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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2021.tde-07022022-145100
Document
Author
Full name
Kamilla Alice de Lima Ramachotte
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2021
Supervisor
Committee
Teixeira, Andreza Corrêa (President)
Volpe, Fabio Antonio Perecim
Medeiros Filho, José Eymard Moraes de
Title in Portuguese
Dilatação vascular intrapulmonar: características clínicas, capacidade funcional e qualidade de vida em indivíduos a espera de transplante de fígado em um hospital universitário
Keywords in Portuguese
Capacidade funcional
Dilatação vascular intrapulmonar
Fisioterapia
Abstract in Portuguese
Introdução: a cirrose hepática (CH) representa o estágio final da doença hepática crônica, e o transplante de fígado (LT) é o principal tratamento. As principais complicações vasculares pulmonares que acometem portadores de doença hepática crônica são a hipertensão portopulmonar (HPP) e a síndrome hepatopulmonar (SHP), esta última caracterizada por: 1) oxigenação arterial anormal; 2) dilatação vascular intrapulmonar (DVIP); e 3) doença hepática grave, hipertensão portal (HP), ou shunt portossistêmico congênito. Há lacunas na literatura sobre o perfil dos pacientes candidatos ao LT que apresentam DVIP. Objetivo: avaliar a presença de DVIP, em indivíduos incluídos em lista de espera para LT, e suas características clínicas, laboratoriais, capacidade funcional e qualidade de vida. Método: estudo prospectivo, descritivo e qualitativo, envolvendo participantes em lista de espera para LT, no Hospital das Clínicas FMRP-USP entre junho de 2018 e julho de 2020. Os participantes foram submetidos a exames laboratoriais, espirometria, ecocardiograma, testes para avaliação de capacidade funcional (dinamometria, manovacuometria, teste de sentar e levantar e teste de caminhada) e os questionários de qualidade de vida Medical outcomes short-form health survey (SF-36) e Chronic liver disease questionnaire (CLDQ). Resultado: 159 pacientes foram inscritos em lista de espera para LT. Destes, 81 participantes foram incluídos no estudo. A mediana de idade foi de 55 anos, com 71,6% do sexo masculino. A presença de DVIP foi evidenciada em 73,5% dos participantes, e 37,7% receberam o diagnóstico de SHP. Maiores valores de pressão arterial parcial de oxigênio (PaO2) e maior distância percorrida no teste de caminhada de seis minutos (TC6), além de menores valores de gradiente alvéolo-arterial (P(A-a)O2) e Borg referido no TC6 foram encontrados no grupo com DIVP, quando comparados àqueles sem DVIP ou com SHP. Maior frequência de encefalopatia hepática (EH), maiores valores de hemoglobina (HB) foram encontrados nos portadores de SHP, bem como, menor média de pressão expiratória máxima (PEmáx). Quando avaliada a qualidade de vida pelo questionário SF-36, maior percepção de dor foi relatada pelos portadores de SHP. Conclusão: A frequência de portadores de DVIP, em indivíduos em lista de espera para LT, no presente estudo, foi de 73,5%, com 37,7% apresentando critérios para SHP. Os participantes com SHP apresentaram maior frequência de EH, pior desempenho nos testes de capacidade funcional e maior percepção de dor, quando avaliada a qualidade de vida. Pesquisas futuras, se mostram necessárias para um melhor acompanhamento desses pacientes, bem como melhor entendimento do mecanismo fisiopatológico envolvido, e em qual momento esses pacientes deixam de apresentar hiperoxemia para evoluir com hipoxemia.
Title in English
Intrapulmonary vascular dilatation: clinical features, functional status and quality of life in individuals awaiting for liver transplantation in a university hospital
Keywords in English
Functional capacity
Intrapulmonary vascular dilation
Physiotherapy
Abstract in English
Introduction: liver cirrhosis (HC) represents the end-stage of chronic liver disease, and liver transplantation (LT) is the main treatment. The main pulmonary vascular complications that affect patients with chronic liver disease are portopulmonary hypertension (PPH) and hepatopulmonary syndrome (HPS), the latter characterized by: 1) abnormal arterial oxygenation; 2) intrapulmonary vascular dilation (DVIP); and 3) severe liver disease, portal hypertension (PH), or congenital portosystemic shunt. There are gaps in the literature on the profile of patients who are candidates for TL who have IPVD. Objective: to evaluate the presence of IPVD in individuals included on the waiting list for LT, and its clinical and laboratory characteristics, functional capacity and quality of life. Method: prospective, descriptive and qualitative study, involving participants on a waiting list for LT, at the Hospital das Clínicas FMRP-USP between June 2018 and July 2020. Participants underwent laboratory tests, spirometry, echocardiography, tests for evaluation of functional capacity (dynamometry, manovacuometry, sit and stand test and walk test) and the Medical Outcomes Short-form Health Survey (SF-36) and Chronic Liver Disease Questionnaire (CLDQ). Results: 159 patients were placed on the waiting list for LT. Of these, 81 participants were included in the study. The median age was 55 years, with 71.6% male. The presence of IPVD was evidenced in 73.5% of the participants, and 37.7% were diagnosed with HPS. Higher values of partial arterial oxygen pressure (PaO2) and greater distance walked in the six-minute walk test (6MWT), in addition to lower values of alveolar-arterial gradient (P(Aa)O2) and Borg reported in the 6MWT were found in the group with IPVD, when compared to those without IPVD or with HPS. Higher frequency of hepatic encephalopathy (HE), higher hemoglobin (HB) values were found in patients with HPS, as well as lower mean maximal expiratory pressure (PEmax). When quality of life was assessed using the SF-36 questionnaire, greater pain perception was reported by patients with HPS. Conclusions: The frequency of patients with IPVD, in individuals on the waiting list for LT, in the present study, was 73.5%, with 37.7% having criteria for HPS. Participants with HPS had a higher frequency of HE, worse performance on functional capacity tests and greater perception of pain, when assessing quality of life. Future research proves necessary for a better follow-up of these patients, as well as a better understanding of the pathophysiological mechanism involved, and at which point these patients no longer present hyperoxemia to progress to hypoxemia.
 
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Publishing Date
2022-02-16
 
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