Fatores preditivos da dor em pacientes submetidos à cirurgia cardíaca

A identificação de fatores que interferem na dor pós-operatória é útil para minimizar o sofrimento desnecessário e favorecer a uma intervenção analgésica adequada, evitando generalizações nas condutas terapêuticas. O propósito dessa investigação foi identificar os fatores preditivos da dor em pacientes submetidos à cirurgia cardíaca e a relação existente entre dor, analgesia e personalidade. Trata-se de um estudo prospectivo e analítico, aprovado pelo comitê de ética da UFRN (175/06), o qual proporcionou uma abordagem multidisciplinar ao envolver áreas distintas como: fisioterapia, psicologia, médica e enfermagem (interdisciplinaridade) na elucidação do objeto de estudo relacionado a fatores preditivos da dor. Para caracterização geral dos pacientes foi utilizada uma ficha de avaliação fisioterapêutica; a dor pós-operatória foi avaliada pela escala numérica de dor e questionário para dor McGill e o Inventário Millon de Estilos de Personalidade (MIPS) foi utilizado para identificar e avaliar as manifestações das características comportamentais e de personalidade. Foram acompanhados, do 1º ao 5º dia de pós-operatório (DPO), 160 pacientes submetidos à cirurgia cardíaca, 57,5% do sexo masculino, com idade média de 56,8±14,4 anos, sendo incluídos no estudo aqueles que se queixaram de dor no pós-operatório em pelo menos um dos dias de avaliação e assinaram termo de concentimento livre e esclarecido (TCLE). Os dados foram submetidos ao teste Qui-quadrado, regressão logística multivariada, teste de correlação de Spearman, teste t e ANOVA. Ao serem submetidos à análise de regressão foram encontrados seis fatores preditivos da dor: tempo cirúrgico > 3 horas, dreno mediastinal e lateral, tosse, vômitos, tempo de dreno > 24 horas e sexo feminino. Estes fatores apresentaram uma correlação positiva e significava com a intensidade dolorosa referida pelos pacientes na escala numérica de dor e os pacientes que apresentaram mais fatores preditivos da dor referiram mais dor. 23 Já em relação ao McGill não se obteve diferença significativa entre os pacientes com mais e menos fatores preditivos. Observou-se que foram administrados diferentes tipos de analgésicos, isolados ou associados, sendo estes: paracetamol, paracetamol associado à codeína, dipirona, tramadol, toradol e tilatil. A percepção dolorosa apresentou magnitudes variando de leve a moderada do 1º ao 5º DPO e ao ser relacionada com as características de personalidade, nos pacientes com menos dor, observou-se os fatores: preservação, individualismo, introversão e os com mais dor foram: proteção, extroversão, retraimento, discrepância, afetividade, acomodação, comunicabilidade e firmeza. Evidenciou-se que o comportamento doloroso pós-cirurgia cardíaca é multifatorial e que a determinação da existência de fatores preditivos da dor permite ao profissional da área de saúde fazer o uso adequado dos analgésicos, haja vista que o alívio da dor é responsabilidade de todos os profissionais da saúde. Os aspectos psicológicos enquanto características de personalidade podem influenciar padrões de comportamento como os observados.

Distribuição regional da ventilação pulmonar em indivíduos com insuficiência cardíaca crônica após serem submetidos a um programa de treinamento da musculatura inspiratória e sua correlação com dados funcionais

Introduction: Chagas Disease is a serious public health problem, with 5 million infected individuals in Brazil. Of these, approximately 30% develop chronic Chagas cardiomyopathy (CCC), where the main symptoms are fatigue and dyspnea. Objective: To correlate maximal exercise capacity with pulmonary function, inspiratory muscle strength and quality of life in patients with CCC. Methodology: Twelve individuals suffering from CCC were evaluated (7 men), with a mean age of 54.91± 8.60 years and the following inclusion criteria: functional class II and III according to the New York Heart Association (NYHA); left ventricle ejection fraction below 45%; clinical stability (> 3 months); symptom duration > 1 year, body mass index (BMI) < 35Kg/m2 and non-smokers or ex-smokers with a history of smoking <10 packs/day. All subjects were submitted to spirometry, manometer testing, maximal cardiopulmonary exercise testing (CPX) and a quality of life questionnaire (Minnesota). Results: A negative correlation was observed between VO2máx and MLHFQ scores (r=-0.626; p=0.03) and a positive association with MIP (r=0.713; p=0.009). Positive correlations were also recorded between MIP and spirometric variables [FEV1(r=0.825;p=0.001 ), FVC(r=0.66;p=0.01 and FEF25-75%(r=0.639;p=0.02)]. Conclusion: The present study demonstrated that in patients with CCC: VO2MAX is directly related to inspiratory muscle strength and quality of life, while deteriorating lung function is directly associated with respiratory muscle weakness

