Avaliação dos parâmetros gasométricos dos traumatizados durante o atendimento pré-hospitalar móvel / Evaluation of gasometric parameters in trauma patients during mobile prehospital care

OBJETIVO: avaliar diferenças gasométricas dos pacientes traumatizados graves que necessitaram de intubação orotraqueal no atendimento pré-hospitalar. MÉTODOS: foram colhidas amostras de sangue dos pacientes que necessitaram de manejo de via aérea no início do atendimento pré-hospitalar e ao dar entrada na Unidade de Urgência. Foram analisados: pH, pressão arterial de CO2 (PaCO2), pressão arterial de O2 (PaO2), excesso de base (BE), saturação da hemoglobina por O2 (satO2) e a relação PaO2 e a fração inspirada de O2 (PaO2/FiO2). RESULTADOS: houve significância estatística entre as diferenças das médias entre os dados coletados no local do sinistro e na entrada da UUE na Frequência respiratória (p=0,0181), na Escala de Coma de Glasgow (p=0,0084), na pressão parcial arterial de oxigênio (PaO2; p<0,0001) e na saturação da hemoglobina pelo oxigênio (p=0,0018). CONCLUSÃO: a intubação orotraqueal altera os parâmetros PaO2 e saturação de oxigênio pela hemoglobina. Não houve diferença nos parâmetros metabólicos (pH, Bicarbonato e excesso de base). Na análise dos parâmetros hemogasométricos dos sobreviventes e não sobreviventes observou-se diferença estatística entre o PaO2, saturação de oxigênio pela hemoglobina e excesso de base.

OBJECTIVE: To evaluate gasometric differences of severe trauma patients requiring intubation in prehospital care. METHODS: Patients requiring airway management were submitted to collection of arterial blood samples at the beginning of pre-hospital care and at arrival at the Emergency Room. We analyzed: Glasgow Coma Scale, respiratory rate, arterial pH, arterial partial pressure of CO2 (PaCO2), arterial partial pressure of O2 (PaO2), base excess (BE), hemoglobin O2 saturation (SpO2) and the relation of PaO2 and inspired O2 (PaO2/FiO2). RESULTS: There was statistical significance of the mean differences between the data collected at the site of the accident and at the entrance of the ER as for respiratory rate (p = 0.0181), Glasgow Coma Scale (p = 0.0084), PaO2 (p <0.0001) and SpO2 (p = 0.0018). CONCLUSION: tracheal intubation changes the parameters PaO2 and SpO2. There was no difference in metabolic parameters (pH, bicarbonate and base excess). In the analysis of blood gas parameters between survivors and non-survivors there was statistical difference between PaO2, hemoglobin oxygen saturation and base excess.

Injuries by marine and freshwater stingrays: history, clinical aspects of the envenomations and current status of a neglected problem in Brazil

Stingrays are a group of rays – cartilaginous fish related to sharks – that have whiplike tails with barbed, usually venomous spines and are found around the world, especially the marine species. Despite recent reports of accidents involving these fish, they are not aggressive, reacting only when stepped on or improperly handled. Injuries by stingrays are seldom mentioned by historians, although they have always been present in riverine communities of inland waters and in South American coasts. Indeed, envenomations by stingrays are quite common in freshwater and marine fishing communities. Although having high morbidity, such injuries are neglected because they have low lethality and usually occur in remote areas, which favor the use of folk remedies. In the present review article, historical aspects of injuries caused by stingrays in Brazil and their distribution on the coast of São Paulo state and riverine communities of the North, Midwest and Southeast regions were studied. In addition, other aspects were analyzed such as clinical features, therapeutic methods, preventive measures and trends in occurrence of these accidents in the country, particularly in areas in which freshwater stingrays had not been previously registered, being introduced after breaching of natural barriers.

Alterações no reparo tecidual cutâneo em um modelo de resistência à insulina / Resistant mice cutaneous wound healing alterations in insulin

