{"id":108536,"date":"2018-03-11T10:33:24","date_gmt":"2018-03-11T10:33:24","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/estudio-de-la-relacion-entre-las-perfusiones-esplacnica-y-renal-en-pacientes-cra%c2%adticos-pediatricos\/"},"modified":"2018-03-11T10:33:24","modified_gmt":"2018-03-11T10:33:24","slug":"estudio-de-la-relacion-entre-las-perfusiones-esplacnica-y-renal-en-pacientes-cra%c2%adticos-pediatricos","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/pediatria\/estudio-de-la-relacion-entre-las-perfusiones-esplacnica-y-renal-en-pacientes-cra%c2%adticos-pediatricos\/","title":{"rendered":"Estudio de la relaci\u00f3n entre las perfusiones espl\u00e1cnica y renal en pacientes cr\u00edticos pedi\u00e1tricos"},"content":{"rendered":"

Tesis doctoral de Jos\u00e9 Antonio Ruiz Dominguez <\/strong><\/h2>\n

Durante los primeros estad\u00edos de inestabilidad hemodin\u00e1mica, la monitorizaci\u00f3n sist\u00e9mica (hemodin\u00e1mica, lactato, gasometr\u00eda arterial) puede resultar insuficiente para detectar precozmente la aparici\u00f3n de fen\u00f3menos de hipoperfusi\u00f3n regional (shock oculto). La persistencia de shock oculto contribuye a la progresi\u00f3n hacia un estado de shock descompensado y disfunci\u00f3n multiorg\u00e1nica. la tonometr\u00eda g\u00e1strica (phi) detecta las situaciones de hipoperfusi\u00f3n regional. Sin embargo, dificultades de diverso tipo han condicionado el que esta t\u00e9cnica no haya llegado a implantarse como monitorizaci\u00f3n habitual. varios estudios experimentales han apuntado la posibilidad de que el territorio nefro-urinario tambi\u00e9n experimente fen\u00f3menos de hipoperfusi\u00f3n tisular. -objetivos de la investigaci\u00f3n: 1. Demostrar la aparici\u00f3n de fen\u00f3menos de hipoperfusi\u00f3n regional espl\u00e1cnica (phi<7.30), en ausencia de alteraciones hemodin\u00e1micas o bioqu\u00edmicas sist\u00e9micas (shock oculto), en pacientes ingresados en ucip. 2. Documentar si, de forma paralela a las alteraciones del phi, aparecen fen\u00f3menos que sugieran la presencia simult\u00e1nea de hipoperfusi\u00f3n renal, detectables mediante patrones bioqu\u00edmicos de funci\u00f3n renal. 3. Aclarar si, en presencia de fen\u00f3menos de acidificaci\u00f3n regional espl\u00e1cnica, se produce un aumento en la acidificaci\u00f3n urinaria (mensurable mediante los par\u00e1metros cl\u00e1sicos de acidificaci\u00f3n urinaria). 4. Definir par\u00e1metros gasom\u00e9tricos urinarios, conceptualmente similares a los descritos para la tonometr\u00eda g\u00e1strica, capaces de detectar la aparici\u00f3n de fen\u00f3menos de acidificaci\u00f3n regional a nivel del territorio nefro-urinario durante las situaciones de hipoperfusi\u00f3n espl\u00e1cnica. resultados: 1. La tonometr\u00eda g\u00e1strica demostr\u00f3 situaciones de hipoperfusi\u00f3n espl\u00e1cnica, no sospechadas por los datos obtenidos mediante la monitorizaci\u00f3n sist\u00e9mica (shock oculto -so-). 2. Los pacientes del grupo so presentaron, a diferencia de los pacientes sin so, un patr\u00f3n pre-renal en los estudios cl\u00e1sicos de funci\u00f3n renal. Estas diferencias no se observaron entre el grupo estable e inestable. 3. Los pacientes del grupo so presentaron significativamente mayor acidificaci\u00f3n urinaria. No se observaron estas diferencias entre el grupo estable e inestable. 4. Definimos un nuevo par\u00e1metro urinario, el phur, que se comport\u00f3 como el mejor par\u00e1metro para detectar el incremento de acidificaci\u00f3n en el territorio nefro-urinario durante las situaciones de hipoperfusi\u00f3n espl\u00e1cnica. Valores de phur en torno a 7.28-7.29 tienen una sensibilidad (60-63%) y especificidad (62-65%) moderadas para predecir un phi<7.30.\n\n\n\n \n\n\n

Datos acad\u00e9micos de la tesis doctoral \u00abEstudio de la relaci\u00f3n entre las perfusiones espl\u00e1cnica y renal en pacientes cr\u00edticos pedi\u00e1tricos<\/strong>\u00ab<\/h3>\n
    \n
  • T\u00edtulo de la tesis:<\/strong>\u00a0 Estudio de la relaci\u00f3n entre las perfusiones espl\u00e1cnica y renal en pacientes cr\u00edticos pedi\u00e1tricos <\/li>\n
  • Autor:<\/strong>\u00a0 Jos\u00e9 Antonio Ruiz Dominguez <\/li>\n
  • Universidad:<\/strong>\u00a0 Aut\u00f3noma de Madrid<\/li>\n
  • Fecha de lectura de la tesis:<\/strong>\u00a0 19\/05\/2011<\/li>\n<\/ul>\n

     <\/p>\n

    Direcci\u00f3n y tribunal<\/h3>\n
      \n
    • Director de la tesis<\/strong>\n
        \n
      • Francisco Ruza Tarrio<\/li>\n<\/ul>\n<\/li>\n
      • Tribunal<\/strong>\n
          \n
        • Presidente del tribunal: Jes\u00fas Argente oliver <\/li>\n
        • Juan ignacio Mu\u00f1oz bonet (vocal)<\/li>\n
        • custodio Calvo mac\u00edas (vocal)<\/li>\n
        • Juan Luis Perez navero (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

           <\/p>\n","protected":false},"excerpt":{"rendered":"

          Tesis doctoral de Jos\u00e9 Antonio Ruiz Dominguez Durante los primeros estad\u00edos de inestabilidad hemodin\u00e1mica, la monitorizaci\u00f3n sist\u00e9mica (hemodin\u00e1mica, lactato, gasometr\u00eda […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"categories":[179,1601,384,161],"tags":[20934,15376,14687,217513,52593,34687],"class_list":["post-108536","post","type-post","status-publish","format-standard","hentry","category-nefrologia","category-patologia-cardiovascular","category-patologia-clinica","category-pediatria","tag-custodio-calvo-macias","tag-francisco-ruza-tarrio","tag-jesus-argente-oliver","tag-jose-antonio-ruiz-dominguez","tag-juan-ignacio-munoz-bonet","tag-juan-luis-perez-navero"],"_links":{"self":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/108536","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/comments?post=108536"}],"version-history":[{"count":0,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/108536\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/media?parent=108536"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/categories?post=108536"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/tags?post=108536"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}