Orientadores: Ivan Felizardo Contrera Toro, Ivete Alonso Bredda Saad / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T12:35:42Z (GMT). No. of bitstreams: 1 Roceto_LigiadosSantos_M.pdf: 1407131 bytes, checksum: 75d349f618530f2bd3849d582a7deaa0 (MD5) Previous issue date: 2011 / Resumo: Introdução: A aplicação de ventilação mecânica não invasiva (VMNI) no período pós-operatório (POS) pode restaurar a capacidade residual funcional, melhorar a oxigenação e poupar os músculos inspiratórios. Objetivos: Verificar e comparar a evolução de variáveis espirométricas, da gasometria arterial, do pico de fluxo expiratório (PFE), da dispneia e do relato de dor, além do tempo de permanência e borbulhamento dos drenos torácicos em dois grupos no POS de ressecção pulmonar: fisioterapia respiratória convencional (FRC) e a associação desta à pressão positiva contínua nas vias aéreas (CPAP). Método: Estudo prospectivo, intervencionista e não randomizado. A avaliação pré-operatória (PRE) constituiu-se da execução da Prova de Função Pulmonar (PFP), da gasometria arterial, do PFE e relato de dispneia, além da realização de espirometria de incentivo, e orientações quanto ao procedimento cirúrgico. Os atendimentos nos grupos FRC e CPAP foram realizados no POS imediato (POSi), primeiro e segundo POS (POS 1, POS2), e a reavaliação na alta hospitalar ou quinto POS . A VMNI foi aplicada durante duas horas e o ajuste pressórico estabelecido entre 7 e 8,5 cmH2O, sendo aumentado conforme tolerância do paciente. Foram analisados o Índice de Oxigenação (IO), relato de dor, presença e borbulhamento dos drenos, e as mesmas variáveis do PRE. Resultados: Houve diferença, entre os grupos, no borbulhamento do dreno anterior no POSi e POS1 (p=0,001 e p=0,012), e para o dreno posterior no POSi (p=0,036). Na análise intra grupo (FRC) verificou-se redução do IO entre PRE e POS1 (p=0,042), e, inter grupo houve aumento no grupo CPAP no POSi (p=0,035). Não houve diferenças significativas entre os dois grupos com relação à escala analógica de dor. Ao se verificar a dispneia no POSi e POS1 observaram-se diferenças significativas entre os grupos (p<0,001). Na análise entre os períodos observaram-se reduções significativas do VEF1 e CVF em ambos os grupos, com p<0,001. O PFE não apresentou diferença significativa entre os grupos (p=0,064). Conclusão: A aplicação preventiva da CPAP no POS de ressecção pulmonar proporcionou melhora da oxigenação sem aumento da perda aérea pelos drenos de tórax / Abstract: Introduction: The application of noninvasive ventilation (NIV) during the postoperative period (POS) can restore functional residual capacity, improve oxygenation and spare inspiratory muscles. Objectives: To determine and compare the evolution of spirometric variables, blood gases, peak expiratory flow (PEF), dyspnea and report of pain, and length of stay and bubbling of chest tubes in two postoperative groups of lung resection: chest physiotherapy (CP) and its association with continuous positive airway pressure (CPAP). Method: Prospective, and not randomized controlled trial. The preoperative evaluation (PRE) consisted of collection of Pulmonary Function Test, arterial blood gas analysis, the report of dyspnea, PEF, and performing such incentive spirometry, and information about the surgical procedure. Primary care groups CP and CPAP were performed in the immediately POS (POSi), first and second POS (POS1, POS2), and reassessment on discharge or fifth POS. NIV was applied for two hours and the pressure adjustment set between 7 and 8.5 cmH2O, and it was increased as the patient's tolerance. Were analyzed the oxygenation index (OI), reporting pain, presence and bubbling of drains, and the same variables from PRE. Results: There were differences between groups in the bubbling of the anterior drain in POSi and POS1, (p = 0.001 and p = 0.012), and for the posterior drain just in POSi (p = 0.036). In intra-group analysis (CP) showed a reduction of OI between PRE and POS1 (p = 0.042), and inter group increased in the CPAP group in the POSi (p = 0.035). There were no significant differences between the two groups to analog pain scale. For the dyspnea in POSi and POS1 were observed significant differences between groups (p <0.001). In the analysis between the periods observed significant reductions in FEV1 and FVC in both groups, p <0.001. The PEF was not significantly different between groups (p = 0.064). Conclusion: The application of CPAP in preventive postoperative pulmonary resection resulted in improved oxygenation without increasing air leaks through the thoracic drains / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

