Avaliação clínica e laboratorial de equinos submetidos à enterotomia de cólon descendente com aplicação ou não de biomaterial
Carregando...
Data
2019-02-01
Autores
Brito, Helena Cristina Delgado [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
As aderências intra-abdominais são complicações presentes após cirurgias do trato gastrointestinal dos equinos, sendo originadas por processos inflamatórios na cavidade abdominal. As aderências resultam do desequilíbrio entre os inibidores e ativadores da fibrinólise, que são mediados por diversas citocinas. Pelo presente buscou-se avaliar as alterações clínicas e laboratoriais, além de observar a formação ou não de aderências intestinais em equinos submetidos à infusão de alteplase e implantação de biomaterial composto por carboximetilcelulose (CMC) e poli (álcool vinílico) (PVA) ou por CMC e PVA impregnado com alteplase, após enterotomia do cólon descendente. Foram utilizados 16 equinos adultos, hígidos, fêmeas, sem raça definida, entre quatro e 15 anos de idade distribuídos aleatoriamente em quatro grupos: grupo controle (GC); grupo tratado 1 (GT1) submetido à infusão de alteplase na cavidade peritoneal; GT2, submetido à implantação de biomaterial na serosa e GT3 submetido a implantação de biomaterial contendo alteplase na serosa. Todos os animais foram submetidos à laparotomia em posição quadrupedal, com acesso pelo flanco esquerdo, para realização da enterotomia na borda antimesentérica do cólon descendente. Os parâmetros clínicos foram avaliados diariamente, durante 12 dias. No décimo quarto dia pós-enterotomia, foi realizada videolaparoscopia para a constatação da presença ou não de aderências. Colheitas de sangue venoso jugular e líquido peritoneal foram realizadas no período pré-operatório (M0) e um (M1), três (M3), cinco (M5), sete (M7), nove (M9) e onze (M11) dias após a enterotomia, para análise laboratorial. Os dados obtidos foram avaliados por meio de análise de variância de duas vias, seguido de teste de Tukey para comparação das médias. Dentre as variáveis clínicas, verificou-se a diminuição da temperatura retal no GT3 nos momentos M5 e M12. A motilidade diminuiu em todos os grupos nos três primeiros dias pós-cirúrgicos (M1, M2 e M3). Os valores de hematócrito (Ht) apresentaram diminuição no M1 quando comparados ao M0, sendo o grupo GT3 apresentou o menor valor de Ht quando comparado aos GC e GT1. A porcentagem de células T CD4+ diminuiu no GT1 no M1, comparado ao GT2, e no M9, GC apresentou menor valor quando comparado ao GT1. Os animais apresentaram neutrofilia, linfopenia e eosinopenia em M1, seguidos de leucopenia em M3 e M5.Na análise de líquido peritoneal (LP) notou-se a redução dos valores de pH e glicose no M1, e aumento do lactato e proteína total (PT) no M1. As contagens de células nucleadas e neutrófilos do LP aumentaram em todos os momentos quando comparados ao M0. Observou-se a presença de aderências em 50% dos animais dos grupos GC, GT1, GT2 e 100% do grupo GT3. A infusão de alteplase, biomaterial de CMC+ PVA e biomaterial de CMC + PVA + alteplase não apresentaram resultados satisfatórios na prevenção de aderências intestinais em equinos
Intra-abdominal adhesions are a complication after gastrointestinal tract surgery in equines, originated by inflammatory processes in the abdominal cavity. Adhesions usually result from the imbalance between fibrinolysis inhibitors and activators, which are activated by several chemokines. The aim of this study is to evaluate the clinical and laboratorial alterations and observe the development of intestinal adhesions after descending colon enterotomy of equine undergoing application or not of biomaterial composed by carboxymethyl cellulose (CMC) and polyvinil alcohol (PVA) or CMC and PVA impregnated with alteplase. Sixteen healthy crossbred mares, mixed breed, aged between 4 and 15 years randomly allotted in 4 groups: control group (CG), treated group 1 (TG1), which received abdominal alteplase infusion, treated group 2 (TG2), which received a biomaterial implant on the colon serosa and treated group 3 (TG3), which received the biomaterial containing alteplase