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Persistência do canal arterial : estudo comparativo entre doentes tratados medicamente e doentes tratados cirurgicamente
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Resumo(s)
A persistência do canal arterial (PCA) é uma cardiopatia congénita muito frequente em recém-nascidos pré-termo. Fisiologicamente, o canal arterial permite a comunicação entre a artéria pulmonar fetal e a artéria aorta descendente. Durante a vida fetal, a patência deste canal é assegurada por níveis plasmáticos de prostaglandinas sustentados. Durante o último trimestre de gestação e na altura do nascimento, surgem alterações favoráveis ao seu encerramento – diminuição da concentração de prostaglandinas e aumento da pressão parcial de oxigénio no sangue arterial (PaO2).
A persistência do canal arterial durante o período neonatal provoca diversas complicações no recém-nascido. Torna-se, assim, essencial a existência de um tratamento eficaz, de modo a garantir a sobrevivência e qualidade de vida dos doentes, sendo que atualmente estão preconizadas duas abordagens possíveis, uma farmacológica e outra cirúrgica, sempre que a conservadora não seja viável.
Os autores pretendem com este trabalho comparar os resultados do tratamento realizado em grandes prematuros com canal arterial significativo, em termos de eficácia de encerramento e morbilidades associadas.
O estudo comparativo foi realizado a partir de uma amostra de grandes prematuros internados na Unidade de Cuidados Intensivos Neonatais do Hospital de Santa Maria/Centro Hospitalar Universitário de Lisboa Norte, durante um período de 5 anos.
Como resultado deste estudo, concluiu-se que não existem diferenças significativas quanto à eficácia de encerramento do canal em doentes com canal arterial persistente hemodinamicamente significativo tratados medica ou cirurgicamente. Existem, porém, algumas diferenças significativas no que diz respeito à gravidade das co-morbilidades, nomeadamente com quadros mais graves de enterocolite necrotizante, retinopatia da prematuridade, pneumotórax, displasia broncopulmonar e sépsis precoce nos doentes submetidos a intervenção cirúrgica.
Patent ductus arteriosus (PDA) is a congenital heart disease, particularly common among preterm infants. Its physiological function allows the communication between fetal pulmonary artery and descending aorta. During fetal stage, the patency of this structure is assured by high and sustained levels of prostaglandins. In the third trimester of pregnancy and when the birth time arrives, some adaptive changes like the decrease of prostaglandins levels and rise of oxygen partial pressure in arterial blood (PaO2) occur, which contribute to the ductus closure. The patency of ductus arteriosus during neonatal period causes multiple complications in the new-born. For this reason, it is highly important for the treatment to be effective, in order to guarantee the survival and quality of life of the patients. Currently, there are two possible approaches when conservative treatment is not possible – the pharmacological therapy and the surgical ligation. The authors of this dissertation aim to compare the outcomes of medical treatment versus surgical ligation in preterm infants with a significant PDA regarding closure success and associated morbidities. The comparative study included premature infants who have been hospitalized in the Neonatal Intensive Care Unit of Hospital de Santa Maria/Centro Hospitalar Universitário de Lisboa Norte, for a period of 5 years. As a result of this study, it was concluded that there are no significant differences concerning to closure success in patients who present a hemodynamically significant PDA and whose treatment approach was whether pharmacological or if a surgical ligation was performed. Nevertheless, there are some significant differences in the comorbidities. Patients who were submitted to surgical ligation presented a more serious clinical condition, with regard to necrotizing enterocolitis, retinopathy of prematurity, pneumothorax, bronchopulmonary dysplasia and early sepsis.
Patent ductus arteriosus (PDA) is a congenital heart disease, particularly common among preterm infants. Its physiological function allows the communication between fetal pulmonary artery and descending aorta. During fetal stage, the patency of this structure is assured by high and sustained levels of prostaglandins. In the third trimester of pregnancy and when the birth time arrives, some adaptive changes like the decrease of prostaglandins levels and rise of oxygen partial pressure in arterial blood (PaO2) occur, which contribute to the ductus closure. The patency of ductus arteriosus during neonatal period causes multiple complications in the new-born. For this reason, it is highly important for the treatment to be effective, in order to guarantee the survival and quality of life of the patients. Currently, there are two possible approaches when conservative treatment is not possible – the pharmacological therapy and the surgical ligation. The authors of this dissertation aim to compare the outcomes of medical treatment versus surgical ligation in preterm infants with a significant PDA regarding closure success and associated morbidities. The comparative study included premature infants who have been hospitalized in the Neonatal Intensive Care Unit of Hospital de Santa Maria/Centro Hospitalar Universitário de Lisboa Norte, for a period of 5 years. As a result of this study, it was concluded that there are no significant differences concerning to closure success in patients who present a hemodynamically significant PDA and whose treatment approach was whether pharmacological or if a surgical ligation was performed. Nevertheless, there are some significant differences in the comorbidities. Patients who were submitted to surgical ligation presented a more serious clinical condition, with regard to necrotizing enterocolitis, retinopathy of prematurity, pneumothorax, bronchopulmonary dysplasia and early sepsis.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Persistência do canal arterial Recém-nascido prematuro Ibuprofeno Paracetamol Encerramento cirúrgico