Avaliação comparativa do perfil imunológico, da função pulmonar e da força muscular respiratória em mulheres submetidas a colecistectomia laparoscópica convencional e por portal único

Detalhes bibliográficos
Autor(a) principal: BORGES, Marisa de Carvalho
Data de Publicação: 2014
Tipo de documento: Tese
Idioma: por
Título da fonte: Biblioteca Digital de Teses e Dissertações da UFTM
Texto Completo: http://bdtd.uftm.edu.br/handle/tede/493
Resumo: Introdução: A colecistectomia laparoscópica tornou-se a intervenção cirúrgica padrão para doentes com patologia benigna da vesícula biliar e o portal-único com a realização de uma única incisão umbilical tornou-se uma importante inovação dessa técnica. Procedimentos cirúrgicos podem desencadear a expressão de citocinas pró ou anti-inflamatórias e alterar a função pulmonar e a força muscular respiratória comprometendo a recuperação do paciente. Objetivos: Avaliar a expressão das citocinas (TNF-α, IFN-γ, IL-1β, IL-17, IL-4) da função pulmonar (CVF, VEF1 e VEF1/CVF%) e da força muscular respiratória (PImáx e da PEmáx) antes e após a Colecistectomia Laparoscópica Convencional e por Portal Único. Casuística e Métodos: Participaram deste estudo 40 mulheres com colelitíase sintomática com idade entre 18 e 70 anos. As pacientes foram divididas em 2 grupos: 21 pacientes foram submetidas a Colecistectomia Laparoscopica Convencional e 19 pacientes foram submetidas a Colecistectomia por Portal Único. As amostras de sangue foram coletadas de todas as pacientes, no pré- operatório e após 24 horas dos procedimentos cirúrgicos, estando os pacientes em jejum noturno de 12 horas. O sangue imediatamente coletado foi centrifugado a 5000 RPM e o sobrenadante aspirado e acondicionados em tubos plásticos de 1,5 ml estéril, sendo estocados à - 70°C. As citocinas TNF-α, IFN-γ, IL-1β, IL-17e IL-4, presentes no plasma foram quantificadas pelo método de ELISA. Para a avaliação da função pulmonar, foi realizada a espirometria em dois momentos: antes e após 24 horas dos procedimentos cirúrgicos. Os parâmetros avaliados neste estudo foram: Capacidade vital forçada (CVF) e Volume expiratório forçado no primeiro Segundo (VEF1) e a relação VEF1/CVF %. A avaliação da força muscular respiratória, baseou-se na medida das pressões respiratórias máximas: Pressão Inspiratória Máxima (PImáx) e Pressão Expiratória Máxima (PEmáx), obtidas pela leitura feita em um manovacuômetro, graduado de –300 + 300 cmH20 e realizadas em três momentos: antes e após 24 horas e 48 horas dos procedimentos cirúrgicos. Resultados: A avaliação da resposta imune não mostrou significância estatística na expressão das citocinas IFN-γ e IL-1β na comparação entre os grupos e tempos analisados. A IL-17 apresentou expressão significativa no pós-operatório em relação ao pré-operatório no grupo submetido a Colecistectomia Laparoscopica por Portal Único. Em relação às citocinas TNF-α e IL-4 não foram detectáveis níveis significativos em nenhum dos grupos ou tempos analisados. Quanto a função pulmonar os resultados obtidos mostraram queda maior dos valores da CVF e da VEF1 no grupo de pacientes submetidas a Colecistectomia Laparoscopica Convencional. O tabagismo certamente contribuiu para o distúrbio ventilatório restritivo leve observado no pós-operatório do grupo submetido a Colecistectomia Laparoscopica por Portal Único. Quanto a força muscular respiratória, os resultados obtidos mostraram queda da PImáx e da PEmáx após 24 horas do procedimento cirúrgico, sendo observado recuperação mais precoce dessas pressões após 48h do procedimento cirúrgico no grupo submetido a Colecistectomia Laparoscopica por Portal Único. Conclusões: A expressão aumentada da pró-inflamatória IL-17A do pré para o pós-operatório no grupo submetido a Colecistectomia Laparoscopica por Portal Único pode indicar o papel importante dessa citocina no reparo tecidual. Apesar da ferida cirúrgica ser menor nesse procedimento, colisões intra e extra-abdominais dos instrumentais, ponto de entrada comum dos equipamentos e consequente aumento das manipulações viscerais podem ter contribuído para os níveis aumentados dessa citocina. Quanto a função pulmonar e a força muscular respiratória o grupo submetido a Colecistectomia Laparoscopica por Portal Único apresentou recuperação mais satisfatória dos parâmetros avaliados, com menor comprometimento dos volumes e capacidades pulmonares.