A obesidade associada às alterações metabólicas, tais como a resitência à insulina, provoca significativas modificações no decorrer do processo de cicatrização. O objetivo desse estudo foi inicialmente avaliar os efeitos da resistência à insulina induzida por uma dieta com elevado teor de gordura durante o reparo tecidual. E, em seguida, investigar o papel dos macrófagos neste processo. Observamos que os animais submetidos à dieta hiperlipídica (RHL) tornaram-se intolerantes à glicose e resistentes à insulina, além de aumentarem as taxas plasmáticas de colesterol e triglicerídeos em relação aos animais alimentados com ração padrão (RP). O grupo RHL apresentou uma menor taxa de contração da lesão e reepitelização em relação ao grupo RP. Observamos ainda maior quantidade de células inflamatórias (células NOS 2-positivas, macrófagos, e neutrófilos), menor densidade de fibras do sistema colágeno e maior densidade de miofibroblastos e vasos sanguíneos no grupo RHL. O dano oxidativo estava maior no grupo RHL bem como a expressão proteica do fator de crescimento transformante-β1 (TGF-β1) e α-actina de músculo liso (α-SMA). O grupo RHL apresentou altos níveis plasmáticos de TNF-α quando comparado com o grupo RP. Além disso, a proporção das células M1 (macrófagos ativados classicamente) e M2 (macrófagos ativados alternativamente) foi a mesma em ambos os grupos. Em relação a síntese e liberação de citocinas e fatores de crescimento avaliados através dos ensaios in vitro, observamos ainda que os níveis do fator de necrose tumoral-α (TNF-α) e interleucina-1β (IL-1β) estavam maiores no meio condicionado de macrófagos isolados dos animais do grupo RHL (MCRHL) em relacão ao meio condicionado de macrófagos isolados dos animais do grupo RP (MCRP). Além disso, os nossos resultados demonstraram claramente que os fatores solúveis produzidos por macrófagos isolados a partir de animais resistentes à insulina inibem a proliferação e a migração de fibroblastos. Através ...

Obesity associated with with metabolic alterations such as insulin resistance causes significant modifications during the healing process. Our aim was initially to analyse the effects of insulin resistance induced by a high- significant changes in skin combined fat diet during cutaneous wound healing. And then investigate the role of macrophages in this process. We observed that animals subjected to a high-fat diet (HFC) became glucose intolerant and insulin resistant and increased plasma cholesterol and triglycerides levels when compared to animals fed with a standard chow (SC). The HFC group had a lower rate of wound contraction and re-epithelialization than the SC group. Besides, HFC group presented a greater number of inflammatory cells (NOS 2- and F4/80-positive cells, and neutrophils), lower density of collagen fibers and higher density of myofibroblasts and blood vessels. Oxidative damage was greater in the HFC group as well as the protein expression of TGF-β1 and α-smooth muscle actin (α- SMA). The HFC group presented higher levels of plasma TNF-α when compared to RP group. Furthermore, the proportion of M1 cells (classically activated macrophages) and M2 (alternatively activated macrophages) was the same in both groups. Regarding to the synthesis and release of cytokines and growth factors evaluated by in vitro assays, we also observed that the levels of TNF-α and IL-1β were higher in conditioned medium of macrophages isolated from animals of HFC (MCHFC) group when compared to the conditioned medium of macrophages isolated from animals in of RP (MCSC) group. Furthermore, our results clearly demonstrate that soluble factors produced by macrophages isolated from insulin resistant animals inhibit the proliferation and migration of fibroblasts. Thus, we can show that insulin resistance delays wound healing process and suggest that the macrophages are involved in this delay

Expression of M3 subtype of muscarinic receptor during the skin incised wound healing in mice / 法医学杂志

OBJECTIVE@#To investigate the expression of M3 subtype of muscarinic receptors (M3R) during the incised wound healing of the skin in mice and the characteristics of its time-dependent.@*METHODS@#The change of M3R in skin incised wound was detected by immunohistochemical staining and Western blot.@*RESULTS@#M3R-positive cells were detected in epidermis, hair follicle, sebaceous glands, sweat glands, dermomuscular layer in normal mouse skin. Expression of M3R was mainly detectable in polymorphonuclear cells (PMNs) in the wound specimens aged from 6h to 12h after injury. Afterwards, the M3R-positive cells were mostly mononuclear cells (MNCs) and fibroblastic cells (FBCs) at 1 d to 3d post-injury, whereas the M3R-positive cells were mostly FBCs aged from 5 d to 14d. Morphometrically, the ratio of the M3R-positive cells increased aged from 6h to 12h after injury, with a peak at 12h. The ratios kept a high relatively level aged from 1 d to 5 d, but significantly that lowered as compared with aged 12h after injury. The ratio reached the peak at 7 d again after injury, and then decreased gradually. The M3R protein also revealed a time-dependent tendency with double peaks at 12h and 7 d after injury as detected by Western blotting.@*CONCLUSION@#M3R is time-dependently expression in PMNs, MNCs and FBCs suggesting that it may play roles during the skin incised wound healing, and M3R may be used as a marker for wound age determination.

