Correlação dos graus de obstrução na DPOC com lactato e teste de caminhada de seis minutos

 

Dante Brasil Santos¹

Carlos Alberto de Assis Viegas ²

 

Resumo

Contextualização: A doença pulmonar obstrutiva crónica (DPOC), importante causa de morbimortalidade em todo mundo, leva não só ao comprometimento pulmonar, mas também a alterações sistémicas, com repercussões sobre músculos esqueléticos e a capacidade de realizar esforços, mensurável pelo teste de caminhada de seis minutos (TC6’).

Objectivos: correlacionar obstrução da DPOC com lactato de repouso, frequência cardíaca de repouso, bem como com distância percorrida. Correlacionar distância percorrida com gasometria e ainda correlacionar dessaturação ao TC6’ com lactato e frequência cardíaca pós-TC6’.

Método: Portadores de DPOC realizaram espirometria, gasometria e TC6’, que avaliou: distância percorrida, frequência cardíaca (FC), lactato capilar (Lct) pré e pós-TC6’, além de dessaturação ao TC6’.

Resultados: Foram avaliados 91 doentes abrangendo todos os graus de obstrução. Os parâmetros pós-TC6’, como FC e Lct, aumentaram de maneira significativa com a realização do mesmo. A queda da saturação da hemoglobina ao oxigénio diante do TC6’ também foi significativa. A análise de correlação significativa mostrou-se positiva entre VEF₁ e distância percorrida, negativa entre VEF₁ e FC de repouso e negativa entre distância percorrida e PaCO₂, sendo não significante para as demais variáveis.

Conclusões: A progressão da obstrução na DPOC, bem como valores maiores de PaCO₂, contribuem para a redução da distância percorrida no TC6’. O grau de obstrução na DPOC leva a alteração hemodinâmica com o aumento da frequência cardíaca de repouso destes doentes.

Palavras-chave: Doença pulmonar obstrutiva crónica, lactato, teste de esforço, dessaturação ao exercício.

 

Correlation of levels of obstruction in COPD with lactate and six-minute walk test

Abstract

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbid-mortality world wide, leading not only to pulmonary damage but also to multisystemic impairment, with repercussions on skeletal muscles and the ability to undertake effort, as measured in the six-minute walk test (6-MWT).

Aims: To correlate the level of obstruction in COPD with lactate concentration and heart rate (HR) at rest, and distance walked. To correlate distance walked with blood gas analysis and correlate desaturation in 6-MWT with post 6-MWT lactate concentration and heart rate.

Methods: COPD patients underwent spirometry, blood gas analysis and 6-MWT to evaluate distance walked, heart rate, capillary lactate (CL) concentration pre– and post 6-MWT, and desaturation with 6-MWT.

Results: 91 patients with all levels of obstruction were evaluated. HR and CL increased significantly post 6-MWT. The decrease in peripheral saturation of haemoglobin to oxygen observed with 6-MWT was also significant. The distance walked was shorter the greater the obstruction. The correlation analysis was significantly positive between FEV₁ and distance walked, negative between FEV₁ and HR at rest and negative between distance walked and PaCO₂, and not significant for the other variables.

Conclusions: Increased obstruction in COPD and higher PaCO₂ values contribute to a reduction in distance walked in 6-MWT. The level of obstruction in COPD leads to a haemodynamic impairment with increased HR at rest of these patients.

Key-words: Chronic obstructive pulmonary disease, lactate, exercise test, exercise desaturation.

 

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¹ Fisioterapeuta do Hospital Universitário de Brasília da Universidade de Brasília (HUB/UnB) / Physiotherapist, Hospital Universitário de Brasília da Universidade de Brasília (HUB/UnB)

² Professor Adjunto IV da Universidade de Brasília – Departamento de Clínica Médica – Universidade de Brasília / Assistant Professor IV, Universidade de Brasília,Departamento de Clínica Médica, Universidade de Brasília

 

Trabalho realizado no Serviço de Pneumologia do Hospital Universitário de Brasília da Universidade de Brasília (HUB-UnB) / Work undertaken at the Pulmonology Unit, Hospital Universitário de Brasília, Universidade de Brasília (HUB-UnB).

Directora do Serviço de Pneumologia do HUB-UnB / Head, Pulmonology Unit HUB-UnB: MD Verônica Amado

 

Endereço para correspondência / Correspondence to:

SQN 206 BLOCO J APT 503. CEP: 70844-100 – Brasília-DF – Brasil

Telefone: 061-32452503

E-mail: dante@unb.br

 

Recebido para publicação/received for publication: 08.07.22

Aceite para publicação/accepted for publication: 08.09.17