Traumatismo encéfalo-craneano : abordaje inicial intrahospitalario y evolución, estudio a realizarse en pacientes adultos del Area de Neurocirugía en el Hospital Guayaquil Abel Gilbert Pontón período 2014-2015
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2016
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Medicina
Resumen
La mejoría del paciente con Trauma craneoencefálico (TCE ) depende de la fase de admisión hospitalaria precoz de los pacientes, el tratamiento y la evaluación de diagnóstico que se realiza de acuerdo con el protocolo ATLS (advanced trauma life support). Una adecuada oxigenación (PaO2> 60 mmHg) y el apoyo de la presión arterial (PA sistólica> 90 mmHg) continúan siendo prioridades para establecer un control inmediato de los factores de morbilidad en los pacientes y mejorar su evolución con la finalidad de reducir la mortalidad en pacientes que sufren este tipo de traumatisma, indistintamente la su causa principal. La incidencia de trauma cráneo-encefálico sigue estando como una de las principales causas de muerte en nuestro país.
Esta investigación realizó la evaluación física –neurológica y manejo clínico-quirúrgico de acuerdo a escala de Coma Glasgow - tomográfico de Marshall de pacientes
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ingresados con diagnóstico de traumatismo craneoencefálico (TCE), en el Hospital Guayaquil Dr Abel Gilbert Pontón, Período 2014-2015 mediante una metodología de tipo descrptivo-analítico con diseño no experimental, longitudinal retrospectivo, con el propósito de evaluar el manejo clíncio intrahospitalario en base a la escala de coma de Glagow y Marshall, observando de igual forma la evolución de dichos pacientes, ya sea TCE LEVE-MODERADO O SEVERO; tratados en el área de Neurocirugía.
Logrando resultados en los que se evidenció ser la patología responsable de dos tercios de las muertes que, en menores de 41 años, se producen en un hospital general. Indicando que el 80% de los pacientes fueron de sexo masculino, 75% del área urbana y en edades entre 20-50 años y mayores de 60 años. La causa principal fue los accidentes de tránsito ( motocicleta 60% > automovilístico 40%); con cuadros clínicos, al ingreso, de Hipoxia, Taquicardia, Somnolencia y/o Estupor, Vómitos, Relajación de esfínteres, Pupilas anisocóricas y mióticas, scalp, más lesiones superficiales en extremidades superiores e inferiores y/o trauma de tórax o abdominal. La escala de Glasgow indicó un 10% de TCE grave, 35% TCE moderado, 55% TCE leve, con resolución quirúrgica en TCE grave un 45%, cuya tasa de mortalidad fue de 1%-morbilidad 99% con secuelas o no. De igual forma se evidenció en el tratamiento clínico intrahospitalario,el uso de Solución salina en 82% en primera instancia,furosemida en 77% , Manitol 23%, terapia del dolor 100%, corticoides el 30%, antibióticos el 85%. En conclusión el diagnóstico oprtuno y con ayuda de escala Glasgow para clasificación de TCE, que posterioremente son de gran ayuda para iniciar tratamiento inicial y de mantenimiento, y para resolución Quirúrgica Escala de Marshall y Rotterdam ( escalas de neuroimagen ). Evitan la mortalidad y mejora la morbilidad de los pacientes, manejando oportunamente los factores de riesgo que lleven a complicaciones del paciente ( Hipoxia- Edema Cerebral,etc).