Análise da variabilidade da frequência cardíaca na síndrome dos ovários policísticos

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Efeitos do exercício físico aeróbio na modulação autonomica da frequência cardíaca de mulheres com sindrome dos ovários policisticos

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Efeito do treinamento resistido na função autônomica cardíaca, nos parâmetros bioquímicos e antropométricos de pessoas vivendo com HIV/AIDS

Introduction: The emergence of High Active Antiretroviral Therapy (HAART) increase the life expectancy of the persons living with HIV/AIDS (PLHIV), therefore the prolonged use cause metabolic implications and influences on body fat distribution and increase the cardiovascular diseases prevalence. Aims: Evaluate the effect of resistance training on heart rate variability, biochemical parameters and somatotype on PLHIV. Methods: Participated this study seven sedentary men, with age above 25 years old, living with HIV/AIDS, under HAART use. Were submitted a 16 week intervention with resistance training. Evaluated the heart rate variability, biochemical parameters and somatotype, before, after 8 weeks and 16 weeks, all in paired form. It was found the data normality by Shapiro-Wilk test and conducted the Anova one way combined with Tukey post hoc to samples in each evaluate moment, adopting significance level p<0,05. Also were calculated percentage change deltas. For somatotype was used the somatotype spatial distance (DES), obeying the significance value DES≥1. Results: Was found significance differences only in variable final heart rate delta 60s (p=0,01), however, is not showed changes on heart rate variability, biochemical parameters and somatotype components. Conclusion: 16 weeks of resistance training showed improvement on heart rate recovery after submaximal effort and, despite is not enough to produce significance differences on biochemical parameters and somatotype components, could be realize improvement on average value of fasting glucose and lipid profile, as well as reducing the endomorphic component

Força muscular respiratória, qualidade de vida e modulação autonômica da frequência cardíaca na distrofia miotônica

Background: The myotonic dystrophy (MD) is a multisystem neuromuscular disease that can affect the respiratory muscles and heart function, and cause impairment in quality of life. Objectives: Investigate the changes in respiratory muscle strength, health-related quality of life (HRQoL) and autonomic modulation heart rate (HR) in patients with MD. Methods: Twenty-three patients performed assessment of pulmonary function, sniff nasal inspiratory pressure (SNIP), the maximal inspiratory (MIP) and expiratory (MEP) pressure, and of HRQoL (SF-36 questionnaire). Of these patients, 17 underwent assessment of heart rate variability (HRV) at rest, in the supine and seated positions. Results: The values of respiratory muscle strength were 64, 70 and 80% of predicted for MEP, MIP, and SNIP, respectively. Significant differences were found in the SF-36 domains of physical functioning (58.7 ± 31,4 vs. 84.5 ± 23, p<0.01) and physical problems (43.4 ± 35.2 vs. 81.2 ± 34, p<0.001) when patients were compared with the reference values. Single linear regression analysis demonstrated that MIP explains 29% of the variance in physical functioning, 18% of physical problems and 20% of vitality. The HRV showed that from supine position to seated, HF decreased (0.43 x 0.30), and LF (0.57 x 0.70) and the LF/HF ratio (1.28 x 2.22) increased (p< 0.05). Compared to healthy persons, LF was lower in both male patients (2.68 x 2.99) and women (2.31 x 2.79) (p< 0.05). LF / HF ratio and LF were higher in men (5.52 x 1.5 and 0.8 x 0.6, p <0.05) and AF in women (0.43 x 0.21) (p< 0.05). There was positive correlation between the time of diagnosis and LF / HF ratio (r = 0.7, p <0.01). Conclusions: The expiratory muscle strength was reduced. The HRQoL was more impaired on the physical aspects and partly influenced by changes in inspiratory muscle strength. The HRV showed that may be sympathetic dysfunction in autonomic modulation of HR, although with normal adjustment of autonomic modulation during the change of posture. The parasympathetic modulation is higher in female patients and sympathetic tends to increase in patients with longer diagnosis

Evidências de validade do Millon Behavioral Medicine Diagnostic na avaliação de aderência terapêutica em pacientes com insuficiência cardíaca crônica

