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Master's Dissertation
DOI
10.11606/D.17.2008.tde-17042012-185744
Document
Author
Full name
Paula Pileggi Vinha
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2008
Supervisor
Committee
Cunha, Selma Freire de Carvalho da (President)
Farina Junior, Jayme Adriano
Moreno, Fernando Salvador
Title in Portuguese
Estresse orgânico e atividade anti e pró-oxidante na queimadura aguda e no pós-operatório de cirurgia reparadora de seqüelas do trauma térmico
Keywords in Portuguese
Anti-oxidantes.
Cirurgia reparadora
Estresse oxidativo
Queimadura
Abstract in Portuguese
O estresse orgânico decorrente da queimadura é intenso e prolongado. O hipercatabolismo e o hipermetabolismo secundários alteram o sistema de pró e anti-oxidantes. Pela necessidade de reepitelização da área doadora e receptora, a cirurgia reparadora pode desencadear ou perpetuar o estresse oxidativo. Objetivos: Em pacientes vítimas de trauma térmico agudo (Grupo Queimadura) e naqueles em pós-operatório de seqüelas de queimaduras (Grupo Seqüela), comparar o estresse oxidativo e os níveis de anti e pró-oxidantes com os obtidos no pré-operatório de pacientes com seqüelas de queimaduras (Grupo Controle). Casuística e métodos: O estudo foi conduzido na Unidade de Queimados do HCFMRPUSP. O Grupo Queimadura (n=11) incluiu pacientes com 48 horas do trauma térmico agudo, SCQ 10%. Os pacientes que necessitaram de correção cirúrgica das seqüelas do trauma térmico, ocorrido 1ano (n=8), foram avaliados no pré-operatório (Grupo Controle) e após 48 horas da cirurgia (Grupo Seqüela). Todos os voluntários foram submetidos à antropometria e quantificação da ingestão alimentar. Foi realizada a avaliação laboratorial do estado nutricional, dos marcadores da atividade inflamatória e dos anti e pró-oxidantes. Resultados: Em pacientes vítimas de trauma térmico agudo, foi documentado estresse orgânico caracterizado pelo aumento das proteínas de fase aguda como a PCR [8,76 (0,91 34,54) vs 0,40 (0,01 0,97)mg/dL, p=0,0004] e ferritina (254,45 ± 84,25 vs 145,10 ± 88,80ng/mL, p=0,014), além da diminuição da albumina (3,55±0,65 vs 4,16±0,26g/dL, p=0,004), da transferrina (110,67±55,13 vs 238,70±67,99mg/dL, p=0,0003), do colesterol (126,82 ± 32,19 vs 193,75 ± 51,64mg/dL, p=0,002) e triglicérides séricos (95,54 ± 36,84 vs 168,75 ± 54,83mg/dL, p=0,003), ferro [30,00 (6,00-73,00) vs 109,00 (70,00 - 252,00)µg/dL, p=0,0004] e zinco (63,55 ± 23,34 vs 92,72 ± 16,65mg/dL, p=0,014). O estresse oxidativo diminuiu os níveis séricos das vitaminas C [0,45 (0341,30) vs 0,93 (0,48 1,30)mg/dL, p=0,016], A (1,55 ± 0,87 vs 3,35 ± 0,72µmol/L, p=0,0002) e da vitamina E (9,49 ± 3,4 vs 4,96 ± 1,60µmol/g lipídeo, p=0,003). Não houve modificação nos níveis do GSH [40,37 (30,27 87,46 ) vs 49,90 (10,09 54,95)µmol/L, p= 0,48] e do MDA [1,75 (1,15 2,74) vs 1,77 (1,62 6,82nmol/g proteína), p=0,043]. O procedimento cirúrgico para correção das seqüelas de queimaduras determinou aumento da proteína C reativa [0,40 (0,01 0,97) vs 2,53 (0,56 4,70)mg/dL, p=0,01], mas não alterou os níveis de anti e pró-oxidantes, exceto a diminuição dos níveis séricos de vitamina A (3,35 ± 0,72 vs 2,52 ± 0,90µmol/L, p=0,006) Conclusões: O estresse orgânico decorrente do trauma térmico agudo diminuiu as respostas anti-oxidantes. Exceto pela queda nos níveis séricos de vitamina A, a cirurgia reparadora acarretou estresse orgânico, sem modificação na resposta anti e pró-oxidante.
