ABSTRACT
El déficit circulatorio de este cuadro se ubica en la microcirculación intestinal por fallo de bomba, shock o uso de digital. Dolor abdominal repentino, distensión, enterorragia y los antecedentes llevan a la sospecha clínica y al diagnóstico. El tratamiento es en principio médico, con el esquema de Boley (Tolazolina y Papaverina), controlado por arteriografía; si no cede, el intestino necrótico debe ser removido quirúrgicamente. Material y Método: Se consideran 22 casos. Todos consultaron por dolor abdominal repentino, distensión y enterorragia. Sólo 3 carecían de antecedentes, los 19 restantes provenían de UTI, U.C., o tenían tratamiento con digital. Se utilizó el análisis univariable de variables cualitativas. Resultados: Se operaron 18 (81,8 por ciento), falleciendo sin operar 4 (18 por ciento). La mortalidad global fue de 15 (68,1 por ciento). Siete (31,8 por ciento) tuvieron buena evolución, ellos presentaron sólo lesiones de intestino delgado.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Angiography/statistics & numerical data , Intestines/pathology , Ischemia/diagnosis , Ischemia/mortality , Ischemia/surgery , Ischemia/therapy , Mesenteric Arteries , Splanchnic Circulation , Abdominal Pain/diagnosis , Multivariate Analysis , Mesenteric Vascular Occlusion , Papaverine/administration & dosage , Papaverine/therapeutic use , Tolazoline/administration & dosage , Tolazoline/therapeutic useSubject(s)
Humans , Male , Infant, Newborn , Persistent Fetal Circulation Syndrome/diagnosis , Dobutamine/administration & dosage , Dopamine/administration & dosage , Echocardiography , Enalapril/administration & dosage , Furosemide/administration & dosage , Medigoxin/administration & dosage , Neurologic Manifestations , Parenteral Nutrition , Radiography, Thoracic/methods , Persistent Fetal Circulation Syndrome/physiopathology , Tolazoline/administration & dosageABSTRACT
Ten critically-ill preterm infants with severe hyaline membrane disease received tolazoline because of persistent hypoxemia refractory to the administration of 100% oxygen and mechanical ventilation. Seven infants (70%) responded immediately with an increase in PaO2 greater than or equal to 20 mmHg in the umbilical arterial gas within 60 minutes after bolus infusion (1 to 2 mg/kg) of tolazoline. Twenty-four hours later after the tolazoline infusion, the FiO2 had been decreased from 1.0 to a mean of 0.82 +/- 0.16, and the MAP from 16.5 +/- 1.8 to 15.6 +/- 4.5 cm H2O. Four of 7 infants (57%) who had an immediate response survived, whereas none survived out of 3 infants who failed to respond initially. Three infants experienced relatively severe complications possibly related to tolazoline. There appears to be a place for the use of tolazoline in a severely hypoxemic infant with hyaline membrane disease who is being ventilated, and in whom arterial oxygenation cannot be improved by a further increase in the inspired oxygen concentration or by an alteration of ventilator settings.