Chronic heart failure (CHF) is the final common pathway of most diseases affecting the heart, being responsible for a high level of mortality and hospitalization, as well as significant reduction in quality of life of those affected. Interventions that claim to optimize patient adherence to their medical regimen, and improve self-care behavior, have proven effective in preventing unplanned admissions and improves the outcome for patients, however, studies have shown the problem of non-adherence, and some psychological instruments have been used to show that traces indicate difficulties with treatment adherence. Having shown this, the aim of this work is to evaluate the evidence of validity of the Millon Behavioral Medicine Diagnostic (MBMD) in a population of patients with CHF. The study included individuals with CHF, males and females, between the age of 18 and 85 years, treated in a reference hospital in the city of NatalRN. A total of 120 patients answered, in addition to the MBMD, another questionnaire structured with sociodemographic aspects and clinical itens. The results indicated that the parameter of the MBMD reliability was satisfactory the most of extracted factors, and some scale. In terms of the population studied, we could verify that the disease was more prevalent in men, but women had the highest average in indicators related to negative health habits and depressed mood. Younger pacients and those who had no partner had the highest averages in groups of items that dealt with feelings of sadness and discouragement. Hasn’t been observed differences related to negative health habits and problematic adherence among patients in different functional classes. More studies in this research line, with a larger population and from other regions of the country, are needed in order to expand the data presented here

Efeitos dos exercícios aeróbio contínuo e intervalado na variabilidade da frequência cardíaca em adultos jovens saudáveis. Ensaio clínico aleatório

The high-intensity interval exercise has been described as an option for increasing physical activity and its use also being suggested in the therapeutic management of many conditions such as diabetes mellitus and heart failure. However, the knowledge of its physiological effects and parameters that can assure greater safety for interval exercise prescription; especially its effect on short- and medium-term (24 hours after exercise) exercise recovery, need to be clarified. This study objective was to evaluate the effect of continuous and interval aerobic exercise on the cardiac autonomic control immediate and medium term (24 hours), by assessing heart rate variability (HRV). The present study is a randomized crossover clinical trial in which healthy young individuals with low level of physical activity had the VFC 24 hours measured by a heart rate sensor and portable accelerometer (3D eMotion HRV, Kuopio, Finland) before and after continuous aerobic exercise (60-70% HR max, 21 min.) and interval exercise (cycle 1 min. 80-90% HR max, 2 min. at 50-60% HR max, duration 21 min.). HRV was measured in the time and frequency domain and the sympathovagal balance determined by the ratio LF / HF. Nonlinear evaluation was calculated by Shannon entropy. The data demonstrated delayed heart rate recovery immediate after exercise and lower HR after 24 hours compared to pre intervention values, especially in the interval exercise group. There was a tendency to higher predominance and representatives index values of sympathetic stimulation during the day in interval exercise group; however, without statistical significance. The study results help to clarify the effects of interval exercise on the 24 hours following interval exercise, setting parameters for prescription and for further evaluation of groups with metabolic and cardiovascular diseases.

Reabilitação cardíaca na insuficiência cardíaca crônica: efeitos de 12 semanas de treinamento intervalado x contínuo na função cardiopulmonar e qualidade de vida

Background: Cardiac Rehabilitation (CR) has effect on mortality in patients with heart failure (HF) chronic, and the exercise of the treatment of this patient. The most common exercise is ongoing training. Recently we have been studying the effects of interval training, but there is no consensus on the optimal dose of exercise. Objective: To evaluate the effects of interval aerobic training are superior to continuous aerobic training in patients with chronic HF. Methods: The clinical trial evaluated patients through cardiopulmonary test (CPX) and quality of life before and after the RC (3 times / 12 weeks). Patients were randomized into Group Interval Training (GTI - 85% of heart rate reserve - FCR), Continuous Training Group (GTC - 60% of HRR) and control group (CG) who received guidelines. Results: 18 patients were evaluated (mean age 44.7 ± 13.2 years and 35.2 ± 8.9% of left ventricular ejection fraction [LVEF]). Both groups were efficient to increase the peak VO2 and 15.1% (P = 0.02) in GTI and 16.1% (P = 0.01) GTC. As for the quality of life the GTI GTC showed improvement compared to the control group (P = 0.006). Hemodynamic mismatch events during the CPX were reduced after training in more GTC (patients 1 to 4) than in the GTI (5 to 3). Cardiac risk also decreased in the GTC (3 patients left the severe risk to take after training). Conclusion: Continuous training becomes more appropriate for improving fitness with little chance of developing cardiac event patients with chronic HF.