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        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Este estudo revela os resultados preliminares da redu&#231;&#227;o de volume pulmonar efectuada em doentes com enfisema pulmonar em est&#225;dio terminal&#44; atrav&#233;s da coloca&#231;&#227;o broncosc&#243;pica de uma v&#225;lvula endobr&#244;nquica &#40;VEB&#41;&#46; A VEB utilizada neste estudo &#233; de silicone e unidireccional&#44; com 3 dimens&#245;es diferentes &#40;dependendo da anatomia br&#244;nquica&#41;&#44; produzindo uma atelectasia seleccionada ao impedir a entrada de ar no segmento tratado&#44; mas permitindo a sa&#237;da de secre&#231;&#245;es e de ar desse mesmo segmento isolado&#46;</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">O estudo foi levado a cabo em 9 centros de endoscopia respirat&#243;ria&#44; em 7 pa&#237;ses a n&#237;vel mundial&#46; Todos os doentes tinham TAC tor&#225;cica e cintigrafia de ventila&#231;&#227;o&#47;perfus&#227;o para confirma&#231;&#227;o&#44; 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Redução de volume pulmonar broncoscópico no enfisema em estádio terminal. Resultados dos primeiros 98 doentes
I. Wan, T. Toma, D. Geddes, G. Snell, T. Williams, F. Venuta, A. Yim
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        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Este estudo revela os resultados preliminares da redu&#231;&#227;o de volume pulmonar efectuada em doentes com enfisema pulmonar em est&#225;dio terminal&#44; atrav&#233;s da coloca&#231;&#227;o broncosc&#243;pica de uma v&#225;lvula endobr&#244;nquica &#40;VEB&#41;&#46; A VEB utilizada neste estudo &#233; de silicone e unidireccional&#44; com 3 dimens&#245;es diferentes &#40;dependendo da anatomia br&#244;nquica&#41;&#44; produzindo uma atelectasia seleccionada ao impedir a entrada de ar no segmento tratado&#44; mas permitindo a sa&#237;da de secre&#231;&#245;es e de ar desse mesmo segmento isolado&#46;</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">O estudo foi levado a cabo em 9 centros de endoscopia respirat&#243;ria&#44; em 7 pa&#237;ses a n&#237;vel mundial&#46; Todos os doentes tinham TAC tor&#225;cica e cintigrafia de ventila&#231;&#227;o&#47;perfus&#227;o para confirma&#231;&#227;o&#44; avalia&#231;&#227;o da gravidade e distribui&#231;&#227;o do enfisema&#44; bem como para exclus&#227;o de comorbilidades&#46;</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos 98 doentes com enfisema em est&#225;dio terminal&#44; em que a pletismografia basal em repouso ap&#243;s broncodilata&#231;&#227;o&#44; revelava volume expirat&#243;rio m&#225;ximo no primeiro segundo &#40;VEMS&#41; de 0&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;3<span class="elsevierStyleHsp" style=""></span>L &#40;30&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;7&#37; do previsto&#41; e volume residual &#40;VR&#41; de 5&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;3<span class="elsevierStyleHsp" style=""></span>L &#40;244&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;3&#37; do previsto&#41;&#46;</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">A op&#231;&#227;o de colocar as VEB num segmento pulmonar ou lobo completo&#44; tratar um ou ambos os pulm&#245;es&#44; dependeu de cada centro&#46; Contudo&#44; ao surgirem alguns casos de pneumot&#243;races em doentes com exclus&#227;o lobar completa&#44; optaram por colocar as VEB apenas unilateralmente&#46;</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">Os doentes foram avaliados durante um per&#237;odo de 90 dias ap&#243;s implante da VEB&#44; sendo efectuadas espirometria&#44; pletismografia&#44; capacidade de difus&#227;o de mon&#243;xido de carbono &#40;DLCO&#41; e teste de toler&#226;ncia ao esfor&#231;o&#44; aos 30 e 90 dias depois da coloca&#231;&#227;o da VEB&#46; Dos resultados obtidos&#44; verificou-se um decr&#233;scimo do VR para 4&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;4 &#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;025&#41; e um acr&#233;scimo do VEMS para 10&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>26&#44;2 &#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;007&#41;&#44; da capacidade vital for&#231;ada &#40;CVF&#41; para 9&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#44;9 &#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;024&#41;&#44; e a dist&#226;ncia percorrida em 6 minutos de marcha tamb&#233;m aumentou para 23&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>55&#44;3 &#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Demonstrou-se um ligeiro aumento da DLCO&#44; que n&#227;o obteve contudo significado estat&#237;stico &#40;17&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>52&#44;0 &#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;063&#41;&#46;</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">Nos doentes tratados unilateralmente observou-se uma melhoria superior em rela&#231;&#227;o aos doentes tratados nos 2 pulm&#245;es&#44; bem como a melhoria foi superior nos doentes tratados a um lobo pulmonar em compara&#231;&#227;o com os tratados apenas a 1 ou 2 segmentos broncopulmonares&#46;</p><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">Ocorreram complica&#231;&#245;es graves em 8 doentes &#40;8&#46;2&#37;&#41;&#44; nos primeiros 90 dias&#44; das quais resultou um &#243;bito &#40;1&#37; de mortalidade&#41;&#46; As complica&#231;&#245;es consideradas graves inclu&#237;ram&#58; o pneumot&#243;rax&#44; a pneumonia obstrutiva ou n&#227;o&#44; o empiema&#44; as hemoptises&#44; a f&#237;stula broncopleural durante mais de 7 dias e a insufici&#234;ncia respirat&#243;ria&#46;</p><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall">Esta an&#225;lise multic&#234;ntrica confirma a melhoria da fun&#231;&#227;o pulmonar e toler&#226;ncia ao esfor&#231;o em doentes enfisematosos tratados com VEB&#46; Contudo&#44; &#233; necess&#225;rio estabelecer no futuro os candidatos ideais a este tipo de interven&#231;&#227;o e a melhor estrat&#233;gia terap&#234;utica de coloca&#231;&#227;o das VEB&#46;</p></span>"
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Article information
ISSN: 08732159
Original language: English
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