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Brazilian Journal of Cardiovascular Surgery

Print version ISSN 0102-7638

Rev Bras Cir Cardiovasc vol.5 no.1 São José do Rio Preto Apr. 1990

http://dx.doi.org/10.1590/S0102-76381990000100001 

Injúria orgânica da circulação extracorpórea nos três primeiros meses de vida

 

Organic injury of extracorporeal circulation in the first three months of life

 

 

Décio O. Elias; Maria Helena L. Souza; Bernardo S. Lacerda; Francisco Eduardo S. Fagundes; Francisco J. S. Lino; Márcio Tiraboshi

Do Hospital de Cardiologia de Laranjeiras

Endereço para separatas

 

 


RESUMO

Diversos fatores contribuíram para aumentar o número de procedimentos com circulação extracopórea para neonatos e lactentes. Esses pacientes necessitam procedimentos especiais de perfusão, fundamentos em sua fisiologia particular, nas características do seu metabolismo e na sua resposta aos desvios da homeostase, principalmente a acidose lática. São analisados os protocolos de perfusão em 110 procedimentos com parada circulatória total, para a realização da correção intracardíaca, durante a qual diversos mecanismos de injúria ao sangue foram identificados. A injúria mecânica, por ação das forças desenvolvidas na circulação artificial do sangue e nas trocas gasosas, pode danificar os elementos figurados e as proteínas do plasma sangüíneo. O contato com as superfícies do circuito extracorpóreo pode ativar os sistemas das cininas, da coagulação, da fibrinólise e do complemento, por ativação inicial do fator XII e produzir uma reação inflamatória generalizada. A produção de ácido lático pode modificar o pH ideal para a função enzimática e celular, e o superaquecimento do sangue, durante o reaquecimento, pode produzir dano ao sangue semelhante àquele causado pelos fatores físicos da circulação extracorpórea. A perfusão neonatal e de pequenos lactentes é um continuado exercício de atenção aos detalhes e respeito aos aspectos particulares da fisiologia, do metabolismo e da resposta à injúria.

Descritores: circulação extracorpórea, crianças.


ABSTRACT

Newborns and small infants require special procedures of extracorporeal circulation for open heart surgery, which must be based on their specific physiological and metabolic patterns, as well as on the response to deviations of their homeostasis. The authors reviewed the protocols of cardiopulmonary bypass utilized during 100 procedures with total circulatory arrest and discuss some mechanisms by which the blood components may be damaged or injured during perfusion. Mechanical injury of solid blood components and plasma proteins are discussed; the activation of certain plasmatic systems as the coagulation, fibrinolytic and complement by the Hageman factor, which can produce a generalized inflammatory reaction is also identified; deviations of acid-base balance by excessive lactic acid production may impair enzymatic and cellular functions which can cause injury of a metabolic nature. Thermal injury may also be produced by overheating blood during rewarming if the dynamic nature of heat exchangers function is not adequately monitored. The conclusion is that neonatal perfusion represents a continuing exercise of attention to detail and must be performed with a profound respect to their specific physiology, metabolism and response to injury.

Descriptors: extracorporeal circulation, children.


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

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Endereço para separatas:
Décio O. Elias
Rua Roberto Oswaldo Cruz, 254
22750 Rio de Janeiro, RJ, Brasil

 

 

Trabalho realizado no Hospital de Cardiologia de Laranjeiras. Rio de Janeiro, RJ, Brasil.
Apresentado ao 17º Congresso Nacional de Cirurgia Cardíaca. Belo Horizonte, MG, 6 e 7 de abril, 1990.

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