936 resultados para Insuficiência renal Teses
Resumo:
O transplante (Tx) renal atualmente considerado a terapia de escolha para o paciente com insuficiência renal crnica terminal (IRCT). A preocupao em se fazer uma avaliao nutricional criteriosa dos pacientes transplantados renais, buscando-se o diagnstico e o tratamento de anormalidades nutricionais, tem sido prejudicada pela falta de consenso na literatura a respeito de um parmetro nutricional ideal. O objetivo deste estudo foi comparar diagnsticos do estado nutricional obtidos com quatro parmetros comumente empregados na avaliao e a presena de desnutrio. Foram avaliados cem transplantados renais em acompanhamento ambulatorial regular, com funo renal estvel, mais de um ano de transplante e idade maior ou igual a 18 anos. Cinqenta e trs por cento destes eram do sexo masculino, com predominncia da raa branca (89%) e mdia de idade de 44 anos. O tipo de dilise pr-Tx mais freqente foi hemodilise (95%) e o tempo desta variou de 1 a 36 meses. O tipo de doador predominante foi cadver (60%). O tempo de Tx variou de 1 a 18 anos. A etiologia da IRC no foi determinada em 33%, hipertenso arterial sistmica foi diagnosticada em 22%, glomerulonefrite crnica em 20% e outras patologias em 25%. Quanto terapia imunossupressora, esquema trplice com ciclosporina (CyA), azatioprina (AZA) e prednisona (Pred) foi mais freqentemente empregado (71%). Os pacientes no apresentaram rejeio aguda em 71% dos casos. Dislipidemia ocorreu na maioria dos pacientes (77%) e DM ps-transplante foi encontrado em 22%. A depurao da creatinina endgena (DCE) foi maior que 50ml/min em 56% dos pacientes Quatro parmetros nutricionais foram empregados na avaliao: avaliao nutricional subjetiva global (ANSG), ndice de massa corporal (IMC), circunferncia muscular do brao (CMB) e albumina srica (Alb). As variveis foram expressas como mdias e DP ou mediana e intervalo inter quartil (percentil 25 e percentil 75) ou freqncia absoluta ou relativa. O nvel de significncia adotado foi P< 0,05 e IC 95%. Dependendo do parmetro empregado, a eutrofia foi diagnosticada em 42 a 89% dos casos, obesidade de 26 a 55% e desnutrio, de 3 a 35%. Observou-se uma interseco de resultados na avaliao nutricional: alguns pacientes classificados como obesos por um parmetro, foram avaliados como desnutridos por outro e vice e versa. Dos 55 pacientes classificados como obesos pelo IMC, 35,8% foram considerados desnutridos pela Alb e, 1,8% pela ANSG. Dos 26 pacientes considerados obesos pelo CMB, 44% foram considerados desnutridos pela Alb e 3,8% pela ANSG. Dos 11 pacientes classificados desnutridos pela ANSG, 9% foram considerados obesos pelo IMC e CMB. J dos 34 pacientes classificados como desnutridos pelo parmetro Alb, 58% foram considerados obesos pelo IMC e 33% pela CMB. Conclui-se que diferentes parmetros podem resultar em diferentes diagnsticos para uma mesma populao, podendo ocorrer uma interseco de diagnsticos para um mesmo paciente. A ocorrncia de desnutrio foi observada nesta populao com percentuais importantes.