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spelling Avaliação comparativa do perfil imunológico, da função pulmonar e da força muscular respiratória em mulheres submetidas a colecistectomia laparoscópica convencional e por portal únicoCirurgia.LaparoscopiaCitocinas.Medidas de volume pulmonar.Força muscular.Teste da função respiratória.Surgery.Laparoscopy.Citokines.Lung volume measurements.Musccle Strengh.Respiratory Function Tests.Fisioterapia e Terapia OcupacionalIntrodução: A colecistectomia laparoscópica tornou-se a intervenção cirúrgica padrão para doentes com patologia benigna da vesícula biliar e o portal-único com a realização de uma única incisão umbilical tornou-se uma importante inovação dessa técnica. Procedimentos cirúrgicos podem desencadear a expressão de citocinas pró ou anti-inflamatórias e alterar a função pulmonar e a força muscular respiratória comprometendo a recuperação do paciente. Objetivos: Avaliar a expressão das citocinas (TNF-α, IFN-γ, IL-1β, IL-17, IL-4) da função pulmonar (CVF, VEF1 e VEF1/CVF%) e da força muscular respiratória (PImáx e da PEmáx) antes e após a Colecistectomia Laparoscópica Convencional e por Portal Único. Casuística e Métodos: Participaram deste estudo 40 mulheres com colelitíase sintomática com idade entre 18 e 70 anos. As pacientes foram divididas em 2 grupos: 21 pacientes foram submetidas a Colecistectomia Laparoscopica Convencional e 19 pacientes foram submetidas a Colecistectomia por Portal Único. As amostras de sangue foram coletadas de todas as pacientes, no pré- operatório e após 24 horas dos procedimentos cirúrgicos, estando os pacientes em jejum noturno de 12 horas. O sangue imediatamente coletado foi centrifugado a 5000 RPM e o sobrenadante aspirado e acondicionados em tubos plásticos de 1,5 ml estéril, sendo estocados à - 70°C. As citocinas TNF-α, IFN-γ, IL-1β, IL-17e IL-4, presentes no plasma foram quantificadas pelo método de ELISA. Para a avaliação da função pulmonar, foi realizada a espirometria em dois momentos: antes e após 24 horas dos procedimentos cirúrgicos. Os parâmetros avaliados neste estudo foram: Capacidade vital forçada (CVF) e Volume expiratório forçado no primeiro Segundo (VEF1) e a relação VEF1/CVF %. A avaliação da força muscular respiratória, baseou-se na medida das pressões respiratórias máximas: Pressão Inspiratória Máxima (PImáx) e Pressão Expiratória Máxima (PEmáx), obtidas pela leitura feita em um manovacuômetro, graduado de –300 + 300 cmH20 e realizadas em três momentos: antes e após 24 horas e 48 horas dos procedimentos cirúrgicos. Resultados: A avaliação da resposta imune não mostrou significância estatística na expressão das citocinas IFN-γ e IL-1β na comparação entre os grupos e tempos analisados. A IL-17 apresentou expressão significativa no pós-operatório em relação ao pré-operatório no grupo submetido a Colecistectomia Laparoscopica por Portal Único. Em relação às citocinas TNF-α e IL-4 não foram detectáveis níveis significativos em nenhum dos grupos ou tempos analisados. Quanto a função pulmonar os resultados obtidos mostraram queda maior dos valores da CVF e da VEF1 no grupo de pacientes submetidas a Colecistectomia Laparoscopica Convencional. O tabagismo certamente contribuiu para o distúrbio ventilatório restritivo leve observado no pós-operatório do grupo submetido a Colecistectomia Laparoscopica por Portal Único. Quanto a força muscular respiratória, os resultados obtidos mostraram queda da PImáx e da PEmáx após 24 horas do procedimento cirúrgico, sendo observado recuperação mais precoce dessas pressões após 48h do procedimento cirúrgico no grupo submetido a Colecistectomia Laparoscopica por Portal Único. Conclusões: A expressão aumentada da pró-inflamatória IL-17A do pré para o pós-operatório no grupo submetido a Colecistectomia Laparoscopica por Portal Único pode indicar o papel importante dessa citocina no reparo tecidual. Apesar da ferida cirúrgica ser menor nesse procedimento, colisões intra e extra-abdominais dos instrumentais, ponto de entrada comum dos equipamentos e consequente aumento das manipulações viscerais podem ter contribuído para os níveis aumentados dessa citocina. Quanto a função pulmonar e a força muscular respiratória o grupo submetido a Colecistectomia Laparoscopica por Portal Único apresentou recuperação mais satisfatória dos parâmetros avaliados, com menor comprometimento dos volumes e capacidades pulmonares.Introduction: Laparoscopic cholecystectomy has become the standard surgical procedure for patients with benign gallstone diseases and the single-port approach through one umbilical incision is a technical option. Surgical procedures can induce the expression