Efeitos da pleurotomia na mecânica pulmonar e trocas gasosas após cirurgia de revascularização do miocárdio sem circulação extracorpórea
Arquivos
Data
2008
Autores
Tavolaro, Kelly Cristiani 
Orientadores
Gomes, Walter José
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
OBJETIVO: Avaliar os efeitos da pleurotomia na mecânica pulmonar e trocas gasosas após cirurgia de revascularização do miocárdio (RM), utilizando enxerto de artéria torácica interna esquerda (ATIE), sem circulação extracorpórea (CEC). MÉTODO: Trinta e dois pacientes foram alocados prospectivamente em dois
grupos: grupo PA (n=16 pacientes com abertura da cavidade pleural esquerda); grupo PI (n=16 pacientes com cavidade pleural intacta). Todos os pacientes foram submetidos às medidas de complacência pulmonar e resistência de vias aéreas durante a cirurgia de RM, antes da abertura do tórax e após o fechamento do
tórax. Nestes momentos também foram avaliados os gases sanguíneos arteriais e o shunt pulmonar. RESULTADOS: Ambos os grupos obtiveram queda significante da complacência estática após o fechamento do tórax (p<0,0001) mas quando comparados entre si o grupo PA obteve queda significantemente maior (p=0,017).
Houve queda da complacência dinâmica para ambos os grupos (p<0,0001), no entanto, entre os grupos não houve diferença significante (p=0,13). A resistência de vias aéreas aumentou em ambos os grupos (p<0,05), porém o grupo PA mostrou maior aumento (p=0,013). Houve decréscimo da PaO2 em ambos os grupos (p<0,0001) com maior queda para o grupo PA (p=0,046). O shunt pulmonar aumentou em ambos os grupos (p<0,0001), mas o grupo PA apresentou maior aumento (p=0,046). O tempo de intubação orotraqueal (p=0,041) e a permanência no hospital (p=0,0004) foram menores no grupo PI. CONCLUSÃO: A cirurgia de RM, utilizando enxerto de ATIE sem CEC, independente da abertura pleural induziu um significante prejuízo na mecânica pulmonar e trocas gasosas após fechamento do tórax. Entretanto os pacientes submetidos à pleurotomia demonstraram um decréscimo maior da complacência estática e aumento mais acentuado da resistência de vias aéreas e do shunt pulmonar quando comparado aos pacientes com pleura intacta.
BACKGROUND: To evaluate the effects of pleurotomy on pulmonary mechanics and gas changes after off-pump coronary artery bypass (OPCAB) using left internal thoracic artery (LITA). METHODS: Thirty two patients were prospectively allocated in two groups: group OP (n=16 patients with opened left pleural cavity); group IP (n=16 patients with intact pleural cavity). All patients were submit for the measure of the pulmonary compliance and resistance of the lungs during the surgery, before the median sternotomy and after the chest closed. In this moment were analyzed the artery blood gas and pulmonary shunt. RESULTS: Both groups showed significantly decrease of static lung compliance after chest closed (p<0,0001) but when compared both groups the group OP had a decrease significantly major (p=0,017). There was decrease of dynamic lung compliance for both groups (p<0,0001), however, between the groups there was no significantly difference (p=0,13). The resistance of the lungs increased in both groups (p<0,05), however the group OP has a major increase (p=0,013). There was decreased of PaO2 for both groups ((p<0,0001) with more decrease for the group OP (p=0,046). The pulmonary shunt had a significantly increase for both groups (p<0,0001), when compared both of then the OP had major increase (p=0,046). Orotracheal intubation time (p=0.041) and hospital stay (p=0,0004) were shorter in group IP. CONCLUSION: OPCAB using LITA, independently of pleural opening, induced significant damage on pulmonary mechanics and gas changes after the chest closed. However the patients undergoing pleurotomy demonstrated a major decrease of static compliance and major increase of the resistance of the lungs and pulmonary shunt when compared patients whit intact pleural cavity
BACKGROUND: To evaluate the effects of pleurotomy on pulmonary mechanics and gas changes after off-pump coronary artery bypass (OPCAB) using left internal thoracic artery (LITA). METHODS: Thirty two patients were prospectively allocated in two groups: group OP (n=16 patients with opened left pleural cavity); group IP (n=16 patients with intact pleural cavity). All patients were submit for the measure of the pulmonary compliance and resistance of the lungs during the surgery, before the median sternotomy and after the chest closed. In this moment were analyzed the artery blood gas and pulmonary shunt. RESULTS: Both groups showed significantly decrease of static lung compliance after chest closed (p<0,0001) but when compared both groups the group OP had a decrease significantly major (p=0,017). There was decrease of dynamic lung compliance for both groups (p<0,0001), however, between the groups there was no significantly difference (p=0,13). The resistance of the lungs increased in both groups (p<0,05), however the group OP has a major increase (p=0,013). There was decreased of PaO2 for both groups ((p<0,0001) with more decrease for the group OP (p=0,046). The pulmonary shunt had a significantly increase for both groups (p<0,0001), when compared both of then the OP had major increase (p=0,046). Orotracheal intubation time (p=0.041) and hospital stay (p=0,0004) were shorter in group IP. CONCLUSION: OPCAB using LITA, independently of pleural opening, induced significant damage on pulmonary mechanics and gas changes after the chest closed. However the patients undergoing pleurotomy demonstrated a major decrease of static compliance and major increase of the resistance of the lungs and pulmonary shunt when compared patients whit intact pleural cavity
Descrição
Citação
TAVOLARO, Kelly Cristiani. Efeitos da pleurotomia na mecânica pulmonar e trocas gasosas após cirurgia de revascularização do miocárdio sem circulação extracorpórea. 2008. 90 p. Dissertação (Mestrado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2008.