Criterios diagnosticados del derrame pleural, estudio a realizarse en el Hospital Teodoro Maldonado Carbo, período 2014-2015
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2016
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Carrera de Medicina
Resumen
El derrame pleural es la acumulación de líquido entre las capas de tejido que recubren los pulmones y la cavidad torácica. Los síntomas relacionados con el DP dependen del grado de compromiso pleural que provocarán alteraciones en la mecánica pulmonar traduciéndose en dolor pleurítico, tos, disnea, el dolor implica afectación de la pleura parietal producida en el área afectada. Ante la presencia de un derrame pleural, la premisa que perseguiremos es conocer si estamos frente a un trasudado, que no requiere maniobras diagnósticas pleurales, de un exudado, que si las necesita. Empleamos los criterios de Light, así definimos si el derrame pleural es un exudado o no al cumplir uno de los siguientes criterios: Razón entre proteínas del líquido pleural (LP)/ proteínas en suero >0,5, razón entre LDH de LP/LDH sérica >0.6, LDH en LP > 2/3 del valor máximo de la normalidad para la LDH en suero. El estudio fue realizado en el Hospital Teodoro Maldonado Carbo con una muestra de 100 pacientes con los siguientes objetivos: Identificar a los pacientes con derrame pleural, establecer el cumplimiento de los criterios de Light en el diagnóstico de laboratorio del derrame pleural y relacionar los criterios clínicos con los datos del laboratorio en el diagnóstico del derrame pleural.
Los resultados fueron 32% de pacientes correspondían al intervalo de edad 34-49 años cuya clínica fue 40% fiebre y 10% dolor pleurítico más examen físico caracterizado por disminución del murmullo vesicular en 60%. El estudio de líquido pleural usando los criterios de Light fue 68% exudado debido a neoplasias pulmonares y extrapulmonares. Respecto a la técnica de imagen más usada fue la TAC simple de tórax. Existe relación entre ambos criterios por lo que deben usarse frente a la sospecha de derrame pleural. (Chi:48,8/valor de p: <0.05%)
Pleural effusion is the accumulation of fluid between the layers of tissue lining the lungs and chest cavity. Symptoms related to the DP depend on the degree of commitment that will cause changes in lung mechanics resulting in pleuritic pain, cough, dyspnea, pain implies involvement of the parietal pleura produced in the affected area. In the presence of pleural effusion, the premise that pursue is to know whether we are facing a transudate, which does not require pleural diagnostic maneuvers, an exudate, which if needed. Light employ criteria and define if the pleural effusion is an exudate or not to meet one of the following criteria: Ratio of pleural fluid protein (LP) / serum protein> 0.5, ratio LDH LP / LDH serum creatinine> 0.6, LDH LP> 2/3 of the maximum value of normal for serum LDH. The study was conducted at the Hospital Teodoro Maldonado Carbo with a sample of 100 patients with the following objectives: Identify patients with pleural effusion, establish compliance with the criteria of Light in the laboratory diagnosis of pleural effusion and related clinical criteria with laboratory data in the diagnosis of pleural effusion. The results were 32% of patients belonged to the 34-49 years age range was 40% whose clinical fever and 10% more physical exam pleuritic pain characterized by decreased breath sounds in 60%. The study of pleural fluid using Light's criteria was 68% exudate due to pulmonary and extrapulmonary malignancies. Regarding the most widely used technique image was simple chest CT. There is a relationship between the two criteria which should be used against suspected pleural effusion. (Chi: 48.8 / P value <0.05%).
Pleural effusion is the accumulation of fluid between the layers of tissue lining the lungs and chest cavity. Symptoms related to the DP depend on the degree of commitment that will cause changes in lung mechanics resulting in pleuritic pain, cough, dyspnea, pain implies involvement of the parietal pleura produced in the affected area. In the presence of pleural effusion, the premise that pursue is to know whether we are facing a transudate, which does not require pleural diagnostic maneuvers, an exudate, which if needed. Light employ criteria and define if the pleural effusion is an exudate or not to meet one of the following criteria: Ratio of pleural fluid protein (LP) / serum protein> 0.5, ratio LDH LP / LDH serum creatinine> 0.6, LDH LP> 2/3 of the maximum value of normal for serum LDH. The study was conducted at the Hospital Teodoro Maldonado Carbo with a sample of 100 patients with the following objectives: Identify patients with pleural effusion, establish compliance with the criteria of Light in the laboratory diagnosis of pleural effusion and related clinical criteria with laboratory data in the diagnosis of pleural effusion. The results were 32% of patients belonged to the 34-49 years age range was 40% whose clinical fever and 10% more physical exam pleuritic pain characterized by decreased breath sounds in 60%. The study of pleural fluid using Light's criteria was 68% exudate due to pulmonary and extrapulmonary malignancies. Regarding the most widely used technique image was simple chest CT. There is a relationship between the two criteria which should be used against suspected pleural effusion. (Chi: 48.8 / P value <0.05%).
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Derrame pleural, Criterios de Light, Técnicas de laboratorio clínico, Hospital de Especialidades Dr. Teodoro Maldonado Carbo, Cantón Guayaquil, Ecuador, Epidemiología descriptiva