Resumo:
Introduo: A variabilidade da freqncia cardaca (VFC) um marcador da modulao autonmica cardaca e tem sido empregada para avaliao da neuropatia autonmica urmica. A reduo da VFC em pacientes com insuficiência renal crnica foi descrita em alguns estudos. Existem, entretanto, poucos relatos sobre a utilizao da VFC para avaliao comparativa da neuropatia autonmica urmica entre pacientes em hemodilise (HD) e em tratamento conservador (TC). Tambm no est definida qual a influncia da anemia sobre a VFC nesses pacientes. Objetivos: Avaliar as diferenas na anlise da VFC no domnio do tempo entre pacientes em HD e em TC e avaliar a influncia da anemia sobre a VFC. Mtodos. Quinze pacientes em HD h mais de trs meses e quinze pacientes com DCE abaixo de 30 ml/min foram submetidos ao registro eletrocardiogrfico (ECG) de 24 horas, mantendo suas atividades habituais. Foram excludos pacientes com diabete melito, cardiopatia ou outras patologias que afetam o sistema nervoso autnomo. HAS no foi critrio de excluso. As medicaes usadas pelos pacientes foram mantidas. A partir do ECG de 24 horas foram calculados os seguintes ndices: mdia dos intervalos RR normais (RRmed), desvio padro de todos os intervalos RR normais (SDNN), raiz quadrada da mdia das diferenas sucessivas entre intervalos RR normais adjacentes (RMSSD) e percentagem das diferenas sucessivas entre os intervalos RR adjacentes normais que excedam 50ms (PNN50). Os testes Q2 e exato de Fisher foram usados para anlise das variveis categricas e o teste t de Student para as variveis quantitativas. O teste de correlao de Pearson e a anlise de covarincia foram utilizados para verificar a relao entre as variveis. Resultados. Os grupos no diferiram quanto distribuio de sexo e idade entre os pacientes. Os valores de hematcrito (respectivamente HD e TC: 26,33 4,20 x 32,27 4,39) e hemoglobina (8,41 1,36 x 10,39 1,69) foram significativamente diferentes entre os grupos (p = 0,001 e p = 0,002). O uso de betabloqueador foi mais freqente no grupo TC (p = 0,02). No havia diferena significativa entre os grupos quanto aos demais anti-hipertensivos. O ndice PNN50 no tinha distribuio normal e foi analisado aps transformao logartmica. Os valores de RRmed (706,36 91,43 ms x 822,67 108,80 ms; p = 0,004), SDNN (93,12 26,54 ms x 118,38 32,97 ms; p = 0,028), RMSSD (13,79 4,17 ms x 20,38 7,82 ms; p = 0,008) e lnPNN50 (0,40 1,38 x 1,60 1,08; p = 0,013) foram significativamente menores nos pacientes em HD. A anlise de covarincia demonstrou que os valores de hematcrito e hemoglobina influenciaram significativamente os ndices RRmed e SDNN, mas no os ndices RMSSD e lnPNN50, os quais so ndices vagais puros. O uso de betabloqueador teve influncia significativa apenas sobre o ndice RRmed. Concluso. Os pacientes em hemodilise apresentam reduo da variabilidade da freqncia cardaca quando comparados aos pacientes em tratamento conservador. A anemia determina reduo da variabilidade da freqncia cardaca medida pelos ndices no domnio do tempo RRmed e SDNN, mas no tem influncia significativa sobre os ndices RMSSD e PNN50.
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ADiabetesMellitus,emespecialadotipo2,umadascausasmaisfrequentesnainsuficiência renalcrnica,eumadasdiversascomplicaesquepodemocorrernumindividuodiabticoa nefropatiadiabtica.Anefropatiadiabticaumadoenaquesecaracterizapelafalnciarenal elevaaquealgunsdospacientescomestadoenatenhamderealizarotratamentode hemodilise.Oobjectivoprincipaldesteestudofoiacaracterizaodoperfilbioqumicoda populaohemodialisadadiabticaenodiabtica.Realizouseumestudoretrospectivoa doentesquerealizaramhemodilise,noperododeNovembrode2004aJulhode2005,na UnidadedeHemodilisedoHospitaldosMarmeleirosdoCentroHospitalardoFunchalena Nefromar,UnidadedeHemodilisedaClnicadeSantaCatarina. Esteestudoenvolveuumaamostragemde267,emque115eramhemodialisadoscomos nveisdaglicoseinferioresa150mg/dl,constituindooGTND,60eramhemodialisadoscom nveis de glicose iguais ou superiores a 150 mg/dl, constituindo o GTD e, finalmente, os restantes 92 indivduos saudveis e que no realizam hemodilise, o GC. Os parmetros analisadosforamacreatinina,aureia,aglicose,asprotenastotais,aalbumina,ocolesterol,o HDLc,LDLcetriglicerdeos,osdio,opotssioeocloro. Aanlisedosparmetrosbioqumicosrevelouumamaiorfrequnciadehemodialisadosno sexomasculino,comidadessuperioresaossessentaanos,oqueestdeacordocomestudos efectuadosanteriormente. Osresultadosmostraramqueosparmetroscreatininaeureia,soosqueapresentammais alteraes nos doentes hemodialisados, devido terem sido determinados em prdilise. Verificousequeosnveiscolesteroltotal,deLDLceostriglicerdeossomaiselevadosnos gruposteste,emespecialnoGTD. Dasanlisesdecorrelaesverificousehaverumarelaoentreaglicoseeosnveiselevados decolesterol,LDLcetriglicerdeosetambmcomosnveisbaixosdeHDLc.Osrestantes parmetrosanalisadoscomaexcepodaglicose,nomostraramdiferenassignificativas entreosgruposemestudo
