Study on functional cardiorespiratory changes after laparoscopic Nissen fundoplication

PURPOSE: To analyze the behavior of cardiopulmonary function in postoperative of laparoscopic Nissen fundoplication.METHODS: Thirty-two patients, 13 males (41%) and 19 females (59%), were evaluated. Their age ranged from 25 to 67 years, with a mean of 44.4 +/- 10.9. Pulmonary volumes, respiratory pressures and exercise tests were performed in the preoperative period (PRE) and in the first (PO1), second (PO2), fifth (PO5) and thirtieth (PO30) postoperative periods.RESULTS: Thirty-two patients were evaluated, of whom 59% were females. Mean age was 44.4 +/- 10.9 years. Lung volumes had significant decrease at PO1 and PO2 and were similar to PRE values at PO5. Respiratory pressures were altered only at PO1. The distance covered in the 6-minute walk test had significant reduction until PO2, and climbing time in the stair-climbing test significantly increased at PO2.CONCLUSION: Patients submitted to LNF surgery have decreased cardiorespiratory function in the early postoperative period; however, they soon return to preoperative conditions.

Predictors of health status do not change over three-year periods and exacerbation makes difference in chronic obstructive pulmonary disease

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

L-carnitine as an ergogenic aid for patients with chronic obstructive pulmonary disease submitted to whole-body and respiratory muscle training programs

The effects of adding L-carnitine to a whole-body and respiratory training program were determined in moderate-to-severe chronic obstructive pulmonary disease (COPD) patients. Sixteen COPD patients (66 ± 7 years) were randomly assigned to L-carnitine (CG) or placebo group (PG) that received either L-carnitine or saline solution (2 g/day, orally) for 6 weeks (forced expiratory volume on first second was 38 ± 16 and 36 ± 12%, respectively). Both groups participated in three weekly 30-min treadmill and threshold inspiratory muscle training sessions, with 3 sets of 10 loaded inspirations (40%) at maximal inspiratory pressure. Nutritional status, exercise tolerance on a treadmill and six-minute walking test, blood lactate, heart rate, blood pressure, and respiratory muscle strength were determined as baseline and on day 42. Maximal capacity in the incremental exercise test was significantly improved in both groups (P < 0.05). Blood lactate, blood pressure, oxygen saturation, and heart rate at identical exercise levels were lower in CG after training (P < 0.05). Inspiratory muscle strength and walking test tolerance were significantly improved in both groups, but the gains of CG were significantly higher than those of PG (40 ± 14 vs 14 ± 5 cmH2O, and 87 ± 30 vs 34 ± 29 m, respectively; P < 0.05). Blood lactate concentration was significantly lower in CG than in PG (1.6 ± 0.7 vs 2.3 ± 0.7 mM, P < 0.05). The present data suggest that carnitine can improve exercise tolerance and inspiratory muscle strength in COPD patients, as well as reduce lactate production.

Correlações entre os níveis de L-carnitina plasmática, o estado nutricional e a função ventilatória de portadores de doença pulmonar obstrutiva crônica

OBJETIVO: Avaliar os níveis de L-carnitina livre no plasma, o estado nutricional, a função pulmonar e a tolerância ao exercício em pacientes com doença pulmonar obstrutiva crônica e verificar as correlações entre a composição corporal e as frações de L-carnitina no plasma. MÉTODOS: Quarenta pacientes entre 66,2±9 anos, com diagnóstico clínico de doença pulmonar obstrutiva crônica, foram divididos em dois grupos: G1, com índice de massa corporal menor que 20kg/m², e G2, com índice de massa corporal maior que 20kg/m². Foram mensurados os parâmetros espirométricos, a tolerância ao exercício no teste de caminhada, a força muscular respiratória, a composição corporal por meio da impedância bioelétrica e as dosagens da L-carnitina plasmática, através de amostras de sangue. RESULTADOS: Foram observados menores valores das variáveis espirométricas (p<0,01), da força muscular respiratória e dos níveis de L-carnitina nos pacientes do G1; porém, não houve diferença entre os grupos quanto à capacidade de realizar exercício físico dinâmico de baixa intensidade. Correlações significativas entre o percentual de gordura e os níveis de L-carnitina plasmática foram observadas nos pacientes (r=0,53 com p<0,002); sendo que, nos pacientes com índice de massa corporal menor que 18kg/m², essa relação aumentou (r<0,73 com p<0,01). CONCLUSÃO: Na doença pulmonar obstrutiva crônica, a desnutrição está associada tanto aos prejuízos da função pulmonar e da força muscular respiratória, quanto aos baixos níveis de L-Carnitina plasmática.