Analysis of alcohol mass concentration in corpse blood / 法医学杂志

The blood alcohol concentration (BAC) is an important evidence to determine the alcohol level at the time of death. But due to the postmortem synthesis and diffusion of alcohol, the cadaveric BAC can not always represent the original BAC at the time of death. It is a crucial problem to determine the original level in corpse. The article reviewed the following points: the distribution in corpse, and how to sample, the influences on the diffusion of alcohol and putrefaction, the discussion about alcohol mass concentration measure methods.

Expression of c-jun during the incised wound healing in mice skin / 法医学杂志

UNLABELLED@#OBJECTIVE To investigate the time-dependent expression of c-jun during the healing of incised wound in mice skin.@*METHODS@#The expression of c-jun in different stages after the incised wound were detected by immunohistochemistry and Western blot.@*RESULTS@#There was a low level expression of c-jun in normal mice skin. Expression of c-jun was mainly detected in neutrophils from 3 h to 12h after injury. The c-jun positive cells were almost mononuclear cells (MNCs) and fibroblasts between 1 d and 5 d after injury. The c-jun positive cells were mostly fibroblasts between 7 d and 14 d after injury. The ratio of the c-jun positive cells increased in the wound specimens from 3 h to 12 h, peaked at 12 h, declined partially from 1 d to 5 d, and reached the peak secondly at 7 d, then decreased from 10 d to 14 d. The expression of c-jun was observed throughout the wound healing stages by Western blot with two peaks occurring at 12 h and 7 d after injury.@*CONCLUSION@#The c-jun may play a potential role in inducing apoptosis of neutrophils, MNCs and fibroblasts during skin wound healing, and it may be used as the marker for wound age determination.

acute inflammatory response in trauma / hemorrhage and traumatic brain injury: current state and emerging prospects

Traumatic injury/hemorrhagic shock [T/HS] elicits an acute inflammatory response that may result in death. Inflammation describes a coordinated series of molecular, cellular, tissue, organ, and systemic responses that drive the pathology of various diseases including T/HS and traumatic brain injury [TBI]. Inflammation is a finely tuned, dynamic, highly-regulated process that is not inherently detrimental, but rather required for immune surveillance, optimal post-injury tissue repair, and regeneration. The inflammatory response is driven by cytokines and chemokines and is partially propagated by damaged tissue-derived products [Damage-associated Molecular Patterns; DAMP's]. DAMPs perpetuate inflammation through the release of pro-inflammatory cytokines, but may also inhibit anti-inflammatory cytokines. Various animal models of T/HS in mice, rats, pigs, dogs, and non-human primates have been utilized in an attempt to move from bench to bedside. Novel approaches, including those from the field of systems biology, may yield therapeutic breakthroughs in T/HS and TBI in the near future

Time-relative changes in the erythrocyte antioxidant enzyme activities and their relationship with Glasgow Coma Scale scores in severe head injury patients in the 21-day posttraumatic study period.

BACKGROUND: Reactive oxygen species are indicated to play a prime role in the pathophysiology of brain damage following a severe head injury (SHI). AIM: The current study was designed to understand the time-relative changes and relationship between erythrocyte antioxidant enzyme activities and Glasgow Coma Scale (GCS) scores of SHI patients in the 21-day posttraumatic study period. SETTINGS AND DESIGN: The study included 24 SHI patients and 25 age- and sex-matched normal controls (NC). Activities of superoxide dismutase (SOD), glutathione reductase (GR) and glutathione peroxidase (GSH-Px) were assayed in these patients and controls. The GCS scores of these patients were also recorded for the comparative study. Materials and Methods: Venous blood samples were collected on day 7 (D7) and D21 from SHI patients and NC for the assay of SOD, GR and GSH-Px activities. These changes were correlated with age and changes in GCS scores of patients. STATISTICAL ANALYSIS: A one-way analysis of variance (ANOVA) was used to compare mean values of each parameter between group 1 (NC), group 2 (D7 changes in SHI patients) and group 3 (D21 changes in SHI patients). ANOVA was followed by Bonferroni post hoc tests. The Pearson correlation was applied to correlate between the antioxidant parameters and age and GCS scores of these patients. RESULTS: A significant increase in erythrocyte SOD and GSH-Px activities was observed in group 3 as compared to groups 1 and 2. The increase in GSH-Px activity was significant in group 2 as compared to group 1. Although not significant, there was an increase in mean GR activity in groups 2 and 3 as compared to group 1. CONCLUSION: These findings indicate that SHI patients have shown significantly enhanced erythrocyte SOD and GSH-Px activities during the 21-day posttraumatic study period.