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Retinopatia de Purtscher-like uma baixa sbita da viso associada imagem de mltiplas reas branco-amareladas (manchas algodonosas) e hemorragias no plo posterior de ambos os olhos. O exato mecanismo da injria ainda no claro, mas provavelmente seria de natureza emblica. Tem sido descrita em uma variedade de condies, incluindo pancreatite aguda, sndrome de embolia gordurosa, insuficiência renal,nascimento (parto e ps-parto), desordens do tecido conectivo, entre outras. Sero relatados trs casos de pancreatite aguda confirmada pelos exames laboratoriais e histria clnica, associadas a alteraes no exame do fundo de olho, compatveis com esta retinopatia
Resumo:
To determine whether there is familiar aggregation of severe preeclampsia in a Brazilian population from Rio Grande do Norte and to characterize the maternal and perinatal outcomes in the studied population. Methods: A case control study was performed with 412 participants who were admitted at Maternidade Escola Janurio Cicco (MEJC) for medical care. Of these, 264 subjects presented normal blood pressure and 148 were cases. Cases were composed of eclampsia (n=47), HELLP Syndrome (n=85) and Eclampsia associated with HELLP syndrome (n=16). The diagnosis of these illness were based on the citeria developed by National High Blood Pressure Education Program Working (2000). An interview was performed with each subject and questions related to personal and familiar history of hypertension, preeclampsia, HELLP syndrome and eclampsia. Statistical analysis was performed and comparison of median and mean between cases and controls were performed, with the level of significance of 5%. The Odds-Ratio was determined to estimate the risk of preeclampsia within the families. Results: There were no difference in the demographic data between cases and controls. Previous history of chronic hypertension and preeclampsia was more frequent in the case group. Headaches were more frequent in eclampsia and epigastric pain in the HELLP syndrome cases. Bleeding and oliguria were more frequently found in the eclampsia associated with HELLP syndrome cases. Acute Renal insufficiency was a common complication in the case group, but these cases did not evolve to chronic renal insufficiency. The maternal mortality was 0.4% and the perinatal mortality was high, 223 per 1,000 live births. The 111 risk of a woman to develop preeclampsia whose mother has hypertension or had preeclampsia was respectively 2.5 and 3.5. This risk was increased 5 times, when a sibling has hypertension and 6 times when both sibling and mother had previous history of preeclampsia. Conclusions: This study confirms that there is familiar aggregation of preeclampsia in this Brazilian population. The potential for cardiovascular complications due to development of chronic hypertension indicates the need of closely follow up of women who develop preeclampsia
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Objective: To determine the clinical maternal and neonatal outcomes in HELLP syndrome patients treated with dexamethasone who either developed renal injury or renal insufficiency and to identify predictive values of urea and creatinine for the identification of subjects with HELLP syndrome at risk of developing renal insufficiency. Methods: Non-radomized intervention study of dexamethasone use in HELLP syndrome. A total of 62 patients were enrolled at Maternidade Escola Janurio Cicco (MEJC). Patients received a total of 30 mg of dexamethasone IV, in three doses of 10 mg every 12 hours. A clinical and laboratory follow up were performed at 24, 48 and 72 hours. Patients were followed up to 6 months after delivery. Patients were grouped in accordance to renal function, i.e, normal and some type of renal lesion. Renal lesion was considered when creatinine was equal or greater than 1.3 mg/dl and diuresis less than 100 ml in 4 hours period and renal insufficiency was defined when dialysis was needed. Results: A total of 1230 patients with preeclampsia were admitted at MEJC. Of those 62 (5%) developed HELLP syndrome. There was no statistical difference in the groups with renal involvement or normal renal function with respect to the demographics, type of anesthesia used and delivery, and weight of the newborn. An improvement in the AST, ALT, LDH, haptoglobine, antithrombine, fibrinogenen and platelets was observed within 72 hours after dexamethosone use. There was a significant increase in the diuresis within the interval of 6 hours before the delivery and 24 hours after it. Of the 62 patients, 46 (74. 