Uso de corticóide como inibidor da resposta inflamatória sistêmica induzida pela circulação extracorpórea

• Autor(a) principal: Brasil, Luiz Antonio
• Data de Publicação: 1999
• Outros Autores: Gomes, Walter José [UNIFESP], Salomão, Reinaldo [UNIFESP], Fonseca, José Honório de Almeida Palma da [UNIFESP], Branco, João Nelson Rodrigues [UNIFESP], Buffolo, Enio [UNIFESP]
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: http://dx.doi.org/10.1590/S0102-76381999000300010; http://repositorio.unifesp.br/handle/11600/798
• topic: Myocardial revascularization; Extracorporeal circulation; Corticoids; Sepsis syndrome; IL6; TNF-alpha; Revascularização miocárdica; Circulação extracorpórea; Corticóides; Síndrome séptica; IL6; TNF-alfa

Cardiopulmonary bypass (CPB) induces the development of a systemic inflammatory response syndrome, with the release of cytokines that are responsible for many clinical manifestations. PURPOSE: The purpose of the study was to observe the release of the cytokines - tumor necrosis factor alpha (TNFa) and Interleukine-6 (IL-6), and to verify the clinical alterations produced in patients undergoing myocardial revascularization with CPB, with or without corticoids. MATERIAL AND METHODS: Thirty patients were studied - 15 used corticoid (methylprednisolone, 30 mg/kg -Group I) and 15 did not (Group II). Serial blood samples were collected and the TNFa and IL-6 release were analyzed, as well as the leukocyte count, erythrocyte sedimentation rate and glycemia. The blood pressure, cardiac rate, temperature, postoperative bleeding, orotracheal tubing time and inotropic drug requirement were also compared. Statistical significance was assumed when p £ 0.05. RESULTS: In Group I TNFa was not detected and IL-6 was detected in 13 patients, with levels ranging from 8.6 to 101.8 pg/ml. In Group II TNFa was detected in 13 patients, with levels between 5.4 and 231.0 pg/ml. The IL-6 in this group was detected in 15 patients, with higher levels than those in Group I, varying between 5.5 and 2569.0 pg/ml. The Group I patients had higher medium blood pressure (7.9 ± 0.5 vs 7.3 ± 0.4 mmHg) and lower inotropic drug requirement (5 vs 11). They evolved with less tachycardia (105.6 ± 5.9 vs 109.3 ± 7.2 bpm), lower temperature (36.5 ± 0.2 vs 37.3 ± 0.2°C), lower postoperative bleeding, (576.6 ± 119.5 vs 810.0 ± 176.2 ml), shorter orotracheal tubing time (11.0 ± 2.0 vs 14.6 ± 2.9 hs) and lower leukocytosis. The glycemia level was just significant (Group I > Grupo II) in the immediate postoperative and in the first postoperative samples. The erythrocyte sedimentation rate did not present significant statistical difference between the two groups. CONCLUSION: The methylprednisolone significantly inhibited the release of inflammatory cytokines mainly the TNFa. The systemic adverse effects caused by the inflammatory response after CPB were minimized by corticoid use.