Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942010000600006
Brazilian Journal of Anesthesiology
Scientific Article

Avaliação hemodinâmica não invasiva de mulheres não grávidas, gestantes saudáveis e gestantes com pré-eclâmpsia usando biorreatância

Non-invasive hemodynamic assessment of non-pregnant, healthy pregnant and preeclamptic women using bio-reactance

Yayoi Ohashi; Hisham Ibrahim; Louis Furtado; John Kingdom; José Carlos Almeida Carvalho

http://dx.doi.org/10.1590/S0034-70942010000600006 Braz J Anesthesiol, vol.60, n6, p.608-613, 2010
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Resumo

JUSTIFICATIVA E OBJETIVOS: Comparamos os perfis hemodinâmicos de gestantes saudáveis e com pré-eclâmpsia leve, a termo, assim como de controles saudáveis não grávidas, usando um novo monitor de débito cardíaco não invasivo (NICOM, do inglês) baseado na biorreatância. MÉTODOS: Estudamos gestantes saudáveis a termo (Preg, n = 10), gestantes a termo com pré-eclâmpsia leve (PregPE, n = 10) e mulheres saudáveis não grávidas (NonPreg, n = 10). Com as pacientes na posição de semidecúbito lateral esquerdo, 4 eletrodos do NICOM foram colocados na parede do tórax. Essa colocação foi seguida de um período de descanso de 15 minutos. Variáveis hemodinâmicas, incluindo pressão arterial sistólica (PAS), diastólica (PAD) e média (PAM), assim como frequência cardíaca (FC), volume sistólico (VS), resistência periférica total (RPT), débito cardíaco (DC), potência cardíaca (PC) e tempo de ejeção ventricular (TEV) foram monitorados por 15 minutos. RESULTADOS: Os grupos Preg e NonPreg apresentaram perfis hemodinâmicos semelhantes, exceto por um TEV mais curto no grupo Preg (213,3 ± 19,3 ms versus 265,0 ± 28,8 ms, p < 0,001). O grupo PregPE apresentou PAS, PAD e PAM mais elevadas, assim como PC (145,5 ± 12,6 mmHg; 94,5 ± 9,1 mmHg; 111,5 ± 9,8 mmHg; 1,6 ± 0,3 watts) quando comparado com os grupos Preg (114 ± 12,1 mmHg; 71,2 ± 8,4 mmHg; 85,9 ± 9,3 mmHg; 1,1 ± 0,3 watts) e NonPreg (101,2 ± 11,9 mmHg; 66,7 ± 10,4 mmHg; 78,1 ± 10,6 mmHg; 1,0 ± 0,2 watts). O grupo Preg apresentou FC, DC e RPT maiores e TEV mais curto (85,4 ± 8,4 batimentos.min-1; 6,6 ± 0,7 L.min-1; 1.369,9 ± 173,5 dina.seg.cm-5, 221,6 ± 22,4 ms) quando comparado ao grupo NonPreg (67,9 ± 9,5 batimentos.min-1; 5,6 ± 0,7 L.min-1; 1.136,9 ± 149,8 dina.seg.cm-5, 265,0 ± 28,8 ms). CONCLUSÕES: O NICOM é um equipamento fácil de ser usado, que independe do operador e fornece sinais de monitoramento claros e consistentes. A avaliação identificou perfis hemodinâmicos distintos e consistentes com os achados obtidos com métodos mais invasivos.

Palavras-chave

FISIOLOGIA, HEMODINÂMICA, MONITORAÇÃO, MONITORAÇÃO, Gravidez

Abstract

BACKGROUND AND OBJECTIVES: We compared hemodynamic profiles of healthy and mildly preeclamptic pregnant women at term, as well as those of non-pregnant controls, using a new non-invasive cardiac output monitor (NICOM) based on bio-reactance. METHODS: We studied healthy term pregnant women at term (Preg, n = 10), mildly preeclamptic pregnant women at term (PregPE, n = 10), and healthy non-pregnant female volunteers (NonPreg, n = 10). With the subjects in the semi left lateral position, 4 electrodes of the NICOM device were applied to their chest wall, followed by a 15-minute rest period. Hemodynamic variables, including the systolic (SBP), diastolic (DPB) and mean arterial (MAP) pressures, as well as the heart rate (HR), stroke volume (SV), total peripheral resistance (TPR), cardiac output (CO), cardiac power output (CPO), and ventricular ejection time (VET) were then monitored for 15 minutes. RESULTS: The Preg and NonPreg groups showed similar hemodynamic profiles, except for a shorter VET in the Preg group (213.3 ± 19.3 ms versus 265.0 ± 28.8 ms, p < 0.001). The PregPE group showed higher SBP, DBP and MAP, as well as CPO (145.5 ± 12.6 mmHg; 94.5 ± 9.1 mmHg; 111.5 ± 9.8 mmHg; 1.6 ± 0.3 watts), compared to both the Preg (114 ± 12.1 mmHg; 71.7 ± 8.4 mmHg; 85.9 ± 9.3 mmHg; 1.1 ± 0.3 watts) and NonPreg (101.2 ± 11.9 mmHg; 66.7 ± 10.4 mmHg; 78.1 ± 10.6 mmHg; 1.0 ± 0.2 watts) groups. The PregPE group showed higher HR, CO, and TPR, and shorter VET (85.4 ± 8.4 beats.min-1; 6.6 ± 0.7 L.min-1; 1,369.9 ± 173.5 dyne.sec.cm-5, 221.6 ± 22.4 ms) compared to the NonPreg group (67.9 ± 9.5 beats.min-1; 5.6 ± 0.7 L.min-1; 1,136.9 ± 149.8 dyne.sec.cm-5, 265.0 ± 28.8 ms). CONCLUSIONS: The NICOM device is simple to use, operator independent, and provides clear and consistent monitoring signals. The output identified distinct hemodymamic profiles that are consistent with the findings of more invasive existing methods.

Keywords

PHYSIOLOGY, HEMODYNAMICS, MONITORING, MONITORING, PREGNANCY

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