Gender differences in predictors of health status in patients with COPD

Objective: To evaluate the health status (HS) of COPD patients and to identify the main predictors of HS in these patients according to gender. Methods: The study included 90 COPD patients (60 males and 30 females; mean age = 64 +/- 9 years) with a wide range of airway obstruction disorders (mean FEV(1) = 56 +/- 19% of predicted). The men were individually matched to the women by % of predicted FEV(1) (ratio: 2:1). The patients were assessed regarding body composition; six-minute walk distance; perception of dyspnea using the Modified Medical Research Council Dyspnea Scale; Saint George's Respiratory Questionnaire (SGRQ); Charlson comorbidity index; and the multidimensional Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index. Multiple linear regression analysis was performed to identify the predictors of HS by gender. Results: Impairment of HS was greater among the women than among the men for SGRQ total score and for all SGRQ domains (total: 51 +/- 18% vs. 38 19%; p = 0.002; symptoms: 61 +/- 22% vs. 42 +/- 21%; p < 0.001; activity: 62 +/- 18% vs. 49 +/- 21%; p = 0.004; and impact: 41 +/- 19% vs. 27 +/- 18%; p = 0.001). The multiple linear regression showed that age and perception of dyspnea correlated with SGRQ total score for both genders (males, r(2) = 0.42; females, r(2) = 0.70; p < 0.05). Conclusions: Our results showed an association between gender and HS in COPD patients. Age and dyspnea are determinants of HS in both genders.

Estudo das alterações funcionais respiratórias em pacientes submetidos à colecistectomia videolaparoscópica

Pós-graduação em Bases Gerais da Cirurgia - FMB

Efeitos do treinamento resistido sobre a variabilidade da frequência cardíaca, capacidade funcional e força muscular periférica na DPOC

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Aspectos físicos, funcionais e qualidade de vida de pacientes com Doença Pulmonar Obstrutiva Crônica após programa de treino resistido com corda elástica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Versão brasileira do Chronic Respiratory Questionnaire: estudo da validade de constructo e reprodutibilidade

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Testes de risco cirúrgico relacionados às complicações cardiopulmonares: comparação entre a cirurgia abdominal supra-umbilical e a torácica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Influência do treinamento físico combinado na função diastólica do ventrículo esquerdo de idosos com hipertensão arterial controlada

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Diagnóstico do nível de atividade física de adultos cadastrados na estratégia de saúde da família de Rubião Junior, Botucatu, SP

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeito do treinamento físico na qualidade de vida, capacidade funcional e fatores de risco cardiovascular nos portadores de doença renal crônica em tratamento conservador

Pós-graduação em Fisiopatologia em Clínica Médica - FMB

Cardiorespiratory evaluation in pre and post operative moments of laparoscopic cholecystectomy

PURPOSE: To analyze the changes in both respiratory function and cardiopulmonary exercise tests results in patients subjected to laparoscopic cholecystectomy. METHODS: Fifty patients were evaluated (76% women) and the average age was 47.8±14.2 years. All individuals underwent the measurement of spirometry, manovacuometry, 6-minute walk test (6MWT) and stair-climbing test (SCT). All tests were performed at the first (PO1), fifth (PO5) and thirtieth (PO30) postoperative days. RESULTS: BMI average was 28.8±4.8 kg/m2. Sample comprised 68% non-smokers, 20% current smokers, and 12% former smokers. There was no incidence of postoperative complication whatsoever. There was a significant decrease in spirometric values at PO1, but values were similar to the ones of PRE at PO30. Manovacuometry showed alterations at PO1 displaying values that were similar to the ones of PRE at PO30. 6MWT was significantly shorter at until PO5, but at PO30 values were similar to ones of PRE. As for SCT, values were significantly compromised at PO5 and PO30 since they were similar to the ones of PRE. CONCLUSION: Patients submitted to laparoscopic cholecystectomy present a decrease in cardiorespiratory function on the first postoperative moments but there is a rapid return to preoperative conditions.

Influence of the resistance training on heart rate variability, functional capacity and muscle strength in the chronic obstructive pulmonary disease

Background. The chronic obstructive pulmonary disease (COPD) is associated with the strength and resistance decreasing in addition to the dysfunction on autonomic nervous system (ANS). The aerobic training isolated or in association with the resistance training showed evidence of beneficial effects on an autonomic modulation of COPD; however, there are no studies addressing the effect of isolated resistance training.Aims. This study aims at investigating the influence of resistance training on an autonomic modulation through heart rate variability (HRV), functional capacity and muscle strength in individuals with COPD.Design. Clinical series study.Setting. Outpatients.Population. The study involved 13 individuals with COPD.Methods. The experimental protocol was composed by an initial and final evaluation that consisted in autonomic evaluations (HRV), cardiopulmonary functional capacity evaluation (6-minute walk test) and strength evaluation (dynamometry) in addition by the resistance training performed by 24 sessions lasted 60 minutes each one and on a frequency of three times a week. The intensity was determined initially with 60% of one maximum repetition and was progressively increased in each five sessions until 80%.Results. The HRV temporal and spectral indexes analysis demonstrates improvement of autonomic modulation, with significant statistical increases to sympathetic and parasympathetic components of ANS representing by SDNN, LF and HF. In addition, it was observed significant statistical increases to shoulder abduction and. knee flexion strength and functional capacity.Conclusion. The exclusive resistance training performed was able to positively influence the autonomic modulation; in addition it promoted benefits on cardiorespiratory functional capacity and strength benefits in individuals with COPD.Clinical Rehabilitation Impact. This study could contribute to clinical and professionals researchers that act with COPD, even though the resistance component of pulmonary rehabilitation presents consensual benefits on several healthy indicators parameters. There is no evidence about the effects on HRV before. Moreover, this study showed, on clinical practice, the HRV uses as an ANS activity on sinus node evaluation and highlights further importance on scientific context.