Importancia del TNF-α en la presentación de síndrome de bajo gasto en el postoperatorio de cirugía cardíaca con circulación extracorpórea
Importance of TNF-α in the Appearance of Low Output Syndrome in the Postoperative Period Following Heart Surgery With Extracorporeal Circulation
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Lara" "autores" => array:8 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Choperena" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Arcega" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Marco" ] 3 => array:2 [ "nombre" => "I." "apellidos" => "Mintegi" ] 4 => array:2 [ "nombre" => "K." "apellidos" => "Reviejo" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Murgialdai" ] 6 => array:2 [ "nombre" => "B." "apellidos" => "Azkarate" ] 7 => array:2 [ "nombre" => "G." "apellidos" => "Lara" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569100796331?idApp=WMIE" "url" => "/02105691/0000002400000009/v1_201304241206/S0210569100796331/v1_201304241206/es/main.assets" ] "es" => array:13 [ "idiomaDefecto" => true "titulo" => "Importancia del TNF-α en la presentación de síndrome de bajo gasto en el postoperatorio de cirugía cardíaca con circulación extracorpórea" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "385" "paginaFinal" => "391" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F. Martínez sagasti, J.L. Iribarren sarrías, C. Naranjo jarillo, A. Lacruz urbina, A.M. De Vera González, M.L. Mora quintero" "autores" => array:6 [ 0 => array:3 [ "nombre" => "F." "apellidos" => "Martínez sagasti" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J.L." "apellidos" => "Iribarren sarrías" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">**</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Naranjo jarillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">**</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Lacruz urbina" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">***</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "A.M." "apellidos" => "De Vera González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">****</span>" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "M.L." "apellidos" => "Mora quintero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">**</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Intensiva. Hospital San Carlos. Madrid" "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Intensiva" "etiqueta" => "<span class="elsevierStyleSup">**</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Cirugía Cardíaca (Perfusionista)" "etiqueta" => "<span class="elsevierStyleSup">***</span>" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Bioquímica Clínica (Laboratorio Central). Hospital Universitario de Canarias. Tenerife" "etiqueta" => "****" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "1" "correspondencia" => "Correspondencia: Dr. F. Martínez Sagasti. Servicio de Medicina Intensiva. Hospital San Carlos. C/ Prof. Martín Lagos, s/n. 28040 Madrid" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Importance of TNF-α in the Appearance of Low Output Syndrome in the Postoperative Period Following Heart Surgery With Extracorporeal Circulation" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaAceptado" => "2000-05-12" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec82379" "palabras" => array:6 [ 0 => "cirugía cardíaca" 1 => "circulación extracorpórea" 2 => "bajo gasto cardíaco" 3 => "citocinas" 4 => "interleucinas" 5 => "TNF-α" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec82380" "palabras" => array:7 [ 0 => "cardiac surgery" 1 => "cardiopulmonary bypass" 2 => "extracorporeal circlation" 3 => "stunt heart" 4 => "low cardiac output" 5 => "cytokines" 6 => "TNF-α" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Fundamento</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La cirugía extracorpórea (CEC) produce un síndrome de respuesta inflamatoria sistémica (SIRS) que puede manifestarse con bajo gasto (BG), estando influido por la activación de diversas citocinas proinflamatorias (interleucina [IL]-1, IL-6, factor de necrosis tumoral [TNF]-α) y antiinflamatorias (IL-10).