Atividade da amilase e ácido úrico salivar em pacientes submetidos à nutrição enteral exclusiva.

Abstract

Saliva is the product of salivary gland. Presented by parotid, sublingual and submandibular as well as mainly others minor oral glands. A normal salivary flow plays vital role in maintaining oropharynx health. In some subjects, who had abnormalities in swallowing, the aspiration of orofaringeal and gastric fluids may lead to infections, into the lower respiratory tract, as pneumonia. That situation, contraindicate oral feeding, and oral feeding is required to maintain adequate nutrition, which is necessarily to life. The changing in mastication status in patients feed by nasogastric tubes may cause an impact in saliva defense mechanism, enzymatic and non enzymatic. Therefore investigation of amylase and acid uric levels in saliva is justified. This work suggest: Compare salivary levels of amylase and uric acid in patients enteral nutrition feeding exclusively; 2) Correlate salivary levels of amylase and uric acid to clinical and laboratorial parameters in patients using enteral nutrition exclusively. This searching was approved by ethical commission of (HC-USP-FMRP).The volunteers and their legal relatives were warned about the objectives and methodologies, and could choose if they wanted participate or not of this study. The work was executed in mainly departments of Hospital das Clinicas da FMRP-USP. Forty- two adult patients constituted our study. Twenty-seven were man 64,3% and fifteen were women 35,7%. The mean age was 57,2 ± 17,0 years. The period in where subject were not feeding orally has mean of 17 days, varying in one day to 2 years and six months. Control group (n=8) was consisted for subjects whom were not feeding orally by period less than 3 days. The group mean duration (n=8) included, patients without oral feeding more than 3 days and less than 11.The group long duration (n=26) was made of patients without ingest no food or drink orally from more than 11 days. Using informatics system, obtained laboratorial bases, 3 days before and after the data when saliva was collected. It was aspired 1 to 3 ml of saliva using orotraqueal aspiration tube. All samples were placed in vacutainers tubes, sterilized without anticoagulant, hermetically closed and frozen in a temperature of -70 degrees until the right moment that were analyzed. Clinical analyses were made by colorimetric enzymatic method, in nutrition laboratories of FMRP-USP. Amylase values were expressed in (U/g), depending on total protein concentration, and uric acid levels were expressed in (Mg/dl). The statistical analyses were done by Statistica 6.0 software. It was used test t for variables in normal and homogeneous distribution. Anova F was used for three variables. The comparison of two variables normal and no-homogeneous or that with no-normal distribution was made by Mann-Whitney test; for three variables, Kruskal-Wallis test was used. A mean correlation was med to for numerical variables and an association analyses for categorical variables. Qui- quadrado test was used when all frequencies were higher 5, and Qui-quadrado de Yates when some frequency was lower than five and higher 1. Differences between variables were considered significant p<0,05. There was a big dispersion around the mean values between subjects using enteral nutrition exclusively during long terms. There were no statistical differences in amylase and uric acid salivary levels between patients of control group and groups relates on duration of enteral nutrition. Respectively no statistical differences were found in values of amylase and uric acid when subjects were grouped in accordance with clinical conditions. It was concluded that exclusive enteral nutrition and its duration did not modify levels of amylase and uric acid, and there is no correlation between this levels and laboratorial parameters used to evaluate patients feeding by enteral nutrition exclusively. Because off particularities in medical conditions of these patients, the salivary parameters must be specifically studied. These findings suggest that oropharynx contamination is a determinant factor in salivary levels concentration of uric acid and amylase. Justifying the variability of results.