Síndrome de repuesta inflamatoria en niños quemados, propuesta para su prevención y manejo
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2015
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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Las quemaduras se encuentran entre las lesiones más graves que pueden afectar al hombre. Su etiología se asocia a la exposición súbita y dañina a agentes físicos, químicos o biológicos, siendo uno de los grupos más afectados el de los niños. El propósito del estudio fue conocer los factores y determinar las variables clínicas y de laboratorio que constituyen factores de riesgo para desarrollar SRIS y elaborar una propuesta de guía para la prevención y manejo del paciente pediátrico quemado. La población estuvo constituida por 101 pacientes de la unidad de quemados del Hospital Pediátrico Dr. Roberto Gilbert Elizalde, que ingresaron de julio a diciembre del 2013. La investigación fue de tipo descriptiva – correlacional y diseño no experimental - transversal – prospectivo. La edad fluctuó entre los 0 meses a 16 años, de los cuales 42 niños (41,58 %) desarrollaron SRIS, siendo el grupo más afectado el de menores de 5 años. La causa más frecuente de la quemadura fue por líquidos calientes. El 47,52 % recibió atención médica previa al ingreso hospitalario, la que no fue especializada. Los niños/as que tuvieron atención especializada antes de las dos horas, desarrollan con menos frecuencia el SRIS con una p= 0,02. Los pacientes presentaron una evaluación nutricional satisfactoria, el 87,13% fueron eutróficos. En los pacientes que presentaron una superficie corporal quemada, mayor al 11% en el cien por cien se desarrolló el SRIS. El recuento leucocitario al quinto día fue estadísticamente significativo p= 0,000 ya que apareció en 32 pacientes. La frecuencia respiratoria, frecuencia cardíaca y temperatura evidenciaron una asociación con presencia del síndrome. Se presentaron complicaciones sistémicas y locales en el 29,76%; el 2,97% presentó sepsis. En el período estudiado todos los pacientes quemados egresaron vivos con una mortalidad del 0%. Se diseñó la propuesta de guía de actuación del manejo del paciente quemado y prevención de las complicaciones para la Unidad de Quemados, con lo cual se logrará reducir la mortalidad por el Síndrome de Respuesta Inflamatoria Sistémica.
Burns were among the more serious injuries that may affect the man. Its etiology is associated with sudden and harmful exposure to physical, chemical or biological agents, being one of the most affected groups of children. The purpose of the study was know the factors and determine clinical variables and laboratory that are risk factors for developing SIRS and draw up a proposal for guidelines for the prevention and management of the pediatric patient burned. The population was made up of the 101 patients of the unity of burn patients of the hospital pediatric Dr. Roberto Gilbert Elizalde, admitted in July to December of 2013. The research was of type descriptive - correlational and design non-experimental - transverse - prospective.Age ranged from 0 months to 16 years, of whom 42 children (41,58%) developed SIRS, being the most affected group of children under 5 years. The most common cause of the burn was by hot liquids. 47.52% Received prior to hospital admission, which was not specialized. The children who had care specialist within two hours, develop less frequently the SIRS with a p = 0.02. Patients have a satisfactory nutritional evaluation, 87,13 per cent were eutrophic. The body surface burned, when it is greater than 11% in one hundred percent develops the SIRS. The lymphocyte count on the fifth day was statistically significant p=0.000 because he appeared in 32 patients, respiratory rate, heart rate and temperature demonstrate an association with the presence of the syndrome. Local and systemic complications were in low percentages and 2.97 per cent submitted sepsis. In the studied period all burned patients graduated alive with a mortality rate of 0%. Design proposal of guide of action for the management of the patient burned and prevention of complications for the unit of burn patients.
Burns were among the more serious injuries that may affect the man. Its etiology is associated with sudden and harmful exposure to physical, chemical or biological agents, being one of the most affected groups of children. The purpose of the study was know the factors and determine clinical variables and laboratory that are risk factors for developing SIRS and draw up a proposal for guidelines for the prevention and management of the pediatric patient burned. The population was made up of the 101 patients of the unity of burn patients of the hospital pediatric Dr. Roberto Gilbert Elizalde, admitted in July to December of 2013. The research was of type descriptive - correlational and design non-experimental - transverse - prospective.Age ranged from 0 months to 16 years, of whom 42 children (41,58%) developed SIRS, being the most affected group of children under 5 years. The most common cause of the burn was by hot liquids. 47.52% Received prior to hospital admission, which was not specialized. The children who had care specialist within two hours, develop less frequently the SIRS with a p = 0.02. Patients have a satisfactory nutritional evaluation, 87,13 per cent were eutrophic. The body surface burned, when it is greater than 11% in one hundred percent develops the SIRS. The lymphocyte count on the fifth day was statistically significant p=0.000 because he appeared in 32 patients, respiratory rate, heart rate and temperature demonstrate an association with the presence of the syndrome. Local and systemic complications were in low percentages and 2.97 per cent submitted sepsis. In the studied period all burned patients graduated alive with a mortality rate of 0%. Design proposal of guide of action for the management of the patient burned and prevention of complications for the unit of burn patients.
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Pediatría, Quemaduras, Síndrome de respuesta inflamatoria sistémica, Factores de riesgo, Medicina preventiva, Hospital de Niños Dr. Roberto Gilbert Elizalde, Cantón Guayaquil, Ecuador