Avaliação de pacientes pediatricos submetidos as correções de comunicação interatrial e de comunicação interventricular : do pre-operatorio a extubação
Elaine Abrahão Dias
DISSERTAÇÃO
Português
T/UNICAMP D543a
Campinas, SP : [s.n.], 2004.
86f. : il.
Orientador: Jose Dirceu Ribeiro
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
Resumo: Objetivo: Avaliar a evolução, desde o período pré-operatório até a extubação de pacientes pediátricos submetidos aos procedimentos cirúrgicos para correção de comunicação interatrial (CIA) e comunicação interventricular (CIV) no HC-UNICAMP e verificar a correlação do tempo de ventilação...
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Resumo: Objetivo: Avaliar a evolução, desde o período pré-operatório até a extubação de pacientes pediátricos submetidos aos procedimentos cirúrgicos para correção de comunicação interatrial (CIA) e comunicação interventricular (CIV) no HC-UNICAMP e verificar a correlação do tempo de ventilação mecânica (VM), com variáveis pré e intra-operatórias. Métodos: Realizou-se um estudo descritivo, retrospectivo, baseado na investigação de variáveis pré, intra e pós-operatórias de 46 crianças e adolescentes que realizaram cirurgia corretiva de CIA e CIV no período de abril de 1998 a abril de 2002. A análise estatística foi realizada utilizando-se o programa "Statistical Analysis System" para Windows, versão 8,02. Resultados: Foram incluídos 46 pacientes (29 do sexo masculino). Vinte e sete (27) foram submetidos à correção de CIA e 19 de CIV - 26 tinham CIA tipo ostium secundum e 1, tipo ostium primum; 18 apresentaram CIV perimembranosa e 1, de via de entrada. O tempo de utilização de circulação extracorpórea (CEC) variou entre 25 e 100 min (47,13:t: 16,54). O oxigenador utilizado foi do tipo membrana em todas as cirurgias. A hipotermia sistêmica foi de leve a moderada, não sendo observado caso de hipotermia profunda. Foi utilizada a ultrafiltração, simples ou modificada, em 23/45 pacientes, sendo que este recurso foi mais utilizado naqueles com CIV. Os pacientes com CIV apresentaram diferença significante quanto à idade (3,17 vs 6,60) e ao peso para idade (-1,40:t: 1,18 vs -O,29:t: 1,60), mas não em relação à altura para idade, quando comparados àqueles com ClA; apresentaram maior tempo de CEC, de pinçamento da aorta, de isquemia do miocárdio (não contínua), de anestesia e de VM. Vinte e nove dos 46 (63,04%) foram extubados em até 3 horas. Pacientes que cursaram com tempo de VM superior a 3 horas eram mais jovens, tinham menor peso, maiores tempos de CEC e de isquemia do miocárdio e, menor temperatura nasofaríngea alcançada durante a CEC. Não houve diferença significante entre os pacientes submetidos à ultrafiltração e aqueles que não foram.Todos evoluíram com sucesso da extubação e nenhum óbito ocorreu. Conclusão: Pacientes desta amostra apresentaram déficit nutricional, expresso primariamente pelo comprometimento do peso, não houve tempo para alterações significantes na altura. Aqueles que evoluíram com tempo de VM superior a 3 horas eram mais jovens, com menor peso e tiveram maiores tempos de CEC. O grupo com CIV mostrou evolução diferenciada, pela maior complexidade clínica e cirúrgica. São necessários estudos randomizados para elucidar o mecanismo de ação e vantagens da ultrafiltração para o pós-operatório. Não ocorreram falhas na extubação para as cardiopatias
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Abstract: Objective: To evaluate the evolution of pediatric patients submitted to surgical procedures to correct atrial septal defect (ASD) and ventricular septal defect (VSD) at the Teaching Hospital of State University of Campinas (UNICAMP), trom the preoperative period until the extubation, and...
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Abstract: Objective: To evaluate the evolution of pediatric patients submitted to surgical procedures to correct atrial septal defect (ASD) and ventricular septal defect (VSD) at the Teaching Hospital of State University of Campinas (UNICAMP), trom the preoperative period until the extubation, and to verify the correlation of mechanicalventilation (MV) time with pre-and intraoperative variables.
