Cirugía de control de daño. Experiencia inicial en el Hospital General de Ciudad Juárez, México, durante el periodo de abril del 2008 a diciembre del 2010
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Universidad Industrial de Santander
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Objetivo: analizar los resultados en cirugía de control de daño en una institución con alta incidencia de trauma enMéxico. Materiales y métodos: estudio prospectivo descriptivo, realizado en el Hospital General de ciudad Juárez. Seincluyeron 66 pacientes con lesiones severas en abdomen ocasionadas por proyectil de arma de fuego o por arma punzocortante,sometidos a cirugía de control de daño durante el periodo de abril del 2008 a diciembre del 2010. El análisisestadístico se realizó con porcentajes como medidas de resumen de variables. Resultados: el promedio de edad fue de29,6 años, con 59 pacientes heridos por arma de fuego y siete por arma blanca. El tiempo quirúrgico promedio fue de97 minutos. La víscera hueca más lesionada fue el intestino delgado con 35 casos y el órgano sólido fue el hígado con30. Se encontró un hemoperitoneo en promedio de 3350 ml. Además, 64 pacientes presentaron choque hipovolémicogrado IV y dos pacientes grado III. La principal complicación fue la presencia de infección de sitio quirúrgico y laprincipal causa de muerte postquirúrgica la falla orgánica múltiple secundaria a la presencia de la triada mortal lacual consiste en la presencia de hipotermia, acidosis metabolica y coagulopatia. Conclusiones: Los pacientes en edadproductiva son los más afectados. El principal mecanismo de acción son las heridas por proyectil de arma de fuego. Sepresenta una alta morbimortalidad relacionada en este tipo de pacientes, como son la presencia de sepsis y fistulas;asociándose la mortalidad principalmente a la falla orgánica múltiple y a la presencia de choque hipovolémico.( MÉD.UIS. 2011;24(2):185-8).Palabras clave: Trauma. Hipotermia. Acidosis.
Damage control surgery. Initial experience in the Hospital General de Ciudad Juárez, México, during the period ofApril 2008 and Dicember 2010Objective: to analyze the results of damage control surgery in an institution with high incidence of trauma in México.Materials and methods: prospective and descriptive study, realized in the Hospital General of Ciudad Juarez. It wasincluded 66 patients with several abdominal injuries made by missile of firearms or sharp-edged objects underwentto damage control surgery between April 2008 and December 2010. The statistical analysis was with percentages assummary measures of variables. Results: the average age was 29.6 years old, with 59 patients with firearm’s injuriesand siete patients with incised wounds. The average surgical time was 97 minutes. The most injured hollow viscuswas small intestine with 35 cases and the solid organ was the liver with 30 patients injured. It was found an averagehemoperitoneum of 3350 ml. Besides, 64 patients showed IV degree hypovolemic shock and 2 with III degree shock.The main complication was surgical site infection and the main cause of postsurgical death was multiple organ failuresecondary to the presence of the deadly triad which is hypothermia, metabolic acidosis and coagulopathy. Conclusions:the patients in the productive age are most affected. The principal mechanism of action is injuries by a firearm projectile.It has a high morbimortality related to these patients, such as sepsis and fistulas, associating mainly the mortality to themultiple organ failure and the presence of hypovolemic shock. (MÉD.UIS. 2011;24(2):185-8).Key words: Trauma. Hypothermia. Acidosis.
Damage control surgery. Initial experience in the Hospital General de Ciudad Juárez, México, during the period ofApril 2008 and Dicember 2010Objective: to analyze the results of damage control surgery in an institution with high incidence of trauma in México.Materials and methods: prospective and descriptive study, realized in the Hospital General of Ciudad Juarez. It wasincluded 66 patients with several abdominal injuries made by missile of firearms or sharp-edged objects underwentto damage control surgery between April 2008 and December 2010. The statistical analysis was with percentages assummary measures of variables. Results: the average age was 29.6 years old, with 59 patients with firearm’s injuriesand siete patients with incised wounds. The average surgical time was 97 minutes. The most injured hollow viscuswas small intestine with 35 cases and the solid organ was the liver with 30 patients injured. It was found an averagehemoperitoneum of 3350 ml. Besides, 64 patients showed IV degree hypovolemic shock and 2 with III degree shock.The main complication was surgical site infection and the main cause of postsurgical death was multiple organ failuresecondary to the presence of the deadly triad which is hypothermia, metabolic acidosis and coagulopathy. Conclusions:the patients in the productive age are most affected. The principal mechanism of action is injuries by a firearm projectile.It has a high morbimortality related to these patients, such as sepsis and fistulas, associating mainly the mortality to themultiple organ failure and the presence of hypovolemic shock. (MÉD.UIS. 2011;24(2):185-8).Key words: Trauma. Hypothermia. Acidosis.