of pro- and anti-inflammatory cytokines and can alter lung function and respiratory muscle strength, thus compromising recovery of the patient. Objectives: To evaluate the expression of cytokines (TNF-α, IFN-γ, IL-1β, IL-17, IL-4), lung function (FVC, FEV1 and FEV1/FVC %) and respiratory muscle strength (PImax and PEmax) before and after conventional and single-port laparoscopic cholecystectomy. Patients and Methods: Forty women with symptomatic cholelithiasis, ranging in age from 18 to 70 years, participated in the study. The patients were divided into two groups: 21 patients submitted to conventional laparoscopic cholecystectomy and 19 patients submitted to single-port laparoscopic cholecystectomy. Blood samples were collected from all patients before and 24 h after the surgical procedures after a 12-h overnight fast. The sample was centrifuged immediately at 5,000 rpm and the supernatant was aspirated and stored in 1.5-ml sterile plastic tubes at -70°C. Plasma levels of TNF-α, IFN-γ, IL-1β, IL-17 and IL-4 were quantified by ELISA. Spirometry was performed for the evaluation of lung function at two time points: before and 24 h after the surgical procedures. The following parameters were evaluated: forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and FEV1/FVC % ratio. Respiratory muscle strength was evaluated by the measurement of maximum respiratory pressures: maximum inspiratory pressure (PImax) and maximum expiratory pressure (PEmax). These pressures were measured wit a manovacuometer (-300 to +300 cmH2O) at three time points: before and 24 and 48 h after the surgical procedures. Results: Evaluation of the immune response showed no significant difference in IFN-γ or IL-1β levels between groups and time points. Significantly higher expression of IL-17 was observed after surgery in the group undergoing single-port laparoscopic cholecystectomy. Serum TNF-α and IL-4 levels were below the detection level (10 pg/ml) in the two groups and at the time points analyzed. With respect to lung function, the results showed a greater reduction in FVC and FEV1 in patients undergoing conventional laparoscopic cholecystectomy. There was no significant difference in FEV1/FVC(%) between the groups or time points studied. Analysis of respiratory muscle strength showed a greater reduction in PImax and PEmax after 24 h in the group undergoing conventional laparoscopic cholecystectomy. Conclusions: Increased postoperative expression of IL-17A in patients submitted to single-port laparoscopic cholecystectomy suggests an important role of this cytokine in tissue repair and in the induction of inflammation. The recovery of lung volumes and respiratory muscle strength occurred earlier in the group submitted to single-port laparoscopic cholecystectomy.Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorUniversidade Federal do Triângulo MineiroInstituto de Ciências da Saúde - ICS::Programa de Pós-Graduação em Ciências da SaúdeBrasilUFTMPrograma de Pós-Graduação em Ciências da SaúdeCREMA, Eduardo25531883668http://lattes.cnpq.br/5607251543658902BORGES, Marisa de Carvalho2018-02-22T20:24:10Z2014-12-05info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisapplication/pdfapplication/pdfBORGES, Marisa de Carvalho. Avaliação comparativa do perfil imunológico, da função pulmonar e da força muscular respiratória em mulheres submetidas a colecistectomia laparoscópica convencional e por portal único. 2014. 148f. 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Current Opinion in Gastroenterology, Philadelphia, v.27, n.3, p.231-239, May 2011.http://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UFTMinstname:Universidade Federal do Triangulo Mineiro (UFTM)instacron:UFTM2019-06-26T19:45:09Zoai:bdtd.uftm.edu.br:tede/493Biblioteca Digital de Teses e Dissertaçõeshttp://bdtd.uftm.edu.br/PUBhttp://bdtd.uftm.edu.br/oai/requestbdtd@uftm.edu.br||bdtd@uftm.edu.bropendoar:2019-06-26T19:45:09Biblioteca Digital de Teses e Dissertações da UFTM - Universidade Federal do Triangulo Mineiro (UFTM)false
dc.title.none.fl_str_mv Avaliação comparativa do perfil imunológico, da função pulmonar e da força muscular respiratória em mulheres submetidas a colecistectomia laparoscópica convencional e por portal único
title Avaliação comparativa do perfil imunológico, da função pulmonar e da força muscular respiratória em mulheres submetidas a colecistectomia laparoscópica convencional e por portal único
spellingShingle Avaliação comparativa do perfil imunológico, da função pulmonar e da força muscular respiratória em mulheres submetidas a colecistectomia laparoscópica convencional e por portal único
BORGES, Marisa de Carvalho
Cirurgia.