2%) had normal renal function and 16 (25.8%) evolved with renal lesion, with 5 (8.1%) needing dialysis. These 5 patients who received dialysis recovered the xi renal function. The delay in administering dexamethasone increased in 4.6% the risk of development of renal insufficiency. Patients with renal insufficiency had received significantly more blood products than subjects without renal lesion (p=0.03). Diuresis, leukocytes, uric acid, urea, creatinine were significantly different between the groups with normal renal function, renal lesion and renal insufficiency. The levels of creatinine 1.2mg/dl and uric acid 51mg/dl, at admission are predictive of subjects who will evolve with renal lesion (p<0.001). Maternal mortality was 3.2%. None of the subjects with renal insufficiency evolved with chronic renal disease. Conclusions: Dexamethasone in patients with HELLP syndrome seems to reduce significantly the hepatic microthrombosis and normalize hemostasis as seen by improvement of liver function. Renal injury can be considered, in HELLP syndrome, when creatinine levels are greater than 1.3 mg/dl and diuresis less than 100 ml/h in interval of 4 hours. The level of creatinine greater than 1.2 mg/dl and urea greater than 51mg/dl are predictive of subjects with HELLP syndrome who will develop renal injury. Patients who receive more red cell packs develop renal insufficiency. Finally, the delay in administering dexamethasone increases the risk of developing renal insufficiency
Resumo:
Background: Malnutrition, inflammation and comorbidities are frequent in patients with chronic renal failure in hemodialysis (HD), contributing for morbidity and mortality. Aims: To evaluate the correlation between anthropometric, laboratory parameters, bioelectrical impedance (BIA) and inflammatory markers with the morbidity and mortality of patients in HD, as well as the impact of its alterations throughout 12 months. Methods: 143 patients of a dialysis facility in Northeast Brazil were evaluated throughout 18 months. Patients with more than 3 months on dialysis, older than 18 years, without amputation of hands and feet, were included in the study. We performed a clinical (subjective global assessment - SGA), anthropometric (BMI, percent of ideal weight, MAC, MAMC, MAMA, percent of fat mass and TSF), laboratory (albumin, creatinine, lymphocyte count as nutritional markers and CRP, IL-6 and TNF- as inflammatory markers) evaluation and BIA (reactance, phase angle and percent of body cell mass) at the beginning of study and after 3, 6 and 12 months of follow-up. The association between study variables and deaths and hospitalizations in 6 and 12 months was investigated. The variable with significance < 10% in the univariate analysis had been enclosed in a multivariate logistic regression analysis. We also investigated the risk of mortality and hospitalization associated with differences in measurements of the variables at baseline and six months later. Results: Patients were aged 52.2 16.6 years on the average, 58% were male, and mean dialysis vintage was 5.27 5.12 years. The prevalence of malnutrition varied from 7.7-63.6%, according to the nutritional marker. The variables associated with morbidity and mortality in 6 and 12 months had been creatinine ≤ 9.45 mg/dl, phase angle ≤ 4.57 degrees, BMI ≤ 23 kg/m2, age ≤ 64.9 years, reactance ≤ 51.7 ohms; Charlsons index ≥ 4 and socioeconomic status ≤ 7. During six months of follow up, decrease in albumin was associated with significantly higher mortality risk. Conclusions: This study detected that the best predictors of morbidity and mortality between nutritional and inflammatory markers are phase angle, reactance, creatinine and BMI and that changes in albumin values over six 107 months provide additional prognostic information. The authors believe that parameters of BIA may detect early changes in nutritional status and emphasize that longitudinal studies with larger number of patients are necessary to confirm these data and to recommend BIA as a routine nutritional evaluation in HD patients
Resumo:
Reconstruct, from listening, the life histories of a chronic renal patient, submitted to hemodialysis, is the objective of this investigation. How methodological procedure,we worked with oral history of life, ,according Meihy, within a qualitative approach. For this, we had the approval of the Ethics Committee in Research of Hospital Universitrio Onofre Lopes (HUOL), under protocol no 591/2011. As instrument to approach the patient, we did interviews with open questions, conducted in the patient's house. There were five meetings, in which we hear his story, experiences and ways of coping during their course of illness and treatment. The analysis was based on the collaborator's narratives, anchored in studies dealing with oral history, of human subjectivity, highlighting the resilience, as indicated Cyrulnik. Her story leads us to conclude that despite the adversities of life and suffering, there is in humans, the strength to navigate the streams and be happy. This is the lesson that leaves us the collaborator this study.