Fos expression in rat skin after different incised wound healing interval / 法医学杂志

OBJECTIVE@#To investigate the expression of c-fos in rats' skin during wound healing.@*METHODS@#Immunohistochemistry was conducted on paraffin section from incised wounding model of rat skin.@*RESULTS@#Fos protein improved from the time of 10 min after wounding in the wound edge, then it reached peak at 3 h. 24 h after injury, the quantity of Fos expression had no difference with that of normal skin.@*CONCLUSION@#Fos is sensitive after wound, but should be used with other criteria in wounding interval estimation as it's unstediness.

Estudio cinético de las proteínas en el traumatizado y su correlación con los índices predictivos / Kinetic study of proteins in the traumatized patient and its correlation with predictive indeces

Se realizó un estudio prospectivo en 52 lesionados, y se estableció la correlación existente entre los valores de los índices predictivos utilizados y los resultados obtenidos en las fracciones protéicas estudiadas al ingreso, 3 y 7 días. Fueron aplicadas las siguientes pruebas estadísticas: medias, desviación estándar, minímo, máximo y prueba de correlación-regresión e hipótesis con una confiabilidad de 95 por ciento (alfa =0,05). El 38,5 por ciento de los lesionados correspondieron al rango entre 21 y 30 años de edad y predominó el sexo masculino (88,5 por ciento). Los accidentes del tránsito constituyeron la causa más frecuente de lesiones (38,5 por ciento); las lesiones ortopédicas fueron las de mayor incidencia (26,4 por ciento) y se encontraron complicaciones en el 38,4 por ciento de la muestra. Las proteínas totales, las albúminas y las globulinas gamma sufrieron disminución significativa a las 72 horas de ocurridas las lesiones, esta depresión se hizo más intensa en los fallecidos y se constató que existe correlación entre las variables estudiadas y los índices predictivos

Alterations in intracellular calcium during sepsis.

Tissue injury and/or infection produce significant alterations in intracellular calcium ion regulation. These alterations in cellular calcium has recently been studied following both short term and long term septic model which uses two types of gram-negative bacteria frequently encountered human abdominal sepsis. Changes in calcium flux as well as functional disturbances has been observed in the major organs, specially in skeletal muscle. The changes in calcium flux in different organs were studied using 45Ca exchange, 19F NMR study or by using calcium-fluorescence probes. Calcium-channel blockers attenuate the increased effects of calcium flux. Further anti-cytokines may be useful to prevent septic injury in tissues.

Is it possible to trigger collagen synthesis by electric current in skin wounds?

The effect of direct micro currents on collagen synthesis in wound healing on the 3rd day of wounding has been examined in rabbit skin. Two circular skin wounds were formed bilaterally on the gluteal region and current was applied to one of the wounds and the other was taken as the control with placebo electrode on it, the current intensities being 200 microA and 400 microA and application time 72 hrs with 8 hr/day. The hydroxyproline content was found to be increased in wound tissue at the end of 72 hrs of applying current which indicated that collagen synthesis is promoted by electric current.

Nutriçäo e sepse / Nutrition and sepsis

A resposta neuroendócrina ao trauma e à sepse leva a um estado de hipermetabolismo e alteraçöes metabólicas que em princípio visam a proteçäo e o restabelecimento das principais funçöes orgânicas, mas que tardiamente podem estar associadas à instalaçäo adicional da síndrome de insuficiência orgânica múltipla. O aporte nutricional tem papel importante, mas näo suficiente, na prevençäo dessa síndrome (ou restriçäo do número de órgäos e sistemas atingidos), através do fornecimento de substratos energéticos específicos, necessários à cicatrizaçäo, reparo, manutençäo das funçöes musculoesqueléticas e hepáticas e prevençäo de distúrbios gastrointestinais. Este artigo tem por objetivo fazer uma revisäo dos estudos realizados sobre o binômio nutriçäo/sepse

Diferenciaçäo metabólica-hormonal de pacientes traumatizados, com e sem lesäo cranioencefálica, recebendo dieta enteral hiperprotéica - hiperenergética, suplementada ou näo com glicose hipertônica endovenosa / Metabolic-hormonal differentiation of traumatized patients with and without brain injury, receiving enteral hyperprotein diet supplemented or not by intravenous hypertonic glucose