</p> <span class="elsevierStyleSectionTitle">Métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo de 31 pacientes consecutivos, con cardiopatía isquémica o valvular, intervenidos bajo CEC para analizar si la elevación del TNF-α plasmático tras la CEC (ingreso, 4 horas y 24 horas) está implicado en el desarrollo de BG.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Sólo se pudo analizar el TNF-α plasmático en 25 pacientes. De ellos, 15 (60%) conservaron un gasto cardíaco (GC) normal y 10 (40%) desarrollaron BG. El TNF-α al ingreso estaba elevado en todos los casos. A las 24 horas, el TNF-α se encontraba significativamente más alto en el grupo de BG, normalizándose en el grupo con GC normal (12,79 [5,7] pg/ml frente a 7,52 [2,1] pg/ml; p < 0,05). No hubo diferencias en cuanto a la edad ni en la función ventricular preoperatoria entre los que desarrollaron BG o mantuvieron GC normal. Respecto a la administración de aprotinina o ácido tranexámico, el TNF-α al ingreso fue significativamente más elevado en quienes no recibieron estos fármacos que en los que habían recibido alguno (14,38 [6,22] frente a 8,77 [3,23] p < 0,01). Posteriormente los valores se equiparan entre ambos grupos. No hubo asociación entre el hecho de haber administrado estos fármacos y la presencia de BG.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los resultados confirman un incremento plasmático supranormal del TNF-α tras la CEC. Quienes desarrollan BG presentan unos valores significativamente más altos de TNF-α en plasma a las 24 horas de la CEC, implicando a esta citocina en la depresión miocárdica funcional post-CEC. La administración de aprotinina o ácido tranexámico se asoció a menores cifras de TNF-α en el postoperatorio inmediato, pero no previno la presentación de BG.</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Extracorporeal circulation (EC) produces a systemic inflammatory response syndrome (SIRS), which is associated to low cardiac output (LCO), and is influenced by the activation of various proinflammatory and antiinflammatory cytokines.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Prospective study of 31 consecutive patients suffering from ischemic or valvular complaints, and operated on using EC, was made in order to establish whether a rise in plasmatic levels of TNF-α following EC (on arrival, after 4 hours and after 24 hours) is related to the appearance of LCO.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Plasmatic levels of TNF-α could be analyzed in only 25 patients. Of these, 15 (60%) maintained a normal cardiac output, and 10 (40%) developed LCO. On arrival, TNF-α levels were significantly higher in the LCO group, whereas in the group showing normal cardiac output the levels returned to normal (12.79 [5.7] pg/ml vs. 7.52 [2.1] pg/ml; p < 0,05). There were not differences either regarding age or ventricular function between the patients with LCO and those with normal cardiac output. With regard to the administration of aprotinin or tranexamic acid, TNF-α levels on arrival were significantly higher in the patients who received neither of these drugs than in those who received one of them (14.38 [6.22] vs. 8.77 [3.23] p < 0.01). During the rest of the study, TNF-α plasmatic levels were similar in both groups. There was no relation between the administration of these drugs and LCO.