Influência do emprego de albumina humana sobre a função pulmonar de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea

Hugo Leonardo de Moura Luz; Mara Regina Guerreiro Moreira; José Otávio Costa Auler Júnior; Maria José Carvalho Carmona

doi:10.1590/S0034-70942004000400009

Scientific Article

Influência do emprego de albumina humana sobre a função pulmonar de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea

Influence of human albumin on pulmonary function of patients submitted to heart surgery with cardiopulmonary bypass

Hugo Leonardo de Moura Luz; Mara Regina Guerreiro Moreira; José Otávio Costa Auler Júnior; Maria José Carvalho Carmona

http://dx.doi.org/10.1590/S0034-70942004000400009 Braz J Anesthesiol, vol.54, n4, p.532-541, 2004

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Resumo

JUSTIFICATIVA E OBJETIVOS: O emprego de albumina humana em cirurgias cardíacas com circulação extracorpórea (CEC) é controverso, embora seja procedimento utilizado com freqüência. O objetivo deste estudo foi analisar os efeitos do uso da albumina humana sobre a função de troca gasosa pulmonar em pacientes submetidos à cirurgia de revascularização do miocárdio com CEC. MÉTODO: Vinte pacientes foram divididos aleatoriamente em dois grupos, em relação à solução utilizada no perfusato da CEC: no grupo controle (n = 10) utilizou-se diluição total com solução de Ringer com lactato, também utilizada na hidratação intra-operatória. No grupo albumina (n = 10) foram adicionados 20 g de albumina humana ao perfusato da CEC ou como parte da hidratação no período pós-CEC. A relação entre a pressão arterial de oxigênio e sua fração inspirada (PaO2/FiO2), o gradiente alvéolo-arterial de oxigênio (GA-aO2) e o shunt pulmonar foram avaliados após a indução anestésica, ao final da cirurgia e no primeiro e segundo dias de pós-operatório e comparados nos dois grupos através de Análise de Variância para medidas repetidas (p < 0,05). RESULTADOS: Os dois grupos estudados foram comparáveis em relação às características pré-operatórias, tempo de CEC e de cirurgia. Os valores de PaO2/FiO2, GA-aO2 e shunt pulmonar não mostraram diferença estatisticamente significativas entre os grupos. CONCLUSÕES: Este estudo demonstrou que a adição de albumina humana no perfusato da CEC ou como parte da hidratação intra-operatória em cirurgia revascularização do miocárdio com circulação extracorpórea não resultou em benefícios para a função pulmonar. Como a albumina apresenta custo elevado, o seu uso rotineiro não está justificado.

Palavras-chave

CIRURGIA, CIRURGIA, SISTEMA RESPIRATÓRIO, VOLEMIA

Abstract

BACKGROUND AND OBJECTIVES: Human albumin in heart surgeries with cardiopulmonary bypass (CPB) is controversial although being a frequent procedure. This study aimed at evaluating the effects of human albumin on pulmonary gaseous exchange function in patients submitted to myocardial revascularization with CPB. METHODS: Participated in this study 20 patients randomly distributed in two groups according to CPB perfusate solution: control group (n = 10) - total dilution with lactated Ringer's solution, also used for intraoperative hydration; albumin group (n = 10) - 20 g human albumin were added to CPB perfusate or as part of post-CPB hydration. Oxygen arterial tension and inspired fraction ratio (PaO2/FiO2), oxygen alveolar-arterial gradient (GA-aO2) and pulmonary shunt were evaluated after anesthetic induction, at surgery completion and in the first and second postoperative day and were compared in both groups by Analysis of Variance for repeated measures (p < 0.05). RESULTS: Both groups were comparable in preoperative characteristics, CPB and surgery duration. PaO2/FiO2, GA-aO2 and pulmonary shunt values were not statistically different between groups. CONCLUSIONS: Our study has shown that the addition of human albumin to CPB perfusate or as part of intraoperative hydration during myocardial revascularization with cardiopulmonary bypass has not improved pulmonary function. Since albumin is expensive, its routine use is not justified.

Keywords

RESPIRATORY SYSTEM, SURGERY, SURGERY, VOLEMIA

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Influência do emprego de albumina humana sobre a função pulmonar de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea

Influence of human albumin on pulmonary function of patients submitted to heart surgery with cardiopulmonary bypass

Hugo Leonardo de Moura Luz; Mara Regina Guerreiro Moreira; José Otávio Costa Auler Júnior; Maria José Carvalho Carmona

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