Resumo:
The therapeutic possibilities for chronic renal failure closely are related to the biological and social condition, and in this perspective the renal transplant is considered the best option, for providing quality of life better. This study it objectified to apprehend, by means of the rescue of the verbal history of life of the kidney transplant patients, the experiences lived since the diagnosis of the renal to the current with the current therapeutic modality. One is about a study of qualitative boarding, exploratory and descriptive, having the verbal history of life as a technique and method. The colony was formed with the ten first kidney transplant patients of the Rio Grande of the North, taken care of in the clinic of the Nephrology in the University Hospital Onofre Lopes-UFRN, located in the city of Christmas-RN. The net was composed for collaborators of both the sex, in the age band between 21 and 56 years of age, submitted it more than has one year to the renal transplant and that, in some cases, together of its familiar ones, they had voluntarily accepted to participate of the study. The first collaborator interviewed for this was excluded not to desire to participate the study more than. After approval for the Committee of Ethics in Search of the UFRN, we carry through the collection of data, by means of a halfstructuralized interview, recorded individually, in environment chosen for the collaborators. We carry through the transcription of the interviews and later we return to the interviewed ones so that the same ones made the conference, what it made possible in them to carry through the transcriation, after consecutive readings. We analyze the stories by means of the analysis of content of Bardin. Guiding the analysis of the stories of the collaborators, we find three axles thematic: Impact in the social relations, Impact in the social condition and Behavior front the illness and treatment. We conclude in this study that the loss of the renal function reed-echo drastically in the life of the collaborators, but that the acceptance of the pathological condition emerged, mainly for the support of the family and in the belief in God. The renal transplant was seen as the chance for a new life, however, so that they reach an improvement in the quality of life, other questions must be optimized, as the guarantee of constitutional laws, the rescue of the citizenship and offer of bigger support of the professionals of the health, family and society for the confrontation of the problems generated for the chronic renal illness and its treatments
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Trasnversal study, with the objective of evaluating the accuracy of clinical indicators of nursing diagnosis excessive fluid volume in patients undergoing hemodialysis. The study occurred in two stages, the first consisted of the evaluation of the diagnostic indicators in study; and the second, the diagnostic inference conducted by nurse diagnosticians. The first stage occurred from december 2012 to april 2013, in a University Hospital and a Hemodialysis Clinic in Northeastern of Brazil, with a sample of 100 chronic renal failure patients on hemodialysis. The data were selected through an interview form and a physical examination, organized into spreadsheets and analyzed as to the presence or absence of the indicators of diagnosis excessive fluid volume. In the second step, the spreadsheets were sent to three nurses diagnosticians, who judged the presence or absence of diagnosis in the clientele searched. This step was conducted from july to september 2013. For analysis of the data, we used descriptive and inferential statistics. In the descriptive analysis, we used measures of central tendency and dispersion. In inferential analysis, we used the tests Chi- square, Fisher and prevalence ratios. The accuracy of the clinical indicators pertaining to the diagnosis were measured as to the specificity, sensitivity, predictive values, likelihood ratios and Diagnostic Odds Ratio. Also developed a logistic regression. The results were organized in tables and discussed with literature. This study was approved by the Ethics Committee in Research of the Federal University of Rio Grande do Norte, with Presentation Certificate for Ethics Appreciation n 08696212.7.0000.5537. The results revealed that the diagnosis studied was present in 82% of patients. The characteristics with prevalence above 50 % that stood out were: azotemia, decreased hematocrit, electrolyte imbalance, intake exceeds output, anxiety, edema, decreased hemoglobin, oliguria and blood pressure changes. Eight defining characteristics were presented statistically significant association with the nursing