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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.55 no.1 São Paulo  1997

https://doi.org/10.1590/S0004-282X1997000100006 

Medida da diferença artério-venosa de oxigênio na monitorização de pacientes com hemorragia subaracnóidea por aneurisma cerebral

 

Measurement of arteriovenous oxygen difference in the monitoring of patients with subarachnoid haemorrhage due to cerebral aneurysm

 

 

Ronaldo Sérgio Santana PereiraI; Márcio Robertti RamalhoIII; Renato Camargo ViscardiII; Luiz Augusto Casulari Roxo da MottaI; Márcio Vinhal de CarvalhoIII; Kunio SuzukiI; Paulo Andrade de MelloIV

IMédico da UNC do HBDF
IIMédico da UTI do HBDF
IIIEx-Médico Residentede Neurocirurgia do HBDF
IVProfessor Titular de Neurocirurgia da Universidade de Brasília

 

 


RESUMO

A diferença artério-venosa de oxigênio (DAVO2), pelo fato de estar relacionada com o metabolismo cerebral, reflete alterações que ocorrem em determinadas situações patológicas, entre elas as causadas pela hemorragia subaracnóidea espontânea (HSAE). Com a finalidade de avaliar a relação entre alterações na DAVO2 com o quadro clínico e a evolução de pacientes com HSAE, devido à ruptura de aneurisma cerebral, este método foi utilizado em 30 pacientes portadores desta patologia, admitidos na Unidade de Neurocirurgia do HBDF. A HSAE foi confirmada por CT de crânio em 17 pacientes e por punção lombar em 13. Dezoito pacientes foram admitidos com Hunt & Hess (H&H) I ou II, sete com H&H III e cinco com H&H IV ou V. A medida da DAVO2 baseou-se na equação de Fick e os resultados clínicos foram avaliados pela escala de seqüelas de Glasgow. Dezenove pacientes apresentaram DAVO2 normais (inicialmente e durante a evolução), sendo que três faleceram; cinco tiveram valores de DAVO2 sempre baixos e três faleceram; os restantes seis pacientes tiveram valores da DAVO2 sempre elevados e dois faleceram. Os pacientes com DAVO2 normais tiveram melhor evolução clínica e índice de mortalidade menor, quando comparados com os pacientes com valores anormais da DAVO2 (p<0,05). O diagnóstico de vasoespasmo foi feito, em sua maioria, pela avaliação clínica, sendo confirmado radiologicamente em oito pacientes, mas estes últimos tiveram DAVO2 normais. A medida isolada da DAVO2 não foi suficiente para o diagnóstico do vasoespasmo, porém refletiu alterações metabólicas precoces. Baseada nestes resultados, a DAVO2 pode ser usada como parâmetro importante na monitorização da evolução dos pacientes com HSAE.

Palavras-chave: hemorragia subaracnóidea espontânea, aneurisma cerebral, vasoespasmo cerebral, fluxo sanguíneo cerebral, diferença artério-venosa de oxigênio (DAV02).


ABSTRACT

The arterious venous oxygen difference (AVDO2) due to the close relationship with cerebral metabolic rate of oxygen and cerebral blood flow shows metabolic alterations that occur in some pathological situations in the brain including subarachnoid haemorrhage. The AVDO2 was calculated by the Fick equation and the results evaluated by the Glasgow outcome scale. Measurements of arteriojugular oxygen difference were carried out in 30 patients with subarachnoid haemorrhage due to rupture of intracranial aneurysms, as an attempt to monitor the relationship between changes in AVDO2, clinical picture, and evolution of the patients. The subarachnoid haemorrhage was diagnosed by CT scan in 17 patients and by lumbar punction in 13 and the diagnosis of arterial vasospasm was carried out by clinical evaluation and confirmed by four vessels angiogram in only eight patients. Eighteen patients were admitted with Hunt & Hess (H&H) I/II, seven with H&H III and five with H&H IV/V. Nineteen patients had AVDO2 normal and this group had three deaths; five patients had AVD02 continuously low with three deaths; and six patients had AVDO2 continuously high with two deaths.
The patients with normal AVDO2 had better prognosis and clinical evolution than the patients with abnormal values of AVDO2. In conclusion, AVDO2 measurements could not be correlated with the diagnosis of vasospasm, but was useful in the early identification of metabolic changes that occur after subarachnoid haemorrhage and could be used as an supplementary monitoring in the clinical evaluation of patients with this pathology.

Key words: subarachnoid haemorrhage, cerebral aneurysm, arterial vasospasm, cerebral blood flow, arterious venous oxygen difference (AVDO2).


 

 

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Aceite: 3-setembro-1996.

 

 

Estudo realizado na Unidade de Neurocirurgia (UNC) e Unidade de Terapia Intensiva (UTI) do Hospital de Base do Distrito Federal (HBDF).
Dr. Ronaldo Sérgio Santana Pereira - Unidade de Neurocirurgia, Hospital de Base do Distrito Federal - SMHS Q 101 Asa Sul - 70335-900 Brasília DF - Brasil.

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