Avaliação dos níveis de citocinas e da função pulmonar de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea

Luciano Brandão Machado; Elnara Marcia Negri; Wanderley Wesley Bonafé; Luciana Moraes Santos; Luís Marcelo Sá Malbouisson; Maria José Carvalho Carmona

doi:10.1590/S0034-70942011000300002

Scientific Article

Avaliação dos níveis de citocinas e da função pulmonar de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea

Evaluation of cytokine levels and pulmonary function in patients undergoing coronary artery bypass graft

Luciano Brandão Machado; Elnara Marcia Negri; Wanderley Wesley Bonafé; Luciana Moraes Santos; Luís Marcelo Sá Malbouisson; Maria José Carvalho Carmona

http://dx.doi.org/10.1590/S0034-70942011000300002 Braz J Anesthesiol, vol.61, n3, p.280-285, 2011

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Resumo

JUSTIFICATIVA E OBJETIVOS: A Síndrome da Resposta Inflamatória Sistêmica é uma ocorrência habitual em cirurgias cardíacas com circulação extracorpórea (CEC). O objetivo deste estudo foi avaliar os níveis sistêmicos e pulmonares de citocinas e a correlação com a função pulmonar em pacientes submetidos à revascularização miocárdica (RM) com CEC. MÉTODOS: O estudo foi aprovado pela Comissão de Ética institucional, com a avaliação de 13 pacientes submetidos à RM com CEC. Após a indução anestésica, ao término da CEC, realizaram-se dosagens plasmáticas e no lavado broncoalveolar de IL-1β, IL-6, IL-8, IL-10 e TNF-α. Foram avaliados o tempo de CEC e de cirurgia, a relação PaO2/FiO2, o gradiente alvéolo-arterial de oxigênio (GA-aO2), o shunt e a complacência pulmonares. Os resultados foram submetidos à análise de variância para medidas repetidas (*p < 0,05) e coeficiente de correlação de Spearman. RESULTADOS: Observaram-se aumento dos níveis de citocinas no plasma e no lavado broncoalveolar após a CEC e relação direta entre o aumento da IL-1β e a diminuição da complacência pulmonar (p = 0,0439), assim como relação inversa entre o aumento da IL-10 e a redução da complacência (p = 0,0325). O aumento da IL-6 teve relação direta com o tempo de CEC (p = 0,012), enquanto o aumento da IL-8 teve relação direta com o tempo de cirurgia (p < 0,0001). Os níveis de IL-1β, IL-8 e TNF-α foram maiores no LBA em relação ao plasma. CONCLUSÕES: Ocorre aumento dos níveis de citocinas no plasma e lavado broncoalveolar após a CEC e há correlação entre o aumento dos níveis de citocinas e o tempo de CEC e de cirurgia e as alterações na complacência pulmonar.

Palavras-chave

CIRURGIA, Cardíaca, EQUIPAMENTOS, Oxigenador, FARMACOLOGIA, FISIOPATOLOGIA, TÉCNICAS DE MEDIÇÃO, Testes de função pulmonar

Abstract

BACKGROUND AND OBJECTIVES: Systemic inflammatory response syndrome is commonly observed in coronary artery bypass grafts (CABG) with cardiopulmonary bypass (CB). The objective of this study was to evaluate the systemic and pulmonary levels of cytokines and their correlation with lung function in patients undergoing myocardial revascularization (MR) with CB. METHODS: This study was approved by the Institutional Ethics Committee, and 13 patients undergoing MR with CB were evaluated. After anesthetic induction and at the end of CB, plasma and bronchoalveolar lavage levels of IL-1β, IL-6, IL-8, IL-10, and TNF-α were determined. The dur ation of CB and surgery, PaO2/FiO2 ratio, alveolar-arterial oxygen gradient (A-a gradient), shunt, and lung compliance were evaluated. Results were submitted to analysis of variance for repeated measurements (*p < 0.05) and Spearman's correlation coefficient. RESULTS: We observed increased levels of cytokines in plasma and bronchoalveolar lavage after CB and a direct relationship between the increase in IL-1β and decrease in lung compliance (p = 0.0439), as well as the inverse relationship between the increase in IL-10 and a decrease in compliance (p = 0.0325). The increase in IL-6 was directly related to the duration of CB (p = 0.012), while the increase in IL-8 was directly related to the duration of surgery (p < 0.0001). Levels of interleukin-1β, IL-8, and TNF-α in bronchoalveolar lavage were higher than in plasma. CONCLUSIONS: There is an increase in cytokine levels in plasma and bronchoalveolar lavage after CB, as well as a correlation between increased cytokine levels and CB duration and surgery and changes in lung compliance.

Keywords

Cytokines, Myocardial Revascularization, Extracorporeal Circulation, Systemic Inflammatory Response Syndrome, Respiratory Function Tests

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Avaliação dos níveis de citocinas e da função pulmonar de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea

Evaluation of cytokine levels and pulmonary function in patients undergoing coronary artery bypass graft

Luciano Brandão Machado; Elnara Marcia Negri; Wanderley Wesley Bonafé; Luciana Moraes Santos; Luís Marcelo Sá Malbouisson; Maria José Carvalho Carmona

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