Avaliação do estado nutricional de pacientes com cardiomiopatia dilatada internados em Unidade de Terapia Intensiva de um hospital especializado
Evaluation of the nutritional status of patients with dilated cardiomyopathy admitted to the Intensive Care Unit of a specialized hospital
Mariana Volante Gengo, Helenice Moreira da Costa, Silvia H. Gélas Lage, Larissa Candido Alves Tavares
Resumo
Objetivo: Avaliar o estado nutricional de pacientes com cardiomiopatia dilatada internados em Unidade de Terapia Intensiva (UTI) clínica de adultos de hospital especializado. Método: Pesquisa prospectiva e observacional, com avaliação subjetiva global (ASG), antropométrica (índice de massa corporal -IMC, prega cutânea tricipital -PCT, circunferência do braço -CB- e circunferência muscular do braço -CMB), bioquímica (proteínas totais, albumina, linfócitos, hemoglobina (Hb), lipídeos e BNP), impedância bioelétrica (IB) e desfechos obtidos. Foram aplicados testes t de Student, correlação de Pearson e Análise de Variância, adotando-se como significante p≤0,05. Resultados: Foram acompanhados 24 pacientes com miocardiopatia dilatada internados na UTI clínica de adultos, com idade média de 48,25±18,05 anos, sendo 62,5% (n=15) homens e 37,5% (n=9) idosos. Os valores de ângulo de fase (AF) variaram de 2,2 a 9,2º, com média de 5,33±1,66º, e verificou-se correlação estatística entre os valores reduzidos de AF e albumina (p=0,018). Em 41,7% da amostra (n=10), o valor do AF foi ≤ ao ponto de corte estipulado de 4,5º, esses com idade média de 46,3±19,26 anos, 50% homens e 40% idosos. Com base na ASG, 60% estavam desnutridos, por meio do IMC, 40% apresentavam baixo peso, e em relação a CB, CMB e PCT, 90%, 70% e 60%, respectivamente, estavam desnutridos. Com base nas dosagens, 80% estavam anêmicos, 100% apresentam hipoalbuminemia e 90% diminuição de colesterol total, sendo que desses, 60% foram a óbito. Conclusão: Pacientes estudados apresentaram desnutrição quando avaliados por ASG e medidas antropométricas, exceto IMC, principalmente naqueles com AF menor. Foi possível associarmos os valores reduzidos de AF ao pior estado nutricional, e não houve significância estatística entre AF e mortalidade e entre AF e demais variáveis, provavelmente devido ao número reduzido de pacientes que compunham a amostra.
Palavras-chave
Abstract
Objective: To evaluate the nutritional status of patients with dilated cardiomyopathy admitted to an Intensive Care Unit (ICU) of a specialized hospital. Methods: Prospective and observational research, with global subjective assessment (SGA), anthropometric (body mass index - BMI, tricipital cutaneous fold - PCT, arm circumference - CB and arm muscle circumference - CMB), biochemistry (total proteins, Albumin, lymphocytes, hemoglobin (Hb), lipids and BNP), Bioelectrical Impedance (BI) and outcomes. Student’s t-tests, Pearson’s correlation and Variance Analysis were applied, with a significance level of p≤0.05. Results: Twenty-four patients with dilated cardiomyopathy were hospitalized in the adult clinical ICU, with a mean age of 48.25±18.05 years, 62.5% (n=15) men and 37.5% (n=9). Phase angle (PA) values ranged from 2.2 to 9.2º, with an average of 5.33±1.66º, and a statistical correlation was observed between the reduced values of PA and albumin (p=0.018). In 41.7% of the sample (n=10), the PA value was ≤ 4.5 s, with a mean age of 46.3±19.26 years, 50% men and 40% elderly. On the basis of SGA, 60% were malnourished, 40% were under weight, and 90%, 70% and 60%, respectively, weremalnourished. Based on the dosages, 80% wereanemic, 100% presented hypoalbuminemia and 90% decreased total cholesterol, of which, 60% died. Conclusion: Patients studied presented malnutrition when evaluated by ASG and anthropometric measurements, except for BMI, especially in those with lower PA. It was possible to associate the reduced values of PA to the worst nutritional status, and there was no statistical significance between PA and mortality and between PA and other variables, probably due to the small number of patients that composed the sample. 1. Nutricionista Especialista em Cardiopneumologia pelo programa de Residência da Faculdade de Medicina da Universidade de São Paulo
Keywords
Referências
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Submetido em:
19/02/2017
Aceito em:
27/03/2017
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