Profilaxia de Úlceras de Stresse numa Unidade de Cuidados Intensivos - Estado da Arte

 

R. Pinho, J. M. Romãozinho(1)

 

Resumo

As lesões da mucosa gastro-duodenal relacionadas com o stresse fisiológico são frequentes nos doentes internados em unidades de cuidados intensivos. Podem condicionar hemorragia digestiva com repercussão hemodinâmica, estando associadas a aumento da  mortalidade. A hipoperfusão esplâncnica tem um papel central na sua fisiopatologia. Foram identificados vários factores de risco para a sua ocorrência, sendo os mais importantes a necessidade de ventilação mecânica e a presença de coagulopatia. A ressuscitação hemodinâmica atempada e a manutenção da nutrição entérica são medidas importantes para prevenir estas lesões. Em doentes com factores de risco deverá ser realizada profilaxia farmacológica. Os medicamentos mais estudados são os anti-ácidos, o sucralfato e os antagonistas H2. Têm surgido recentemente estudos sobre o papel dos inibidores da bomba de protões. A escolha da terapêutica farmacológica deverá ter em conta a via de administração, as vantagens e desvantagens de cada fármaco, incluindo o seu custo comparado e a evidência sobre a sua eficácia.

 

Summary

Stress related mucosal lesions of the gastro-duodenal mucosa are common in the intensive care setting. They may result in clinically significant gastrointestinal bleeding with increased mortality. Splanchnic hypoperfusion has a central role in their pathophysiology. Several risk factors were identified, the most important being respiratory failure requiring mechanical ventilation and coagulopathy. Fluid resuscitation and enteral nutrition are important measures to prevent these lesions. Pharmacologic prophylaxis is indicated in patients with known risk factors. Anti-acids, sucralfate and H2-receptor antagonists are the most extensively studied drugs. Recent studies evaluating the role of proton pump inhibitors were published. The choice of the  prophylactic regimen should be based on the route of administration, possible advantages and disadvantages of the drugs, including their comparative cost and available evidence of their efficacy.

 

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(1) Unidade de Cuidados Intensivos de Gastrenterologia - Serviço de Gastrenterologia  - Hospitais da Universidade de Coimbra

 

Correspondência:

Rolando Taveira Pinho

Unidade de Cuidados Intensivos de Gastrenterologia

Serviço de Gastrenterologia – Hospitais

da Universidade de Coimbra

Av. Bissaya Barreto e Praceta Prof. Mota Pinto

3000-075 – Coimbra

Telef. 00351239400468

e-mail: rolandopinho@portugalmail.pt

 

Recebido para publicação: 25/09/2007

Aceite para publicação: 16/07/2008