L'apnée obstructive du sommeil (AOS) est un problème de santé important, affectant jusqu’à 38% de la population générale et augmentant en prévalence avec l’âge. L'AOS mène à une hypoxémie intermittente, une fragmentation du sommeil et des changements de flot sanguin qui peuvent provoquer des dommages vasculaires et neuronaux. Récemment, des anomalies de flot sanguin cérébral (FSC) mesurées à l’éveil ont été observées chez les adultes présentant de l’AOS sévère. On ne sait toutefois pas si ces anomalies s’accentuent avec le temps et si le traitement de l'AOS (généralement la pression positive continue - PPC) peut diminuer ces anomalies chez les personnes âgées. Ainsi, ce projet de maîtrise vise à déterminer si le traitement par PPC d’une durée de 18 mois chez les personnes apnéiques de plus de 55 ans normalise le FSC mesuré en tomographie d'émission monophotonique. De plus, ce projet vise à investiguer les effets à moyen-terme de l'AOS non traitée relativement à un groupe contrôle. Nous avons émis l’hypothèse que les sujets avec de l'AOS traitée par PPC auront des augmentations de FSC dans des régions précédemment hypoperfusées alors que les individus avec l'AOS non traitée auront des diminutions de FSC à travers le temps dans des régions sensibles à l’AOS. Nous avons évalué 12 participants contrôles et 23 participants nouvellement diagnostiqués avec de l’AOS. Ces-derniers ont été référés à une clinique d’AOS et 13 d’entre eux ont suivi un traitement par PPC. Pour l’analyse de l’imagerie par émission monophotonique, nous avons utilisé une méthode basée sur le voxel ainsi qu’une méthode d’extraction pour mesurer les changements à travers le temps dans chacun des groupes. Nous avons observé une augmentation du FSC chez le groupe traité au niveau du gyrus temporal inférieur gauche. De plus, nous avons observé des diminutions de FSC chez le groupe non traité au niveau de l’hippocampe gauche, du gyrus parahippocampal droit et du pôle temporal supérieur gauche. Aucun changement n’a été observé chez le groupe contrôle. Les diminutions de FSC observées dans le groupe non traité pourraient être causées par les conséquences de l’AOS, notamment par une combinaison de diminution du calibre vasculaire et une perte cellulaire. En éliminant ces mécanismes pathologiques, le traitement par PPC permettrait une revascularisation et une prolifération cellulaire. Puisque les régions cérébrales affectées par l’AOS dans ce projet sont associées au déclin cognitif, d’autres études sont nécessaires pour clarifier le lien entre l’AOS, son traitement et la démence. / Obstructive sleep apnea (OSA) is an important health problem, affecting up to 38% of the general population and increasing in prevalence with age. OSA causes blood flow changes leading to vascular and neuronal damage. Indeed, decreases in regional cerebral blood flow (rCBF) have been observed in OSA. The treatment of OSA is continuous positive airway pressure (CPAP). CPAP treatment has been associated with increases in rCBF. However, studies evaluating rCBF in OSA were predominantly composed of middle-aged people. Therefore, we don’t know if these results could be generalized to the aging population. Thus, this master's project aims to determine whether an 18-month CPAP treatment for apneic individuals older than 55 years normalizes the rCBF measured in single-photon emission computed tomography. In addition, this project aims to investigate the longitudinal effects of untreated OSA relative to a control group. We hypothesized that treated subjects will have rCBF increases in previously hypoperfused regions while individuals with untreated OSA will have decreased rCBF over time in OSA-sensible regions. We evaluated 12 control participants and 23 newly diagnosed participants with OSA. The latter were referred to an OSA clinic and 13 of them followed a CPAP treatment. For the analysis of single photon emission imaging, we used a voxel-based method and an extraction method to measure changes over time in each of the groups. We observed an increased rCBF in the treated group in the left inferior temporal gyrus. In addition, we observed decreased rCBF in the untreated group in the left hippocampus, the right parahippocampal gyrus, and left superior temporal pole. No change was observed in the control group. The decreased rCBF seen in the untreated group could be caused by the consequences of OSA, including a combination of decreased blood vessels caliber and cell loss. By eliminating these pathological mechanisms, CPAP treatment would allow revascularization and cell proliferation. Since brain regions affected by OSA in this project are associated with cognitive decline, further studies are needed to clarify the link between OSA, its treatment, and dementia.