Koroner arter bypass greftleme cerrahisi geçiren hastalarda görülen gastrointestinal sistem değişiklikleri ve intestinal fatty asit binding proteinin intestinal iskemide erken prediktör olarak kullanılabilir mi?

The incidence of gastrointestinal system complications in patients undergoing cardiopulmonary bypass, changes between 0.3-2%, which is rare. However, mortality rate is considerably high at patients that GIS complication is observed (%11-59). The aim of our study was to determine the incidence of GI complications in patients undergoing open heart surgery with or without CPB and to investigate the corelation between GI complications and plasma intestinal fatty acid binding protein (I-FABP) levels. After Başkent University Clinical Research and Ethics Committee and approval informed consent obtained, ASA III patients undergoing elective coronary artery bypass surgery greft aging between 50-70 were studied prospectively. CABG surgery was performed with or without CPB in 35 (group I) and 16 (group II) patients respectively preoperative and 24 hours postoperative. Patients with chest pain, hepatic or renal failure, ejection fraction less than 40%, needing valve surgery or reoperation were excluded from the study. Preoperative and 24th hour of postoperative period aspartate aminotransferase, alanine aminotransferase, total and direct bilirubin, amilase, blood urea nitrogen, creatinin, leukocyte and hemoglobin levels of the patients were recorded. Arterial blood gases, plasma I-FABP levels and intraabdominal pressures were measured before and immediately after the operation and 12 and 24 hours postoperatively. The variables between and within the groups were analized with Student's t and Mann Whitney U and Wilcoxon test respectively. The demographic properties were similiar. The duration of operation was longer CPB group (p<0.001). The number of greft was 3.8±1.16 and 2.1±0.88 in group I and II respectively (p<0.01). Although duration of mechanical ventilation and hospital stay was similar in both groups, intensive care unit was longer in the CPB group (p<0.001). In the CPB group had neurological complication postoperatively (p>0.05). Atrial fibrilation was observed in 8 patients postoperatively (p<0.043). Urine output the amount of red blood cell transfusion and cristalloid infusion were significantly higher in the CPB group. The amount of colloid infusion was higher in group II (p=0.035). First oral intake time was earlier in the group II (p<0.05). Defacation time of both groups were similar (p>0.05). Plasma AST, total and direct bilirubin and white blood cell levels were significantly high and hemoglobine levels were significantly low at 24th hour postoperatively in both groups when compared to preoperative values. Intraabdominal pressure values of both groups were similar during the study. Plasma I-FABP levels of both groups increased significantly at the end of the operation (p<0.05). This levels decreased in the CPB group at postoperative 12 and 24 hrs. In conclusion, we did not observe any GIS complication in our patients. However, postoperative AST, total and direct bilirubine, lactate levels increased significantly in both groups. Plasma IABP levels of both groups increased significantly at the end of the operation and return to preoperative levels. Therefore we consider plasma IABP levels may be used to verify GI changes in patients undergoing open heat surgery.