Title in English
Organic stress and anti- and pro-oxidant activity in acute burns and during the postoperative period of surgery for the repair of the sequels of thermal shock.
Keywords in English
Anti-oxidants.
Burn
Oxidative stress
Reparative surgery
Abstract in English
Organic stress due to burns is intense and prolonged, Secondary hypercatabolism and hypermetabolism alter the pro- and anti-oxidant system. Due to the need for reepithelialization of the donor and recipient areas, reparative surgery can trigger or perpetuate the oxidative stress. Objectives: To compare the oxidative stress and the levels of anti- and pro-oxidants in patients victims of acute thermal trauma (Burn Group) and in patients during the postoperative period after surgery for burn sequels (Sequel Group) with those obtained preoperatively in patients with burn sequels (Control Group). Cases and methods: The study was conducted at the Burn Unit of HCFMRPUSP. The Burn Group (n=11) consisted of patients studied 48 hours after acute thermal trauma, SCQ 10%. The patients who required surgical correction of the sequels of thermal trauma suffered 1 year before (n=8) were assessed during the preoperative period (Control Group) and 48 hours after surgery (Sequel Group). All volunteers were submitted to anthropometry and to quantitation of food intake. Laboratory evaluation of nutritional status, of the markers of inflammatory activity and of the anti- and pro-oxidant levels was performed. Results: Organic stress was documented in the patients victims of acute thermal trauma, characterized by an increase of acute phase proteins such as C-reactive protein (CRP) [8.76 (0.91 34.54) vs 0.40 (0.01 0.97) mg/dL, p=0.0004] and ferritin (254.45 ± 84.25 vs 145.10 ± 88.80 ng/mL, p=0.014) and by a reduction of serum cholesterol (126.82 ± 32.19 vs 193.75 ± 51.64 mg/dL, p=0.002), triglycerides (95.54 ± 36.84 vs 168.75 ± 54.83 mg/dL. p=0.003), iron [30.00 (6.00 73.00) vs 109.00 (70.00 252.00) µg/dL, p=0.0004], and zinc (63.55 ± 23.34 vs 92.72 ± 16.65 mg/dL, p=0.014). Oxidative stress reduced the serum levels of vitamins C [0.45 (0341.30) vs 0.93 (0.48 1.30) mg/dL, p=0.016] and A (1.55 ± 0.87 vs 3.35 ± 0.72 µmol/L, p=0.0002), and did not modify the levels of vitamin E (9,49 ± 3,4 vs 4,96 ± 1,60µmol/g lipídeo, p=0,003)or of the anti-oxidant substance GSH [40.37 (30.27 87.46 ) vs 49.90 (10.09 54.95) µmol/L, p= 0.48, but caused a fall in MDA levels [1.04 (0.75 1.39) vs 1.26 (1.07 4.30 nmol/L), p=0.007]. The surgical procedure for the correction of burn sequels caused an increase in CRP [0.40 (0.01 0.97) vs 2.53 (0.56 4.70) mg/dL, p=0.01], but did not change the levels of anti- or pro-oxidants, except for a reduction of serum vitamin A levels (3.35 ± 0.72 vs 2.52 ± 0.90 µmol/L, p=0.006) Conclusions: The organic stress due to acute thermal stress reduced the antioxidant responses. Except for the fall in serum vitamin A levels, reparative surgery caused organic stress, with no change in the anti- or pro-oxidant response.
 
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Publishing Date
2012-07-18
 
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