Efecto de la rehabilitación física sobre la tensión arterial y la frecuencia cardíaca en pacientes con infarto del miocardio / Effect of the physical rehabilitation on blood pressure and the heart frequency in patients with acute myocardial infarction

Introducción: Numerosos estudios epidemiológicos efectuados en las últimas cuatro décadas han demostrado los efectos negativos de la inactividad física, así como los beneficios que representa la práctica regular de ejercicios para la salud en general. Objetivo: Evaluar el efecto de la terapia física sobre la tensión arterial y la frecuencia cardíaca en pacientes con cardiopatía isquémica que sufrieron infarto agudo del miocardio. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo de 41 pacientes con cardiopatía isquémica que sufrieron infarto agudo del miocardio y realizaron ejercicios físicos como parte del tratamiento rehabilitador en el Servicio de Terapia Física y Rehabilitación del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde mayo de 2017 hasta igual mes de 2018, para lo cual se utilizó una planilla de recolección de datos durante cada sesión del programa de rehabilitación. Resultados: La tensión arterial y la frecuencia cardíaca basal tuvieron una tendencia a la disminución y durante la actividad física aumentaron dentro de los límites aceptados como fisiológicos, lo que demostró una buena respuesta ionotrópica. Conclusiones: El programa de rehabilitación cardiovascular empleado mejoró la capacidad funcional de los afectados luego del infarto del miocardio.

Introduction: Numerous epidemiological studies carried out in the last four decades have demonstrated the negative effects of the physical inactivity, as well as the benefits that the regular practice of exercises represents for health in general. Objective: To evaluate the effect of physical therapy on arterial tension and the heart frequency in patients with ischemic heart disease who suffered acute myocardial infarction. Methods: A descriptive, longitudinal and prospective study of 41 patients with ischemic heart disease that suffered acute myocardial infarction and carried out physical exercises as part of the rehabilitative treatment in the Service of Physical Therapy and Rehabilitation of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba was carried out from May, 2017 to the same month of 2018, for which a schedule for gathering data was used during each session of the rehabilitation program. Results: The arterial tension and the basal heart frequency had a tendency to decrease and during the physical activity they increased within the limits accepted as physiologic, what demonstrated a good ionotropic response. Conclusions: The used program of cardiovascular rehabilitation improved the functional capacity of those affected after the myocardial infarction.

Estudio de la respuesta hipertensiva en adultos con riesgo coronario practicantes de ejercicios físicos / Study of the hypertensive responsein adults with coronary risk practitioners of physical exercises

RESUMEN Se realizó un estudio descriptivo en sujetos adultos con riesgo coronario y practicantes sistemáticos de ejercicios físicos para determinar la respuesta de la tensión arterial al hacer esfuerzos. El universo ascendió a 52 practicantes, compuesto por 29 mujeres y 23 hombres, a los cuales se les aplicó una encuesta con variables que permitieron identificar los factores de riesgo coronario que padecen y una prueba de caminata durante 12 minutos. Los datos fueron procesados mediante el programa estadístico IBM SPSS, versión 21.0. El grupo de edad seleccionado fue de 40-60 años; los factores de riesgo predominantes fueron el sobrepeso u obesidad, el hábito de fumar y el hipercolesterolemia. La respuesta hipertensiva al esfuerzo ligera fue la más frecuente con el 40 %. Se estableció que la respuesta hipertensiva al esfuerzo se asoció, de manera significativa, a los factores de riesgo y la edad.

ABSTRACT It was carried out a descriptive study to know the answer from the arterial tension to the effort in mature fellows with risk coronary systematic practitioners of physical exercises. The universe ascended 52 practitioners composed by 29 women and 23 men, to which were applied a survey with variables that allowed to identify the factors of coronary risk /they suffer and they were applied an it approves of walk during 12 minutes. The data were processed by means of the program statistical IBM SPSS, version 21.0. The selected age group was of 40-60 years, the predominant factors of risk were the overweight or obesity, the habit of smoking and the hypercholesterolemia; the answer hypertensive to the slight effort was the most frequent with 40% it was observed, also that the hypertensive answer to the effort was associated from a significant way to the factors of risk and the age.

