ml/kg BW, sodium bicarbonate 30 mEq, potassium chloride 10mEq andmagnesium sulphate 10mEq. Blood samples for CRP, C3, C4 were obtained: (1)afterintravenous heparin (3mg/kg) administration before CPB; (2) after CPB; (3) two hoursafter CPB and (4) four hours after CPB from radial arteriel line. Also we measure 24 hoursdrainage and amount of blood usage, preoperative and postoperative 24?th hour CBC, PT,aPTT, INR, BUN, Creatinin levels. Blood samples for plasma colloid oncotic pressurewere obtained: (1) after induction of anesthesia before skin incision; (2) 15 minute after theonset of CPB following cardioplegic cardiac arrest; (3) before weaning from CPB; (4) twohours after CPB and (5) four hours after CPB. Also we measured postoperative extubationtime. Patients showing the following characteristics were not included in the study:emergency operations; additional valvular diseases; impaired renal function (creatinine>1.3 mg%); hematocrit <30%.FINDINGS: In our study statistically important difference between Ringer, 6% HES130/0.4 and 10% HES 200/0.5 groups according to age, sex, height, body surface area,body weight, diabetes mellitus, hypertension, myocardial infarction, ACC, CPB, drainageamount (cc), extubation time (hour), intensive care period (day), number of anastomosesand CRP did not find. C3 level of blood which was taken at the end of CPB in 10% HESgroup was found lower from ringer group (p<0.05). Also four hours after end of CPB C3level was lower in 10% HES 200/0.5 group then %6 HES 130/0.4 group (p<0.05). C4 levelof 10% HES group was lower then other groups in repeated measurements. Becouse oflower C4 level in this group before CPB, significant differences in C4 levels was not foundreliable.RESULT: Ringer, 6% HES 130/0.4 and 10% HES 200/0.5 solutions are reliable solutionsfor mortality and morbidity as prime solution. In 10% HES 200/0.5 solution of these threesolutions; C3 levels at the end of CPB and four hours after CPB found significantly lowerthan ringer and 6% HES 130/0.4 solutions. And this shows that compleman activation inthis group possibly higher than others.Key Words: : HES 130/0.4, HES 200/0.5, Ringer, Complement, CRP, CPB