Hepatitis hipóxica en pacientes postquirúrgicos cardiovasculares
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2020
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Ediciones Universidad Simón Bolívar
Facultad de Ciencias de la Salud
Facultad de Ciencias de la Salud
Resumen
ANTECEDENTES: La perfusión hepática desempeña un papel importante en el desarrollo de la hepatitis hipóxica (HH), puesto que, aunque se ha demostrado ser causado por diversos factores, existen condiciones que tienen mayor influencia para el desarrollo de esta patología como lo son el bajo gasto cardiaco y el shock séptico.
OBJETIVO: Evaluar la incidencia de hepatitis hipóxica en pacientes en postoperatorio de cirugía cardiovascular de revascularización miocárdica o reemplazo valvular en la unidad de cuidados intensivos cardiovascular en un centro de referencia de Barranquilla (ATL) entre los años 2018-2019
MATERIALES Y MÉTODOS: Estudio observacional, descriptivo, retrospectivo. Se tomaron los pacientes que ingresaron a las Unidades de Cuidados Intensivos Cardiovasculares 1 y 2, intervenidos quirúrgicamente por cirugía cardiovascular que cursaron con hepatitis hipóxica teniendo en cuenta los siguientes criterios: el pilar para el diagnóstico de hepatitis hipóxica son las transaminasas, lactato deshidrogenasa (LDH), alteración del INR, tp y bilirrubinas séricas. Criterios para el diagnóstico como son un estado de insuficiencia circulatoria, cardíaca, respiratoria, exclusión de otras causas de necrosis hepática.
RESULTADOS: en este estudio, la mediana de edad es de 62 años, con un índice de masa corporal (IMC) de 23. Por otro lado, de las intervenciones quirúrgicas realizadas, el 72,3% fueron realizadas en hombres. El 99,4% de los pacientes tenían algún antecedente patológico, el 98% padecían hipertensión arterial. La incidencia de hepatitis hipóxica se presentó en el 2.6% de los procedimientos. El tiempo de CEC fue del 51.2% para un tiempo de 61 a 90 min.TAM menor del 65 mmHg 6.3%.
CONCLUSIONES: La hepatitis hipóxica suele ser subdiagnosticada en los pacientes que han sido intervenidos por cirugía cardiovascular. El evento cardiovascular con mayor impacto fue la enfermedad coronaria multivaso en un 76,6%. La incidencia de hepatitis hipóxica en pacientes postrasplantados fue del
2,6% en los procedimientos cardiovasculares realizados. El tiempo de circulación extracorpórea con mayor porcentaje fue entre 61 a 90 minutos (51,2%). En el ionograma los datos con mayor presentación fue la hiperazoemia (52,5%) e hipernatremia (22,5%).
BACKGROUND: Liver perfusion plays an important role in the development of hypoxic hepatitis (HH), since although it has been shown to be caused by various factors, there are conditions that have a greater influence on the development of this pathology such as low cardiac output and septic shock. OBJECTIVE: To assess the incidence of hypoxic hepatitis in patients after cardiovascular surgery for myocardial revascularization or valve replacement in the cardiovascular intensive care unit at a reference center in Barranquilla (ATL) between the years 2018-2019 METHODOLOGY: Observational, descriptive, retrospective study. Patients admitted to Cardiovascular Intensive Care Units 1 and 2, who have undergone surgery for cardiovascular surgery and who have hypoxic hepatitis will be taken into account according to the following criteria: the mainstay for the diagnosis of hypoxic hepatitis is transaminases, lactate dehydrogenase (LDH), INR alteration, tp and serum bilirubin. Criteria for diagnosis are a state of circulatory, cardiac, respiratory failure, exclusion of other causes of liver necrosis. RESULTS: in our study, the median age was 62 years, with a body mass index (BMI) of 23. On the other hand, of the surgical procedures performed, 72.3% were performed on men. 99.4% of the patients had some pathological background, 98% suffered from high blood pressure. The incidence of hypoxic hepatitis occurred in 2.6% of the procedures. The CEC time was 51.2% for a time of 61 to 90 min. MAT less than 65 mmHg 6.3%. CONCLUSIONS: Hypoxic hepatitis is usually underdiagnosed in patients who have undergone cardiovascular surgery. The cardiovascular event with the greatest impact was multivessel coronary disease in 76.6%. The incidence of hypoxic hepatitis in post-transplant patients was 2.6% in the cardiovascular procedures performed. The extracorporeal circulation time with the highest percentage was between 61 to 90 minutes (51.2%). In the ionogram, the data with the highest presentation were hyperazoemia (52.5%) and hypernatremia (22.5%).
BACKGROUND: Liver perfusion plays an important role in the development of hypoxic hepatitis (HH), since although it has been shown to be caused by various factors, there are conditions that have a greater influence on the development of this pathology such as low cardiac output and septic shock. OBJECTIVE: To assess the incidence of hypoxic hepatitis in patients after cardiovascular surgery for myocardial revascularization or valve replacement in the cardiovascular intensive care unit at a reference center in Barranquilla (ATL) between the years 2018-2019 METHODOLOGY: Observational, descriptive, retrospective study. Patients admitted to Cardiovascular Intensive Care Units 1 and 2, who have undergone surgery for cardiovascular surgery and who have hypoxic hepatitis will be taken into account according to the following criteria: the mainstay for the diagnosis of hypoxic hepatitis is transaminases, lactate dehydrogenase (LDH), INR alteration, tp and serum bilirubin. Criteria for diagnosis are a state of circulatory, cardiac, respiratory failure, exclusion of other causes of liver necrosis. RESULTS: in our study, the median age was 62 years, with a body mass index (BMI) of 23. On the other hand, of the surgical procedures performed, 72.3% were performed on men. 99.4% of the patients had some pathological background, 98% suffered from high blood pressure. The incidence of hypoxic hepatitis occurred in 2.6% of the procedures. The CEC time was 51.2% for a time of 61 to 90 min. MAT less than 65 mmHg 6.3%. CONCLUSIONS: Hypoxic hepatitis is usually underdiagnosed in patients who have undergone cardiovascular surgery. The cardiovascular event with the greatest impact was multivessel coronary disease in 76.6%. The incidence of hypoxic hepatitis in post-transplant patients was 2.6% in the cardiovascular procedures performed. The extracorporeal circulation time with the highest percentage was between 61 to 90 minutes (51.2%). In the ionogram, the data with the highest presentation were hyperazoemia (52.5%) and hypernatremia (22.5%).
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Cirugía cardiovascular, Hepatitis hipóxica, Hepatitis hipóxica por Cirugía cardiovascular, Hepatitis isquémica, Cardiovascular surgery, Hypoxic hepatitis, Hypoxic hepatitis from cardiovascular surgery, Ischemic hepatitis