Evaluación de la tensión arterial de pacientes preeclámpticas, que reciben anestesia epidural: Lidocaína mas Epinefrina / Evaluation of the arterial tension of preeclamptic patients that receive epidural anesthesia: Lidocain-Epinephrin

Tipo de estudio: retrospectivo, longitudinal y analítico.Objetivos:•Evaluar el comportamiento de la tensión arterial materna, durante la operación cesárea de pacientes preeclámpticas que reciben anestesia epidural con lidocaína al 2% con epinefrina al 1:200,000.•Evaluar si la utilización de lidocaína con epinefrina afecta la hemodinamia materna, hasta contraindicarla en la anestesia epidural de la paciente preeclámptica. Hipótesis: La epinefrina en la anestesia epidural, produce crisis hipertensiva en las pacientes preeclámpticas.Resultados: Una vez instalada la anestesia epidural, las tensiones arteriales mostraron un descenso gradual, más acentuado al minuto 35 posterior a la administración de la dosis total de lidocaína con epinefrina, que corresponden a la máxima extensión metamérica y a la mayor profundidad obtenida con el bloqueo epidural, así como a la descompresión abdominal y a la hemorragia quirúrgica tras la extracción del producto; conforme aumentó la cantidad perfundida de soluciones intravenosas, la tensión arterial inició un ascenso paulatino sin haber requerido soporte vasopresor. Ninguna paciente respondió con crisis hipertensiva a la administración de lidocaína con epinefrina. Conclusiones: Se concluye que en cesárea de preeclampticas previamente tratadas, la anestesia epidural fraccionando lidocaína con epinefrina no produce hipertensión arterial ni colapso vascular materno, se pueden predecir y por lo tanto evitar los descensos tensionales

Type of study: retrospective, longitudinal and analytic studyObjectives: •To evaluate the behavior of the maternal arterial tension, during the Caesarean operation of preeclamptic patients that received epidural anesthesia with lidocain 2% with epinephrin 1:200,000.•To evaluate if the lidocain used with epinephrin affects the maternal hemodynamic, that it would lead to contraindicate it in the epidural anesthesia of the preeclamptic patient. Hypothesis: The enunciated hypothesis was: The epinephrin in the epidural anesthesia, produces hipertensive crisis in the preeclamptic patients.Results: Once the epidural anesthesia is administered , the arterial tensions showed a gradual decrease, accentuated 35 minute later to the administration of the total dose of lidocain with epinephrin that corresponds to the maximum metametric extension and the biggest depth obtained with the epidural block. Also to abdominal decompression and the surgical hemorrhage after the extraction of the product. As the quantity of intravenous solutions are prefused increases, the arterial tension increases it began a gradual increase without having required vasopressor support. No patient responded with hipertensive crisis to the lidocain administration with epinephrin. Conclusions: We conclude that in Caesarean operation of previously treated preeclamptic patients, the epidural anesthesia fractioning lidocain with epinephrin doesn't produce hypertension nor maternal vascular collapse, they can be predicted and therefore be able to avoid a decrease in arterial tension.

Differences of Hemodynamics and Arterial Blood Gas in Right and Left Lung Ventilation during Thoracoscopic Surgery with CO2 Insufflation / 대한마취과학회지

BACKGROUNDS: There is difference of blood flow between right and left lung, and it is also affected by positional change. The purpose of this study is to compare hemodynamics and arterial blood gas changes between two lungs in thoracoscopic surgery with CO2 insufflation METHODS: Fourteen thoracoscopic-surgical patient were randomly selected and divided into two groups; Group I : right lung ventilation, Group II: left lung ventilation. Blood gas analysis, blood pressure and heart rate were measured at three stages in lateral position; stage I: 10minutes after two-lung ventilation, stage II: 10minutes after one-lung ventilation and CO2 insufflation, stage III: 10minutes after two-lung ventilation and CO2 deflation. RESULTS: In both groups, blood pressure and heart rate were slightly increased at stage II, pH was decreased, PaO2 and PaCO2 were increased at stage II and stage III. But changes of pH and PaCO2 were greater in left lung ventilation. Arterial oxygen saturation and base excess did not change in all stages. CONCLUSIONS: Thoracoscopic surgery with CO2 insufflation did not increase the risk of hypoxemia if FiO2 is 1.0. However blood CO2 retension is higher in left lung ventilation than in right one. So we have to observe PaCO2 more carefully when the left lung is ventilated.