diagnosis investigated: pulmonary congestion, intake exceeds output, electrolytes imbalance, jugular vein distension, edema, weight gain over short period of time, agitation and adventitious breath sounds. Among these, the 10 characteristics which showed higher prevalence ratios were: edema and weight gain over short period of time. The features with the highest sensitivity were edema, electrolytes imbalance and intake exceeds output and the standing out with greater specificity were: anasarca, weight gain over short period of time, change in respiratory pattern, adventitious breath sounds, pulmonary congestion, agitation and jugular vein distension. The indicators jugular vein distension, electrolytes imbalance, intake exceeds output, increased central venous pressure and edema, together, were identified in the logistic regression model as the most significant predictors. It is concluded that the identification of accurate clinical indicators allow a good prediction of the nursing diagnosis of excessive fluid volume in patients undergoing hemodialysis in order to assist the nurse in the inference process, which will contribute to the success of patient care. In addition, nurses will consider for diagnostic inference not only his clinical experience, but also scientific evidence of the occurrence of excessive fluid volume, contributing to the control of volemia in these patients
Resumo:
CONTEXTO E OBJETIVO: Portadores de insuficiência renal crnica em dilise apresentam alta prevalncia de desnutrio proteico-energtica. No existe ainda um mtodo uniforme para avaliar o estado nutricional desses pacientes. Recomenda-se a aplicao de um conjunto de mtodos subjetivos e objetivos para se chegar aos diagnsticos nutricionais adequados. O objetivo deste estudo traar o perfil nutricional de pacientes submetidos a hemodilise. TIPO DE ESTUDO E LOCAL: Estudo transversal descritivo realizado na Unidade de Tratamento Dialtico de Araraquara, So Paulo, Brasil, em 2008. MTODOS: 48 pacientes tiveram seus indicadores antropomtricos e bioqumicos caracterizados, sendo tambm submetidos ao questionrio Avaliao Global Subjetiva modificada (SGAm), verificando-se possveis correlaes entre esses indicadores. RESULTADOS: A frequncia de desnutrio moderada e grave variou de 22% a 54%, de acordo com o parmetro utilizado. Com relao adequao do peso ideal, 29% da amostra estavam com porcentagem de adequao abaixo do percentil 75, classificados como portadores de desnutrio moderada e grave. As correlaes mais significativas foram observadas entre ndice de massa corporal (IMC) e adequaes de prega triciptal (PCT), circunferncia do brao (CB) e circunferncia muscular do brao (CMB); e entre o SGAm e adequaes de CB e CMB. CONCLUSO: A desnutrio apresentou grande variabilidade de frequncia entre os pacientes de acordo com o critrio escolhido para avaliao. O acompanhamento nutricional de rotina e a validao de mtodos que avaliem a composio corporal desses pacientes so de extrema importncia para diagnosticar precocemente a desnutrio e assim prevenir complicaes e reduzir as taxas de morbimortalidade nesta populao.
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Introduction: This work intents to characterize behavioral indicators of tack to the hemodialysis treatment in a sample of carrying patients of chronic kidney failure (CKF) in the great Natal/RN. The therapeutical adherence represents the agreement degree between the patient behavior and the health team lapsings. The CKF is the gradual and irreversible loss of the renal function, being the hemodialysis treatment an important alternative to assist or to substitute the kidneys. Method: The sample consisted in 80 chronic kidney patients in hemodialysis treatment in two located clinical centers in the region of the great Natal, RN. It was used as instruments (a) a protocol of clinical data collection, (b) the Millon Index of Personality Styles (MIPS) and (c) a script of halfstructuralized interview. Results: The results show a balance between the genders (51% of female and 48.8% of the male sex), average age and equal average time of dialysis respectively to the 43,4 years (13,25 years) and 22,04 years (4,24 years). The marital status of half of the sample is married, predominating basic education (43.6%) and a familiar income until a minimum wage (43.8%). It had been defined six physicianlaboratorial indicators to evaluate the therapeutical adherence, further the use of the evaluation of the health team and the patient themselves. Thus, there was an average adherence around 55.97% of the sample 18.37%). However only between selfassessment of the patients about the adherence and the assessment made by blood pressure post-dialysis indicated a significant