Patient improvement with Traumatic brain injury (TBI) depends on the stage of early hospital admission of patients, treatment and diagnostic evaluation is performed according to the protocol ATLS (advanced trauma life support). Adequate oxygenation (PaO 2> 60 mmHg) and support of blood pressure (systolic BP> 90 mmHg) remain priorities to establish immediate control of the factors of morbidity in patients and improve their evolution in order to reduce mortality in patients suffering from this type of traumatisma, either the main cause. The incidence of traumatic brain injury remains as one of the leading causes of death in our country. This research conducted the -neurológica physical evaluation and clinical-surgical management according to Glasgow Coma Scale - tomographic Marshall of patients 11 admitted with a diagnosis of traumatic brain injury (TBI) in Guayaquil Hospital Dr Abel Gilbert Ponton, 2014-2015 by methodology descrptivo-analytic retrospective non-experimental, longitudinal design, with the purpose of evaluating the clíncio management-hospital based on coma scale Glagow and Marshall, noting equally the evolution of these patients, either TCE MILD -Moderate OR SEVERE; treaties in the area of neurosurgery. It achieved results which showed the pathology to be responsible for two thirds of deaths in children under 41 years are produced in a general hospital. Indicating that 80% of patients were male, 75% in urban areas and aged between 20-50 years and over 60 years. The main cause was traffic accidents (60% motorcycle> automobile 40%); with medical conditions, income, Hypoxia, Tachycardia, Drowsiness and / or Stupor Vomiting, Relaxation of sphincters, anisocoric and miotic pupils, scalp, superficial lesions in upper and lower extremities and / or chest or abdominal trauma. The GCS said 10% of severe TBI, 35% moderate TBI, 55% mild head injury, with surgical intervention in severe head injury by 45%, the death rate was 1% -morbilidad 99% with sequelae or not. Similarly it evidenced in the clinical hospital treatment, the use of saline at 82% in the first instance, 77% furosemide, mannitol 23%, 100% pain therapy, corticosteroids, 30%, 85% antibiotics. In conclusion oprtuno Glasgow and using TCE classification scale for diagnosis, which they are posterioremente of great help to start initial and maintenance treatment, and resolution Surgical Scale Marshall and Rotterdam (scales neuroimaging). Prevent mortality and improves patient morbidity, appropriately managing risk factors that lead to patient complications (hypoxia Cerebral Edema, etc).
Patient improvement with Traumatic brain injury (TBI) depends on the stage of early hospital admission of patients, treatment and diagnostic evaluation is performed according to the protocol ATLS (advanced trauma life support). Adequate oxygenation (PaO 2> 60 mmHg) and support of blood pressure (systolic BP> 90 mmHg) remain priorities to establish immediate control of the factors of morbidity in patients and improve their evolution in order to reduce mortality in patients suffering from this type of traumatisma, either the main cause. The incidence of traumatic brain injury remains as one of the leading causes of death in our country. This research conducted the -neurológica physical evaluation and clinical-surgical management according to Glasgow Coma Scale - tomographic Marshall of patients 11 admitted with a diagnosis of traumatic brain injury (TBI) in Guayaquil Hospital Dr Abel Gilbert Ponton, 2014-2015 by methodology descrptivo-analytic retrospective non-experimental, longitudinal design, with the purpose of evaluating the clíncio management-hospital based on coma scale Glagow and Marshall, noting equally the evolution of these patients, either TCE MILD -Moderate OR SEVERE; treaties in the area of neurosurgery. It achieved results which showed the pathology to be responsible for two thirds of deaths in children under 41 years are produced in a general hospital. Indicating that 80% of patients were male, 75% in urban areas and aged between 20-50 years and over 60 years. The main cause was traffic accidents (60% motorcycle> automobile 40%); with medical conditions, income, Hypoxia, Tachycardia, Drowsiness and / or Stupor Vomiting, Relaxation of sphincters, anisocoric and miotic pupils, scalp, superficial lesions in upper and lower extremities and / or chest or abdominal trauma. The GCS said 10% of severe TBI, 35% moderate TBI, 55% mild head injury, with surgical intervention in severe head injury by 45%, the death rate was 1% -morbilidad 99% with sequelae or not. Similarly it evidenced in the clinical hospital treatment, the use of saline at 82% in the first instance, 77% furosemide, mannitol 23%, 100% pain therapy, corticosteroids, 30%, 85% antibiotics. In conclusion oprtuno Glasgow and using TCE classification scale for diagnosis, which they are posterioremente of great help to start initial and maintenance treatment, and resolution Surgical Scale Marshall and Rotterdam (scales neuroimaging). Prevent mortality and improves patient morbidity, appropriately managing risk factors that lead to patient complications (hypoxia Cerebral Edema, etc).
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Traumatismos craneocerebrales, Neurocirugía, Estudios retrospectivos, Hospital de Especialidades Guayaquil Dr. Abel Gilbert Pontón, Cantón Guayaquil, Ecuador, Abordaje intrahospitalario, Evolución clínica