Laparoscopia
Citocinas.
Medidas de volume pulmonar.
Força muscular.
Teste da função respiratória.
Surgery.
Laparoscopy.
Citokines.
Lung volume measurements.
Musccle Strengh.
Respiratory Function Tests.
Fisioterapia e Terapia Ocupacional
title_short Avaliação comparativa do perfil imunológico, da função pulmonar e da força muscular respiratória em mulheres submetidas a colecistectomia laparoscópica convencional e por portal único
title_full Avaliação comparativa do perfil imunológico, da função pulmonar e da força muscular respiratória em mulheres submetidas a colecistectomia laparoscópica convencional e por portal único
title_fullStr Avaliação comparativa do perfil imunológico, da função pulmonar e da força muscular respiratória em mulheres submetidas a colecistectomia laparoscópica convencional e por portal único
title_full_unstemmed Avaliação comparativa do perfil imunológico, da função pulmonar e da força muscular respiratória em mulheres submetidas a colecistectomia laparoscópica convencional e por portal único
title_sort Avaliação comparativa do perfil imunológico, da função pulmonar e da força muscular respiratória em mulheres submetidas a colecistectomia laparoscópica convencional e por portal único
author BORGES, Marisa de Carvalho
author_facet BORGES, Marisa de Carvalho
author_role author
dc.contributor.none.fl_str_mv CREMA, Eduardo
25531883668
http://lattes.cnpq.br/5607251543658902
dc.contributor.author.fl_str_mv BORGES, Marisa de Carvalho
dc.subject.por.fl_str_mv Cirurgia.
Laparoscopia
Citocinas.
Medidas de volume pulmonar.
Força muscular.
Teste da função respiratória.
Surgery.
Laparoscopy.
Citokines.
Lung volume measurements.
Musccle Strengh.
Respiratory Function Tests.
Fisioterapia e Terapia Ocupacional
topic Cirurgia.
Laparoscopia
Citocinas.
Medidas de volume pulmonar.
Força muscular.
Teste da função respiratória.
Surgery.
Laparoscopy.
Citokines.
Lung volume measurements.
Musccle Strengh.
Respiratory Function Tests.
Fisioterapia e Terapia Ocupacional
description Introdução: A colecistectomia laparoscópica tornou-se a intervenção cirúrgica padrão para doentes com patologia benigna da vesícula biliar e o portal-único com a realização de uma única incisão umbilical tornou-se uma importante inovação dessa técnica. Procedimentos cirúrgicos podem desencadear a expressão de citocinas pró ou anti-inflamatórias e alterar a função pulmonar e a força muscular respiratória comprometendo a recuperação do paciente. Objetivos: Avaliar a expressão das citocinas (TNF-α, IFN-γ, IL-1β, IL-17, IL-4) da função pulmonar (CVF, VEF1 e VEF1/CVF%) e da força muscular respiratória (PImáx e da PEmáx) antes e após a Colecistectomia Laparoscópica Convencional e por Portal Único. Casuística e Métodos: Participaram deste estudo 40 mulheres com colelitíase sintomática com idade entre 18 e 70 anos. As pacientes foram divididas em 2 grupos: 21 pacientes foram submetidas a Colecistectomia Laparoscopica Convencional e 19 pacientes foram submetidas a Colecistectomia por Portal Único. As amostras de sangue foram coletadas de todas as pacientes, no pré- operatório e após 24 horas dos procedimentos cirúrgicos, estando os pacientes em jejum noturno de 12 horas. O sangue imediatamente coletado foi centrifugado a 5000 RPM e o sobrenadante aspirado e acondicionados em tubos plásticos de 1,5 ml estéril, sendo estocados à - 70°C. As citocinas TNF-α, IFN-γ, IL-1β, IL-17e IL-4, presentes no plasma foram quantificadas pelo método de ELISA. Para a avaliação da função pulmonar, foi realizada a espirometria em dois momentos: antes e após 24 horas dos procedimentos cirúrgicos. Os parâmetros avaliados neste estudo foram: Capacidade vital forçada (CVF) e Volume expiratório forçado no primeiro Segundo (VEF1) e a relação VEF1/CVF %. A avaliação da força muscular respiratória, baseou-se na medida das pressões respiratórias máximas: Pressão