Perfüzyon Pratiğinde Biyobelirteçler: Güncel Yaklaşımlar ve Klinik Perspektifler

Mehmet Ramat; Mahmut Padak

doi:10.5281/zenodo.18103813

Yazarlar

Mehmet Ramat Harran Üniversitesi https://orcid.org/0000-0003-4922-6708
Mahmut Padak Harran University, Institute of Health Sciences, Department of Perfusion Technologies, Şanlıurfa, Turkey https://orcid.org/0000-0001-6863-1907

DOI:

https://doi.org/10.5281/zenodo.18103813

Anahtar Kelimeler:

Kardiyopulmoner Bypass, Biyobelirteç, Endotel Glikokaliks, Akut Böbrek Hasarı, Viskoelastik Testler

Özet

Amaç: Kardiyopulmıner bypass (KPB) sırasında ve sonrasında gelişen hemodilüsyon, iskemi-reperfüzyon hasarı ve sistemik inflamatuvar yanıtla ilişkili endotel, renal, nörolojik, miyokardiyal, inflamatuvar ve hemostaz biyobelirteçlerinin klinik önemini güncel kanıtlar ışığında bütüncül olarak değerlendirmek; risk sınıflaması ve kişiselleştirilmiş tedaviye katkılarını ortaya koymak.

Materyal ve Metot: Konuya ilişkin güncel literatür gözden geçirilmiş; KPB uygulanan hastalarda biyobelirteçlerin (endotel glikokaliks ürünleri, renal hasar belirteçleri, nörospesifik proteinler, kardiyak belirteçler ve hemostaz göstergeleri) tanısal/öngörüsel değerini inceleyen klinik çalışmalar ve derlemeler karşılaştırmalı olarak değerlendirilmiştir. Tek biyobelirteç temelli yaklaşımlar ile panel/çoklu belirteç ve hasta başı (TEG/ROTEM) fonksiyonel test entegrasyonunu inceleyen çalışmalar özellikle dikkate alınmıştır.

Bulgular: KPB’de biyobelirteçler çok eksenli etkilenimi ortaya koymaktadır: Endotel glikokaliks yıkım ürünleri (özellikle syndecan-1) damar bariyerinin bozulmasını ve kapiller kaçak riskini yansıtırken, renal eksende NGAL ile TIMP-2·IGFBP7 akut böbrek hasarını serum kreatinine kıyasla daha erken dönemde öngörebilmektedir. Nörolojik etkilenimde S100B, NSE ve GFAP, ameliyat sonrası bilişsel bozulma ve deliryum riskine işaret eden nörospesifik göstergeler olarak öne çıkmaktadır. Miyokardiyal stres ve prognoz değerlendirmesinde yüksek duyarlılıklı troponinler ile NT-proBNP güçlü öngörücülük sergilemekte; hemostaz dengesinde ise D-dimer, trombin-antitrombin (TAT) kompleksleri ve viskoelastik testler (TEG/ROTEM) kanama-tromboz yönetiminde tamamlayıcı bilgi sağlamaktadır. Bununla birlikte tek bir belirtece dayalı karar verme, özgüllük ve zamanlama sınırlılıkları nedeniyle yetersiz kalmakta; panel temelli değerlendirmelerin hasta başı fonksiyonel testlerle entegrasyonu daha güvenilir ve klinik olarak işe yarar bir yaklaşım sunmaktadır.

Tartışma ve Sonuç: KPB pratiğinde biyobelirteçlerin erken komplikasyon saptaması, risk düzeylemesi ve tedavinin kişiselleştirilmesi açısından belirgin potansiyeli vardır. Endotel, renal, nörolojik, kardiyak ve hemostatik eksenleri birlikte izleyen panel-temelli yaklaşımlar ile TEG/ROTEM gibi fonksiyonel testlerin entegrasyonu, tek belirtece dayalı kararların sınırlılıklarını azaltır ve klinik doğruluğu artırır. Rutin perfüzyon pratiğine sistematik entegrasyon; kapiller kaçak, AKI, nörokognitif bozulma, kardiyak disfonksiyon ve kanama/tromboz dengesizliğinin daha erken ve hedefe yönelik yönetimini mümkün kılabilir. Bununla birlikte, standardize eşik değerlerin belirlenmesi ve çok merkezli, geniş ölçekli klinik çalışmaların yürütülmesi, bulguların genellenebilirliğini ve klinik uygulamaya tam aktarımını sağlamak için gereklidir.

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