Methods: A retrospective descriptive study based on investigation of pre-, intra- and postoperative variables of 46 children and teenagers submitted to corrective surgery of ASD and VSD was carried out in the period trom April1998 to April2002. The statistical
analysis was performed using the Statistical Analysis System for Windows software, version 8.02. Results: The population included 46 patients (29 males). Twenty-seven (27) patients were submitted to ASD correction and 19to VSD, ofwhich 26 had ostium secundum and 1 had the ostium primum type (ASD) while 18 presented perimembranous defect and 1 presented inlet septal defect (VSD). The length of time the patients were on cardiopulmonary bypass (CPB) varied between 25 and 100 minutes (47.13 +- 16.54). The
oxygenator used was of the membrane type in alI the surgeries performed. Systemic hypothermia was trom light to moderate and no case of deep hypothermia was observed. The use of ultrafiltration, either simple or modified, was identified in 23/45 patients, and
this resource was used more often in those with VSD. The VSD group showed some differences regarding age (3.17 vs 6.60) and weight to age ratio (-1.40::1:1.18 vs -0.29::1: 1.60), but no difference in the height to age ratio; it required more time for cardiopulmonary bypass (CPB), aortic cross-clamp, myocardial ischemia (not continuous), anesthesia and mechanical ventilation. Twenty-nine of the 46 patients (63.04%) were extubated in up to 3 hours; patients with MV time longer than 3 hours were younger,
weighed less, had longer CPB and myocardial ischemia times and lower nasopharyngeal temperature during CPB; there was no difference between patients who had or had not been submitted to uItrafiltration. All of them progressed successfully from extubation and no death occurred. Conclusion: Patients of this sample showed nutritional deficits primarily expressed by weight deficit; there was no time for their height to be compromised. Those who had MV time superior to 3 hours were younger, weighed less and required longer periods of CPB support. The VSD group showed a differentiated evolution, as a consequence of higher clinical and surgical complexity. It is necessary to carry out random studies to elucidate the mechanism of action and the advantages of ultrafiltration in the postoperative period. There were no extubation failures in the studied cardiopathy cases Ver menos
Methods: A retrospective descriptive study based on investigation of pre-, intra- and postoperative variables of 46 children and teenagers submitted to corrective surgery of ASD and VSD was carried out in the period trom April1998 to April2002. The statistical
analysis was performed using the Statistical Analysis System for Windows software, version 8.02. Results: The population included 46 patients (29 males). Twenty-seven (27) patients were submitted to ASD correction and 19to VSD, ofwhich 26 had ostium secundum and 1 had the ostium primum type (ASD) while 18 presented perimembranous defect and 1 presented inlet septal defect (VSD). The length of time the patients were on cardiopulmonary bypass (CPB) varied between 25 and 100 minutes (47.13 +- 16.54). The
oxygenator used was of the membrane type in alI the surgeries performed. Systemic hypothermia was trom light to moderate and no case of deep hypothermia was observed. The use of ultrafiltration, either simple or modified, was identified in 23/45 patients, and
this resource was used more often in those with VSD. The VSD group showed some differences regarding age (3.17 vs 6.60) and weight to age ratio (-1.40::1:1.18 vs -0.29::1: 1.60), but no difference in the height to age ratio; it required more time for cardiopulmonary bypass (CPB), aortic cross-clamp, myocardial ischemia (not continuous), anesthesia and mechanical ventilation. Twenty-nine of the 46 patients (63.04%) were extubated in up to 3 hours; patients with MV time longer than 3 hours were younger,
weighed less, had longer CPB and myocardial ischemia times and lower nasopharyngeal temperature during CPB; there was no difference between patients who had or had not been submitted to uItrafiltration. All of them progressed successfully from extubation and no death occurred. Conclusion: Patients of this sample showed nutritional deficits primarily expressed by weight deficit; there was no time for their height to be compromised. Those who had MV time superior to 3 hours were younger, weighed less and required longer periods of CPB support. The VSD group showed a differentiated evolution, as a consequence of higher clinical and surgical complexity. It is necessary to carry out random studies to elucidate the mechanism of action and the advantages of ultrafiltration in the postoperative period. There were no extubation failures in the studied cardiopathy cases Ver menos
Avaliação de pacientes pediatricos submetidos as correções de comunicação interatrial e de comunicação interventricular : do pre-operatorio a extubação
Elaine Abrahão Dias
Avaliação de pacientes pediatricos submetidos as correções de comunicação interatrial e de comunicação interventricular : do pre-operatorio a extubação
Elaine Abrahão Dias
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