Inspiratória Máxima (PImáx) e Pressão Expiratória Máxima (PEmáx), obtidas pela leitura feita em um manovacuômetro, graduado de –300 + 300 cmH20 e realizadas em três momentos: antes e após 24 horas e 48 horas dos procedimentos cirúrgicos. Resultados: A avaliação da resposta imune não mostrou significância estatística na expressão das citocinas IFN-γ e IL-1β na comparação entre os grupos e tempos analisados. A IL-17 apresentou expressão significativa no pós-operatório em relação ao pré-operatório no grupo submetido a Colecistectomia Laparoscopica por Portal Único. Em relação às citocinas TNF-α e IL-4 não foram detectáveis níveis significativos em nenhum dos grupos ou tempos analisados. Quanto a função pulmonar os resultados obtidos mostraram queda maior dos valores da CVF e da VEF1 no grupo de pacientes submetidas a Colecistectomia Laparoscopica Convencional. O tabagismo certamente contribuiu para o distúrbio ventilatório restritivo leve observado no pós-operatório do grupo submetido a Colecistectomia Laparoscopica por Portal Único. Quanto a força muscular respiratória, os resultados obtidos mostraram queda da PImáx e da PEmáx após 24 horas do procedimento cirúrgico, sendo observado recuperação mais precoce dessas pressões após 48h do procedimento cirúrgico no grupo submetido a Colecistectomia Laparoscopica por Portal Único. Conclusões: A expressão aumentada da pró-inflamatória IL-17A do pré para o pós-operatório no grupo submetido a Colecistectomia Laparoscopica por Portal Único pode indicar o papel importante dessa citocina no reparo tecidual. Apesar da ferida cirúrgica ser menor nesse procedimento, colisões intra e extra-abdominais dos instrumentais, ponto de entrada comum dos equipamentos e consequente aumento das manipulações viscerais podem ter contribuído para os níveis aumentados dessa citocina. Quanto a função pulmonar e a força muscular respiratória o grupo submetido a Colecistectomia Laparoscopica por Portal Único apresentou recuperação mais satisfatória dos parâmetros avaliados, com menor comprometimento dos volumes e capacidades pulmonares.
publishDate 2014
dc.date.none.fl_str_mv 2014-12-05
2018-02-22T20:24:10Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/doctoralThesis
format doctoralThesis
status_str publishedVersion
dc.identifier.uri.fl_str_mv BORGES, Marisa de Carvalho. Avaliação comparativa do perfil imunológico, da função pulmonar e da força muscular respiratória em mulheres submetidas a colecistectomia laparoscópica convencional e por portal único. 2014. 148f. Tese (Doutorado em Ciências da Saúde) - Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Triângulo Mineiro, Uberaba, 2014.
http://bdtd.uftm.edu.br/handle/tede/493
identifier_str_mv BORGES, Marisa de Carvalho. Avaliação comparativa do perfil imunológico, da função pulmonar e da força muscular respiratória em mulheres submetidas a colecistectomia laparoscópica convencional e por portal único. 2014. 148f. Tese (Doutorado em Ciências da Saúde) - Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Triângulo Mineiro, Uberaba, 2014.
url http://bdtd.uftm.edu.br/handle/tede/493
dc.language.iso.fl_str_mv por
language por
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dc.publisher.none.fl_str_mv Universidade Federal do Triângulo Mineiro
Instituto de Ciências da Saúde - ICS::Programa de Pós-Graduação em Ciências da Saúde
Brasil
UFTM
Programa de Pós-Graduação em Ciências da Saúde
publisher.none.fl_str_mv Universidade Federal do Triângulo Mineiro
Instituto de Ciências da Saúde - ICS::Programa de Pós-Graduação em Ciências da Saúde
Brasil
UFTM
Programa de Pós-Graduação em Ciências da Saúde
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repository.name.fl_str_mv Biblioteca Digital de Teses e Dissertações da UFTM - Universidade Federal do Triangulo Mineiro (UFTM)
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