implant on the colon serosa, were used in this study. All animals were subjected to left flank laparotomy and descending colon enterotomy. Clinical parameters were evaluated daily for 12 days (M0 – M12). On the 12th day postsurgery, videolaparoscopy was performed to evaluate whether there was of not abdominal adherences. Venous jugular blood and peritoneal fluid samples were collected for laboratorial analysis during immediate preoperative period (M0) and 1 (M1), 3 (M3), 5 (M5), 7 (M7), 9 (M9) and 11 (M11) days after the enterotomy. In the clinical parameters, rectal temperature decreased in GT3 in M5 and M12. Intestinal motility decreased in the first three days post-surgery (M0, M1 and M3) for all groups. Hematocrit values decreased in M1 when compared to M0, and GT3 presented the lower value when compared to GC and GT1. Equines presented neutrofilia, lymphopenia and eosinophenia in M1, followed by leukopenia in M3 and M5. Peritoneal fluid analysis revealed reduction in pH values and glucose concentration in M1, and an increase in lactate concentration and total protein in M1. Nucleated cells total count and neutrophil counts in peritoneal fluid increased in all moments when compared to M0. Abdominal adhesions were present in 50% of GC, GT1 and GT2 groups, and 100% in GT3. Alteplase infusion, biomaterial, and biomaterial containing alteplase did not produce satisfactory results regarding preventing intestinal adhesions in horses.
Intra-abdominal adhesions are a complication after gastrointestinal tract surgery in equines, originated by inflammatory processes in the abdominal cavity. Adhesions usually result from the imbalance between fibrinolysis inhibitors and activators, which are activated by several chemokines. The aim of this study is to evaluate the clinical and laboratorial alterations and observe the development of intestinal adhesions after descending colon enterotomy of equine undergoing application or not of biomaterial composed by carboxymethyl cellulose (CMC) and polyvinil alcohol (PVA) or CMC and PVA impregnated with alteplase. Sixteen healthy crossbred mares, mixed breed, aged between 4 and 15 years randomly allotted in 4 groups: control group (CG), treated group 1 (TG1), which received abdominal alteplase infusion, treated group 2 (TG2), which received a biomaterial implant on the colon serosa and treated group 3 (TG3), which received the biomaterial containing alteplase implant on the colon serosa, were used in this study. All animals were subjected to left flank laparotomy and descending colon enterotomy. Clinical parameters were evaluated daily for 12 days (M0 – M12). On the 12th day postsurgery, videolaparoscopy was performed to evaluate whether there was of not abdominal adherences. Venous jugular blood and peritoneal fluid samples were collected for laboratorial analysis during immediate preoperative period (M0) and 1 (M1), 3 (M3), 5 (M5), 7 (M7), 9 (M9) and 11 (M11) days after the enterotomy. In the clinical parameters, rectal temperature decreased in GT3 in M5 and M12. Intestinal motility decreased in the first three days post-surgery (M0, M1 and M3) for all groups. Hematocrit values decreased in M1 when compared to M0, and GT3 presented the lower value when compared to GC and GT1. Equines presented neutrofilia, lymphopenia and eosinophenia in M1, followed by leukopenia in M3 and M5. Peritoneal fluid analysis revealed reduction in pH values and glucose concentration in M1, and an increase in lactate concentration and total protein in M1. Nucleated cells total count and neutrophil counts in peritoneal fluid increased in all moments when compared to M0. Abdominal adhesions were present in 50% of GC, GT1 and GT2 groups, and 100% in GT3. Alteplase infusion, biomaterial, and biomaterial containing alteplase did not produce satisfactory results regarding preventing intestinal adhesions in horses.
Descrição
Palavras-chave
Aderências intestinais, Alteplase, Carboximetilcelulose, Gastrenterologia equina, Poli (álcool vinílico), Videolaparoscopia, Carboxymethyl cellulose, Equine gastroenterology, Intestinal adhesions, Polyvinil alcohol, Videolaparoscopy