association (p=0,029, qui-square test). On the other hand, there was a significant association (p <0.05, chi-square test) among the criteria for treatment adherence and issues investigated in the interview - the perception on the quality of the health services provided to patients, the difficulties following the prescribed diet, the characterization of the days between dialysis sessions and the perception of patients about the dialysis sessions. It was also noted a significant association (p <0.05, Levene test) between adherence to therapy and scales that constitute the MIPS. The health team characterized the patients more adherent behavior as an attitude of acceptance of the treatment, looking actively for their implementation, for more information and knowledge, and establishing a positive communication with the team and with other patients. Similar results were confirmed by the MIPS evaluation. According to that assessment the more compliant patients adopt a more optimistic attitude, trying to act or adapt themselves to their environment, processing cognitively both concrete and objective information, such as more speculative and symbolic information. In addition they establish a gregarious, cooperative, submissive and flexibly pattern of interpersonal relationships to social demands. These characteristics managed to explain 55.7% of the adherence variation according the health team and 23.3% of the variation according the CaxP laboratory indicator. Conclusions: The MIPS shown to be able to identify the most and least adherent to therapy patients. The use of different adherence indicators is important for an evaluation covering the different facets of this process. The adhesion levels are observed within registered by the relevant literature. There is need for further studies with a larger sample to deepen the data findings in this work
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JUSTIFICATIVA E OBJETIVOS: A plasmafresis a tcnica de tratamento de escolha para pacientes com anemia hemoltica grave. Uma de suas conseqncias a depleo de colinesterase plasmtica, o que interfere na metabolizao de alguns bloqueadores neuromusculares de uso corrente na prtica anestesiolgica. RELATO do CASO: Paciente com 26 anos, estado fsico ASA IV, gestao de 30 semanas e 3 dias, portadora de anemia falciforme, trao talassmico e alo-imunizao para antgenos de alta freqncia. Apresentou crise de falcizao, sendo transfundida com derivado sangneo incompatvel. Evoluiu com hemlise macia, sendo admitida com hemoglobina de 3 g/dL e hematcrito de 10%, ictercia intensa, taquicardia, apatia e descoramento. Na avaliao hematolgica concluiu-se ser situao de inexistncia de sangue compatvel para transfuso. Foi tratada com corticoterapia, imunoglobulinas e plasmafresis. No segundo dia de internao, evoluiu com insuficiência renal aguda e edema pulmonar agudo, piora do estado geral e instabilidade hemodinmica. Indicada a resoluo da gestao em decorrncia do quadro clnico da paciente e do sofrimento fetal agudo que se sobreps. A paciente foi admitida na sala de operaes consciente, dispnica, plida, ictrica, SpO2 de 91% em ar ambiente, freqncia cardaca de 110 bpm e presso arterial de 110 x 70 mmHg, em uso de dopamina (1 g.kg-1.min-1) e dobutamina (10 g.kg-1.min-1). Optou-se por anestesia geral balanceada, com alfentanil (2,5 mg), etomidato (14 mg) e atracrio (35 mg) e isoflurano. No se observou intercorrncias anestsico-cirrgicas. Ao final, a paciente foi encaminhada UTI, sob intubao orotraqueal, e em uso de drogas vasoativas, tendo sido extubada aps 3 horas. CONCLUSES: Este caso mostrou-se um desafio para a equipe, visto que a paciente apresentava instabilidade hemodinmica e alterao do coagulograma, condies que contra-indicam a anestesia regional; alm disto, a plasmafresis potencialmente depleta os estoques de colinesterases plasmticas, o que interfere na anestesia. Entretanto, o arsenal medicamentoso disponvel permitiu o manuseio seguro desta situao.
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RESUMO A fstula arteriovenosa com bom fluxo sangneo de fundamental importncia para os pacientes portadores de insuficiência renal crnica em tratamento hemodialtico. Uma das complicaes da fstula arteriovenosa a sndrome do roubo, mas esta de ocorrncia incomum, e o seu tratamento est diretamente indicado quando h sintomas manifestos. Vrios mtodos foram propostos para sua correo nos membros superiores, sendo considerada a revascularizao distal com ligadura arterial o procedimento de escolha. Neste relato de caso indito, descreve-se o tratamento da sndrome do roubo de uma fstula arteriovenosa realizada em membro inferior, tratada com sucesso por meio da mesma tcnica indicada para os membros superiores.