O trauma resulta invariavelmente, em desnutriçäo pelo hipercatabolismo que impöe aos pacientes. Imagina-se que os mediadores hormonais desse hipercatabolismo possam ser diferentes no trauma com (TCE) ou sem (PT) lesäo cranioencefálica. A fim de evitar ou atenuar as conseqüências nutricionais do trauma, recomenda-se o suporte nutricional precoce desses pacientes. Assim, estudou-se a resposta metabólico-hormonal desses pacientes que receberam hiperalimentaçäo enteral suplementada ou näo com glicose hipertônica endovenosa. Foram estudados 12 pacientes, 6 com TCE (escala de Glasgow 4-6) e 6 com PT (ISS 30-42), adultos (21-39 anos), no período 4-11 dias pós-trauma. As avaliaçöes foram feitas em três momentos consecutivos (M1, M2, M3) coincidentes com três períodos dietéticos de três dias cada. M1 e M3 corresponderam à oferta de dieta enteral contendo 1,9g de proteína/kg/dia e 47 kcal/kg/dia e M2 a mesma dieta suplementada com glicose 50 por cento endovenosa (17,6 kcall/kg/dia). Amostras de sangue e urina (24 horas) foram colhidas no 3§ dia de cada regime dietético e utilizadas para dosagens de proteínas da fase aguda (proteína C reativa,alfa1-antitripsina, ceruloplasmina, transferrina, transtiretina e proteína ligadora do retinol), substratos energéticos (glicose, ácidos graxos livres e nitrogênio amínico) e triacilgliceróis, hormônios (insulina, peptídeo C, glucagon, cortisol, dopamina, epinefrina e norepinefrina) e uréia urinária. A partir da relaçäo entre proteínas positivas e negativas (da fase aguda) calculou-se o índice inflamatório e, da diferença entre N-ingerido e N-uréico excretado o índice catabólico. Em M1, o PT diferenciou-se do TCE por apresentar maiores níveis de glicemia e do índice inflamatório enquanto que o TCE houve maiores cortisolemias e índice catabólico. No transcorrer do estudo, ambos os grupos se assemelharam por apresentarem alto índice catabólico e elevados níveis de epinefrina e dopamina. Elevaçöes mais acentuadas da glicemia, insulinemia e peptídeo C foram mais característicos do PT denotando maior resistência insulínica, enquanto maiores elevaçöes do cortisol, glucagon, epinefrina e norepinefrina, sugestivos de maior descarga adrenérgica, foram observados no TCE. Esses padröes metabólicos dos grupos foram minimamente alterados pela suplementaçäo de glicose ou pelo curso da doença, demonstrando que essas individualidades dos tipos de trauma...

Efeitos da desnutriçäo protéica sobre a resposta metabólica ao trauma / Effects of protein malnutrition on the metabolic response to trauma

Com o objetivo de estudar as alteraçöes metabólicas pós-traumáticas frente, à desnutriçäo protéica, ratos alimentados com dietas de teor proteíco variado foram submetidos a um trauma osteo muscular padronizado e tiveram analisados aspectos metabólicos de balanço nitrogenado e composiçäo corpórea. Após 21 dias de alimentaçäo com dieta apropriada para cada grupo de estudo (normoprotéica e hipoprotéica), praticou-se ferida cutânea dorsal (subgrupos NJ (6) e DJ (6) e, em parte dos animais, traumatismo osteomuscular em ambas as patas traseiras (subgrupos NF(6) e DF (6). Após 14 dias da realizaçäo do trauma (35§ dia do experimento), os animais foram sacrificados e as carcaças foram preparadas para a determinaçäo dos compartimentos de composiçäo corpórea. Peso corpóreo, ingesta alimentar, excreçäo urinária e fecal de nitrogênio foram observados diariamente. Verificou-se que, nos animais alimentados com dieta normoprotéica, o trauma osteomuscular provocou reduçäo da ingestäo alimentar, do ganho de peso, do balanço nitrogenado e perda de gordura total. Nos animais com restriçäo protéica, a resposta ao trauma osteomuscular foi caracterizada por aumento na excreçäo de nitrogênio urinário e reduçäo no balanço nitrogenado, näo se verificando reduçäo na ingestäo alimentar, peso corporal e nos compartimentos de composiçäo corpórea

Soporte metabolico hipocalorico del paciente en estado septico / Hypocaloric metabolic support of the patient in septic state