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The results of this study confirm a greater-than-normal rise in plasmatic levels of TNF-α after EC. Those patients who develop LCO have significantly higher plasmatic levels of TNF- á 24 hours after EC, which suggests this cytokine is involved in depressed myocardial function following EC. The administration of aprotinin or tranexamic acid produced lower plasmatic levels of TNF-α in the immediate postoperative period, but did not prevent the LCO.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:45 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 7 | 20 | 27 |
| 2024 Octubre | 45 | 72 | 117 |
| 2024 Septiembre | 64 | 42 | 106 |
| 2024 Agosto | 49 | 74 | 123 |
| 2024 Julio | 49 | 50 | 99 |
| 2024 Junio | 43 | 41 | 84 |
| 2024 Mayo | 40 | 42 | 82 |
| 2024 Abril | 41 | 48 | 89 |
| 2024 Marzo | 45 | 46 | 91 |
| 2024 Febrero | 36 | 56 | 92 |
| 2024 Enero | 38 | 42 | 80 |
| 2023 Diciembre | 43 | 55 | 98 |
| 2023 Noviembre | 28 | 46 | 74 |
| 2023 Octubre | 42 | 41 | 83 |
| 2023 Septiembre | 32 | 54 | 86 |
| 2023 Agosto | 24 | 23 | 47 |
| 2023 Julio | 24 | 38 | 62 |
| 2023 Junio | 27 | 18 | 45 |
| 2023 Mayo | 19 | 23 | 42 |
| 2023 Abril | 20 | 30 | 50 |
| 2023 Marzo | 33 | 60 | 93 |
| 2023 Febrero | 28 | 42 | 70 |
| 2023 Enero | 28 | 49 | 77 |
| 2022 Diciembre | 38 | 58 | 96 |
| 2022 Noviembre | 58 | 45 | 103 |
| 2022 Octubre | 31 | 50 | 81 |
| 2022 Septiembre | 42 | 48 | 90 |
| 2022 Agosto | 31 | 59 | 90 |
| 2022 Julio | 20 | 43 | 63 |
| 2022 Junio | 18 | 44 | 62 |
| 2022 Mayo | 27 | 57 | 84 |
| 2022 Abril | 21 | 62 | 83 |
| 2022 Marzo | 15 | 73 | 88 |
| 2022 Febrero | 21 | 41 | 62 |
| 2022 Enero | 24 | 56 | 80 |
| 2021 Diciembre | 31 | 46 | 77 |
| 2021 Noviembre | 36 | 65 | 101 |
| 2021 Octubre | 40 | 76 | 116 |
| 2021 Septiembre | 30 | 72 | 102 |
| 2021 Agosto | 33 | 74 | 107 |
| 2021 Julio | 24 | 50 | 74 |
| 2021 Junio | 30 | 46 | 76 |
| 2021 Mayo | 35 | 97 | 132 |
| 2021 Abril | 69 | 105 | 174 |
| 2021 Marzo | 64 | 42 | 106 |
| 2021 Febrero | 42 | 40 | 82 |
| 2021 Enero | 36 | 34 | 70 |
| 2020 Diciembre | 44 | 34 | 78 |
| 2020 Noviembre | 18 | 23 | 41 |
| 2020 Octubre | 17 | 25 | 42 |
| 2020 Septiembre | 20 | 16 | 36 |
| 2020 Agosto | 18 | 19 | 37 |
| 2020 Julio | 29 | 12 | 41 |
| 2020 Junio | 26 | 22 | 48 |
| 2020 Mayo | 17 | 29 | 46 |
| 2020 Abril | 16 | 29 | 45 |
| 2020 Marzo | 10 | 19 | 29 |
| 2020 Febrero | 35 | 34 | 69 |
| 2020 Enero | 26 | 31 | 57 |
| 2019 Diciembre | 26 | 37 | 63 |
| 2019 Noviembre | 31 | 35 | 66 |
| 2019 Octubre | 20 | 22 | 42 |
| 2019 Septiembre | 18 | 17 | 35 |
| 2019 Agosto | 14 | 17 | 31 |
| 2019 Julio | 20 | 14 | 34 |
| 2019 Junio | 23 | 19 | 42 |
| 2019 Mayo | 46 | 60 | 106 |
| 2019 Abril | 26 | 39 | 65 |
| 2019 Marzo | 14 | 27 | 41 |
| 2019 Febrero | 17 | 34 | 51 |
| 2019 Enero | 12 | 27 | 39 |
| 2018 Diciembre | 31 | 53 | 84 |
| 2018 Noviembre | 15 | 48 | 63 |
| 2018 Octubre | 18 | 22 | 40 |
| 2018 Septiembre | 8 | 8 | 16 |
| 2018 Agosto | 10 | 11 | 21 |
| 2018 Julio | 8 | 14 | 22 |
| 2018 Junio | 19 | 10 | 29 |
| 2018 Mayo | 5 | 6 | 11 |
| 2018 Abril | 11 | 8 | 19 |
| 2018 Marzo | 9 | 7 | 16 |
| 2018 Febrero | 7 | 7 | 14 |
| 2018 Enero | 6 | 16 | 22 |
| 2017 Diciembre | 11 | 8 | 19 |
| 2017 Noviembre | 12 | 6 | 18 |
| 2017 Octubre | 8 | 11 | 19 |
| 2017 Septiembre | 15 | 17 | 32 |
| 2017 Agosto | 8 | 17 | 25 |
| 2017 Julio | 9 | 3 | 12 |
| 2017 Junio | 17 | 7 | 24 |
| 2017 Mayo | 19 | 4 | 23 |
| 2017 Abril | 18 | 10 | 28 |
| 2017 Marzo | 14 | 5 | 19 |
| 2017 Febrero | 13 | 2 | 15 |
| 2017 Enero | 8 | 5 | 13 |
| 2016 Diciembre | 23 | 6 | 29 |
| 2016 Noviembre | 39 | 5 | 44 |
| 2016 Octubre | 27 | 20 | 47 |
| 2016 Septiembre | 21 | 17 | 38 |
| 2016 Agosto | 18 | 16 | 34 |
| 2016 Julio | 9 | 6 | 15 |
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