Variáveis hemodinâmicas, gasométricas e imunomoleculares em pacientes submetidos a revascularização miocárdica com uso de azul de metileno: estudo clínico e prospectivo / Hemodynamic, gasometric and immunomolecular responses to coronary artery bypass grafting with methylene blue infusion: a randomized and prospective study

AUTOR(ES)

Nilzo Augusto Mendes Ribeiro

DATA DE PUBLICAÇÃO

2004

RESUMO

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.

ASSUNTO(S)

estudos propectivos inflammation azul de metileno inflamação revascularização miocárdica methylene blue prospective studies myocardial revascularization cytokines citocinas reação da fase aguda acute-phase reaction

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