O PAPEL DA FUNÇÃO DOS MÚSCULOS RESPIRATÓRIOS COMO PREDITOR DE COMPLICAÇÕES PULMONARES PÓS-OPERATÓRIAS DE RESSECÇÃO PULMONAR

Resumo




Introdução: A avaliação pré-operatória para cirurgia pulmonar geralmente não inclui a avaliação da função muscular respiratória, a qual pode ser um preditor de complicações pulmonares pós-operatórias (CPP).


Objetivos: Verificar se a função muscular respiratória pré-operatória prediz CPP em doentes submetidos a ressecção pulmonar por toracotomia.


Métodos: Além das avaliações das funções musculares pulmonares e respiratórias, a aptidão física foi avaliada através do teste de marcha de 6 minutos. Foram registadas as CPP até 30 dias após a alta hospitalar. A análise da função discriminante foi realizada para identificar quais as variáveis que atuam como melhores preditores de CPP. Foi utilizada regressão logística para analisar a associação entre as variáveis da função muscular respiratória e a CPP.


Resultados: Doentes com CPP (n = 20), em comparação com aqueles que não desenvolveram CPP (n = 85), apresentaram hábito tabágico pesado significativo (t = –2,412; p = 0,027; d = 0,547), diminuição do volume expiratório forçado no primeiro segundo (FEV1; t = –2,932; p = 0,004; d = 0,703), do pico de fluxo expiratório (PEF; t = –2,412; p = 0,018; d = 0,586) e da capacidade de difusão de monóxido de carbono (DLCO; t = 2,183; p = 0,039; d = 0,673). Em relação à função muscular respiratória, a pressão expiratória máxima estava significativamente reduzida nos doentes com CPP (PEmáx; t = 3,116; p = 0,002; d = 0,744). Os coeficientes estruturais da função discriminante mostraram que a pressão expiratória máxima (MEP%; –0,519), o FEV1 % (-0,488), a DLCO% (-0,465), o PEF% (-0,402) e os maços de cigarros por ano (0,374) foram os fatores mais importantes para discriminar os doentes que desenvolveram CPP. Os resultados da regressão logística indicaram que os doentes com menor PEmáx (%) apresentam risco aumentado de CPP (OR = 7,440; IC 95% = 1,228 – 19,471).


Conclusão: A pressão expiratória máxima pré-operatória foi o preditor mais forte de CPP e deverá ser considerado para avaliação de risco em candidatos cirúrgicos.




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Publicado
2022-02-02
Como Citar
KENDAL, Filipa et al. O PAPEL DA FUNÇÃO DOS MÚSCULOS RESPIRATÓRIOS COMO PREDITOR DE COMPLICAÇÕES PULMONARES PÓS-OPERATÓRIAS DE RESSECÇÃO PULMONAR. Revista Portuguesa de Cirurgia, [S.l.], n. 51, p. 63-73, feb. 2022. ISSN 2183-1165. Disponível em: <https://revista.spcir.com/index.php/spcir/article/view/933>. Acesso em: 27 june 2022. doi: https://doi.org/10.34635/rpc.933.
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