Kardiyopulmoner Baypass Sırasında Homosistein, Vitamin B12 ve Folik Asit Seviyelerinin Değişimi ve Birbirleri ile Olan İlişkilerinin İncelenmesi

Ozet Amac: Yaptigimiz bu calismada Kardiyopulmoner bypass (KPB) sirasinda homosistein, vitamin B12 ve folik asit parametrelerinin degisimlerine bakilarak birbirleri ile olan iliskilerinin arastirilmasi amaclanmistir. Materyal ve Metod: Gogus Kalp Damar Cerrahisi bolumunde cesitli sebeplerden dolayi KPB cerrahisi ile ameliyat olan hastalardan ameliyat oncesi, pompaya (kalp akciger makinesi) giris, kross klemp sonrasi ve protamin verilmesi sonrasi olmak uzere 4 jelsiz tupe kan alinarak bir calisma grubu olusturuldu. Alinan kanlarda serum Vitamin B12 duzeyi ve serum Folik asit duzeyi Kemiluminesans yontemi ile serum Homosistein duzeyi ise Kolorimetrik yontem ile olculmustur. Bulgular: Vitamin B12, pg/MI degeri; Ameliyat oncesi 206.30 ±64.76, Pompaya Giris108.03 ± 35.75, Kross Klemp Sonrasi 128.53 ± 38.43, Protamin Sonrasi 141.33 ± 39.21, p<0,001 olarak bulunmustur. Folik Asit, ng/MI degeri sirasiyla; 10.04 ± 2.89, 6.53 ± 1.84, 6.53 ± 1.95,  9.02 ± 2.83 ve p<0,001 olarak bulunmustur. Homosistein, μmol/L         degeri sirasiyla;14.40 ± 4.48, 7.63 ± 2.30, 9.44 ± 2.62, 9.15 ± 2.55 ve p<0,001 olarak bulunmustur. Sonuc: Pompaya giriste homosistein, vitamin B12 ve folik asit duzeyi prime solusyondan dolayi sayisal olarak duserken; pompa girisinden kross klemp sonrasina kadar homosisteinde anlamli artis olmus, folik asit duzeyinde artis olmamis, vitamin B12 oranindaki artis ise homosistein kadar olmamistir. Bu durum Vitamin B12 ve Folik asit duzeyi ile serum homosistein konsantrasyonu arasinda negatif bir korelasyon gostermistir. Kross klemp sonrasindan protamin sonrasina kadarki donemde homosistein seviyesinde dusus olmasina ragmen, Vitamin B12 ve folik asit seviyesinde yukselmeler olmustur. Bu yukseklik homositeinin Vitamin B12 ve folik asit ile negatif iliskisine destek olmaktadir. Perfuzyon suresi uzadikca artan inflamatuar yanit ve kullanilan ilaclar ile homosistein seviyesinde degisimlere neden olmus fakat bu etkilesimlerin homosistein, Vitamin B12 ve folik asit duzeyi ile iliskisi istatistiksel olarak gosterilememistir. INVESTIGATION OF THE RELATIONSHIP BETWEEN HOMOCYSTEINE, VITAMIN B12 AND FOLIC ACID LEVELS AND THEIR RELATIONSHIP BETWEEN THE CARDIOPULMONARY BYPASS ABSTRACT Background: The aim of this study was to investigate the association between homocysteine, vitamin B12 and folic acid parameters in cardiopulmonary bypass (CPB). Methods: In the thoracic cardiovascular surgery department, a study group was formed by taking 4 gel-free scales from pre-operative, pump (heart lung machine), after cross-clamp and protamine administration from patients who underwent surgery with CPB surgery for various reasons. Serum vitamin B12 level and serum Folic acid level were measured by chemiluminescence method and serum homocysteine level by Colorimetric method. Results: Vitamin B12, pg / mL value; Preoperatively 206.30 ± 64.76, Pump Entry 108.03 ± 35.75, Post Cross Clamp 128.53 ± 38.43, Post Protamine 141.33 ± 39.21, p <0.001. Folic Acid, ng / ml value respectively; 10.04 ± 2.89, 6.53 ± 1.84, 6.53 ± 1.95, 9.02 ± 2.83 and p <0.001 respectively. Homocysteine, μmol / L values were found to be 14.40 ± 4.48, 7.63 ± 2.30, 9.44 ± 2.62, 9.15 ± 2.55 and p <0.001 respectively. Conclusions: While homocysteine, vitamin B12 and folic acid levels were decreased by prime solu- tion in the pump, there was a significant increase in homocysteine from the pump inlet to the end of the cross clamp, no increase in folic acid level, and no increase in vitamin B12 as homocysteine. This showed a negative correlation between Vitamin B12 and Folic acid level and serum homocysteine concentration. Although there was a decrease in homocysteine levels after the crosstalk after protamine, there was a rise in vitamin B12 and folic acid levels. This elevation supports the negative association of homocyte with Vitamin B12 and folic acid. Increased duration of perfusion resulted in increased inflammatory response and changes in homocysteine levels with drugs used, but these interactions were not statistically related to homocysteine, Vitamin B12 and folic acid levels.