{"id":87021,"date":"2018-03-10T00:11:43","date_gmt":"2018-03-10T00:11:43","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/evaluacion-de-la-funcion-cardiaca-y-el-estado-hemodinamico-en-la-ictericia-obstructiva\/"},"modified":"2018-03-10T00:11:43","modified_gmt":"2018-03-10T00:11:43","slug":"evaluacion-de-la-funcion-cardiaca-y-el-estado-hemodinamico-en-la-ictericia-obstructiva","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/ciencias-medicas\/evaluacion-de-la-funcion-cardiaca-y-el-estado-hemodinamico-en-la-ictericia-obstructiva\/","title":{"rendered":"Evaluacion de la funcion cardiaca y el estado hemodinamico en la ictericia obstructiva"},"content":{"rendered":"<h2>Tesis doctoral de <strong>  Puente Gutierez Juan  Jes\u00fas <\/strong><\/h2>\n<p>Introduccion: en los pacientes con ictericia obstructiva (io) existe una elevacion de los niveles plasm\u00e1ticos de p\u00e9ptido natriur\u00e9tico atrial (anp), consecuencia de un aumento en la secreci\u00f3n cardiaca del peptido, recientemente la determinacion en sangre periferica de anp y bnp constituye un marcador de disfuncion cardiaca subclinica.  objetivos: 1.-Determinar la funcion cardiaca y los parametros hemodinamicos basales en la ictericia obstructiva. 2.-Analizar si estos se correlacionan con anp y bnp.3.- Estudiar la repercusion del drenaje biliar interno.  metodo: estudio clinico prospectivo longitudinal antes-despues sobre 13 pacientes con ictericia obstructiva sometidos a drenaje biliar interno (percutaneo 7, endoscopico 6). Se realizaron determinaciones hormonales (anp, bnp, renina, aldosterona) y un estudio hemodinamico 24 horas antes del drenaje biliar y 72 horas despues de este. El estudio hemodinamico consistia en la insercion de un cateter swan-ganz. A su vez, cada medici\u00f3n cosntaba de 2 fases: una basal y otra tras una sobrecarga de volumen hasta una pcp 14 mmhg.  resultados: los niveles de anp (104 pg\/ml)y de bnp (47 pg\/ml) se encontraron elevados respecto del grupo control. En la comparacion basal con los rangos de normalidad no hubo alteraciones en los parametros de funcion cardiaca, si bien el trabajo sistolico ventricular izquierdo (tsvi) guardo correlacion con la colemia (r=-0.78,p=0.002) y con el tiempo de ictericia (r=-0.73, p=0.005). En el analisis multivariante fueron pedictores del tsvi la bilirrubinemia, el tiempo de ictericia y los niveles de bnp. Tras el drenaje biliar se produce una mejora en el i.Cardiaco 3.4 vs 3.8 l\/min.M2, p=0.03), i.Sistolico (48 vs 52 ml\/m2) y tsvi (94 vs 112 g.M\/m2). Esta mejora se acentu\u00f3 comparando la respuesta a la sobrecarga de volumen tras el drenaje (tsvi 6 vs 14%), asi como el volumen requerido durante la sobrecarga (427 vs 703 ml).  conclusiones: en la io existe una disfuncion c<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Evaluacion de la funcion cardiaca y el estado hemodinamico en la ictericia obstructiva<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Evaluacion de la funcion cardiaca y el estado hemodinamico en la ictericia obstructiva <\/li>\n<li><strong>Autor:<\/strong>\u00a0  Puente Gutierez Juan  Jes\u00fas <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 C\u00f3rdoba<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 23\/10\/2000<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Gonzalo Mi\u00f1o Fugarolas<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: sebastian Rufian pe\u00f1a <\/li>\n<li> Miras parra fco. julio (vocal)<\/li>\n<li>Javier Salmeron escobar (vocal)<\/li>\n<li>antoni Sitges serra (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Puente Gutierez Juan Jes\u00fas Introduccion: en los pacientes con ictericia obstructiva (io) existe una elevacion de los [&hellip;]<\/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 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