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Doctoral Thesis
DOI
10.11606/T.5.2004.tde-04042007-134346
Document
Author
Full name
Nilzo Augusto Mendes Ribeiro
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2004
Supervisor
Committee
Stolf, Noedir Antonio Groppo (President)
Evora, Paulo Roberto Barbosa
Loures, Danton Richlin da Rocha
Oliveira, Sergio Almeida de
Rivetti, Luis Antônio
Title in Portuguese
Variáveis hemodinâmicas, gasométricas e imunomoleculares em pacientes submetidos a revascularização miocárdica com uso de azul de metileno: estudo clínico e prospectivo
Keywords in Portuguese
Azul de metileno
Citocinas
Estudos propectivos
Inflamação
Reação da fase aguda
Revascularização miocárdica
Abstract in Portuguese
O objetivo do presente estudo, prospectivo e randomizado, é avaliar comparativamente as respostas hemodinâmicas, laboratoriais, imunomoleculares e clínicas, em dois grupos de pacientes submetidos a cirurgia de revascularização miocárdica com extracorpórea utilizando-se, em um deles infusão de azul de metileno durante o período intraoperatório. As variáveis hemodinâmicas estudadas foram: FC, PAE, PVC, DC, RVS, RVP, PAPM, PASS, PASD e PASM. Os dados laboratoriais avaliados foram: gasometria arterial, creatinina, leucócitos, bastões, neutrófilos, eosinífilos, basófilos, linfócitos, Ht, Hb, paquetas, Na+ e K+. Os marcadores imunomoleculares estudados foram: IL - 1ß, IL-6, IL-8, IL-10, IL-12 p40, TNF alfa e NO. Os dados clínicos avaliados foram: idade, sexo, raça, tabagismo, hipertensão, diabetes, angina estável, angina instável, infarto prévio, tempo de CEC, tempo de pinçamento aórtico, número de pontes realizadas, urina azulada, fezes azuladas, diarréia, náuseas, cefaléia, tontura, disúria, astenia e dispnéia. As variáveis citadas foram obtidas em todos ou em parte dos períodos seguintes: antes da indução, terceira hora, sexta hora, 24ª hora e 48ª hora após o término da CEC. Ocorreram diferenças estatisticamente significativas na resistência vascular sistêmica, na pressão arterial sistêmica diastólica, em parte das citocinas estudadas e no óxido nítrico. A análise dos resultados mostra que no grupo que utilizou azul de metileno houve resistência vascular sistêmica mais alta no período da sexta hora de pós-operátório, menor concentração de TNF alfa no período da terceira e 48ª hora e menores níveis de óxido nítrico no período da sexta hora. As medidas laboratoriais foram semelhantes em ambos os grupos exceto maior número de leucócitos e neutrófilos na 48ª hora após CEC no grupo contrôle. Verifica-se que o azul de metileno levou a melhores condições hemodinâmicas e menores valores e alguns marcadores de reposta inflamatória sistêmica após cirurgia de revascularização miocárdica com circulação extra-corpórea e não apresentou efeitos adversos importantes.
Title in English
Hemodynamic, gasometric and immunomolecular responses to coronary artery bypass grafting with methylene blue infusion: a randomized and prospective study
Keywords in English
Acute-phase reaction
Cytokines
Inflammation
Methylene blue
Myocardial revascularization
Prospective studies
Abstract in English
The objective of the present study, prospective and randomized, is to evaluate the hemodynamic, gasometric, immunomolecular and clinical response in two groups of patients submited to coronary artery surgery under cardiopulmonary bypass with the use, in one of them, of methylene blue infusion during the intraoperative period. The hemodynamic variable data evaluated were: heart rate, left atrial pressure, central venous pressure, cardiac output, systemic vascular resistance, pulmonary vascular resistance, mean pulmonary artery pressure, systolic systemic arterial pressure, dyastolic systemic arterial pressure and mean systemic arterial pressure. Laboratoryal data were: arterial gasimetry, urea, creatinine, leucocytes, neutrophils, eosinophils, basophils, lymphocytes, hematocrit, hemoglobin, platelets, sodium and potassium. The immunomolecular data were: IL-1ß, IL-6, IL-8, IL-10, IL-12p40, TNF alfa and NO. The clinical data evaluated were: age, gender, race, smoking, hypertension, diabetes, stable angina, unstable angina, previous infarction, cardiopulmonary bypass duration, aortic cross-clamp time, graft number, bluish urine, bluish feces, diarrhea, nausea, headache, dizziness, dysuria, tiredness and dyspnea. All the data were obtained, in all or part of the following periods: before the anesthesia and at the third, sixth, 24th and 48th hour after the end of the cardiopulmonary bypass. Statistically significant differences occurred in the systemic vascular resistance, diastolic systemic arterial pressure and in part of the evaluated cytokines, as well as with the nitric oxide. The analysis of the results show that, in the methylene blue patients group, the systemic vascular resistance was higher at the sixth hour, lower concentrations of TNF alfa at the third and at the 48th hour and lower levels of NO at the 6th hour. The laboratorial data were similar in the two groups, except for the number of leucocytes and neutrophils were higher in the control group at the 48th hour after the end of the cardiopulmonary bypass. The gasometric data showed no difference between the groups. It was verified that the methylene blue has induced better hemodynamic conditions and lower levels of part of markers of SIRS after coronary artery surgery under cardiopulmonary bypass and no siginifcant deleterious side effects.
 
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Nilzoamribeiro.pdf (387.07 Kbytes)
Publishing Date
2007-04-09
 
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