Avaliação de pacientes pediatricos submetidos as correções de comunicação interatrial e de comunicação interventricular : do pre-operatorio a extubação

AUTOR(ES)
DATA DE PUBLICAÇÃO

2004

RESUMO

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

ASSUNTO(S)

cardiopatias coração - cirurgia pediatria

ACESSO AO ARTIGO

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