El organismo requiere una provision calorica para atender sus necesidades fisiologicas y del metabolismo intermediario. En condiciones de stress se presenta un mayor gasto calorico, pero las formulas que han sido comunmente utilizadas para el calculo de la demanda calorica en el estado critico resultan en provisiones excesivas con efectos fisiologicos adversos. El Centro Medico de los Andes ha establecido protocolos fundamentados en el calculo de gasto metabolico basal mediante la ecuacion de Harris-Benedict, utilizando el peso ideal cuando hay obesidad y el peso actual en individuos desnutridos, con un factor de aumento por stress del orden de 5-15//, y hasta 30//, lo cual generalmente significa provisiones caloricas totales de menos de 1600 calorias/dia para adultos, cifra muy inferior a las provisiones del orden de 2500 cal/dia que son comunes en la actualidad. Tambien ha sido de gran valor practico la determinacion del gasto metabolico total a partir de la medicion de producccion de CO2 y de consumo de O2 utilizando la formula abreviada de Weir. Sin embargo, cuando el paciente se encuentra en estado critico y exhibe un elevado nivel de estres, a juzgar por hipermetabolismo, catabolismo exagerado y cuadro hiperdinamico, nuestra conducta es administrar una carga muy baja de carbohidratos de 200-600 cal/dia y un maximo aporte de proteina, regimen que permite la oxidacion de grasa endogena y que parece ser altamente ahorrador de proteina corporal. Este regimen solo es utilizado ...

Efeitos do trauma e desenvolvimento tumoral sobre o processo de cicatrizaçäo e estado nutricional do hospedeiro: estudo experimental / Effects of trauma and tumor development on wound healing and nutritional status of the host: experimental study

Os autores examinam aspectos metabólicos do desenvolvimento de tumor maligno e da cicatrizaçäo da ferida cutânea aberta, em modelo experimental que permite analisar as conseqüências do trauma cirúrgico, do processo de cicatrizaçäo e da expansäo da massa tumoral: para tanto utilizam grupos de ratos Wistar em que tais situaçöes desenvolvem-se isolada ou simultaneamente. Os resultados indicam que a cicatrizaçäo näo é alterada pelo crescimento do tumor, nem este sofre reduçäo pela concorrência da cicatrizaçäo; na verdade, é o hospedeiro que sofre prejuízo com cada um dos processos, em particular, quando ambos se desenvolvem simultaneamente

A extraçäo de oxigênio pelo membro inferior de pacientes no período pós-traumático imediato / Oxigen extraction by the lower limb of patients in the immediate post-traumatic period

A etiologia do hipermetabolismo pós-traumático näo está ainda totalmente esclarecida. O estado metabólico do paciente traumatizado caracteriza-se por hipercatabolismo protéico, gliconeogênese hepática e considerável aumento do consumo de O2 total, entre outros atributos. Nesses pacientes, o hipercatabolismo é quantitativamente mais importante no tecido muscular esquelético. O objetivo do presente estudo é avaliar o perfil de extraçäo de O2 pelo tecido muscular esquelético em pacientes traumatizados, comparando-o com o mesmo perfil em controles normais. Foram estudados 14 pacientes, com idades variando entre 15 e 55 anos (média de 32 anos), vítimas de traumatismo que exigiu cirurgia de grande porte para seu tratamento, e comparados a 12 voluntários normais, com idades variando entre 13 e 64 anos (média 36 anos). Pacientes e voluntários pertenciam ao sexo masculino e se apresentavam hemodinamicamente estáveis, afebris, em repouso, jejum e recebendo apenas, soro fisiológico nas 12 horas que antecederam o estudo. As coletas de sangue arterial (artéria radial) e venoso (veia femoral comum) foram efetuadas entre 24 e 36 horas de pós-operatório e às 8 horas da manhä. Foram medidas nas amostras: pO2 saturaçäo de O2 hemoglobina, sendo calculado o conteúdo de O2 nas amostras arteriais e venosas. Sua diferença é diretamente proporcional ao consumo de O2 pelo membro inferior, dentro de certas limitaçöes. A extraçäo de O2 no território muscular esquelético dos pacientes (6,41 + ou - 1,69 ml/100 ml) foi elevada em relaçäo ao O2 nos voluntários (4,94 + ou - 1,63 ml/100 ml) com significância estatística ao nível de 5% (t = 2,25). As alteraçöes observadas refletem indiretamente a aceleraçäo das reaçöes oxidativas que caracterizam a fase catabólica do período pós-traumático imediato