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Efectividad de la cirugía de control de daños vers= us cirugía convencional en pacientes con trauma abdominal grave hospital de especialidades Abel Gilbert Pontón

&nbs= p;

Effectiveness of damage control surgery versus conventional surgery in patients with severe abdominal trauma in Abel Gilbe= rt Pontón specialty hospital

 

= 1=

Diana Gabriela Ibadango Ávila=

https://orcid.org/0000-= 0002-6517-9035

 

 <= /span>

Ministerio de S= alud Pública, Hospital Vicente Corral Moscoso, Cuenca, Ecuador

digaby41@hotmail.com=

= 2=

María Augusta Velasco Basantes=

https://orcid.org/0000-= 0003-0085-8587=

 

 <= /span>

Ministerio de S= alud Pública, Hospital Vicente Corral Moscoso, Cuenca, Ecuador

mariaaugustavelasco@gmail.com= =

= 3=

Jhoana Elizabeth Fernández Morocho=

https://orcid.org/0000-0003-4236-2213

 

 <= /span>

Ministerio de Salud Pública, Hospital Aida León = de Rodríguez Lara, Cuenca, Ecuador

= jhoaely@hotmail.com<= /a>

4

Diego Andrés Marín Rodas=

https:= //orcid.org/0000-0002-1442-8249

 

 

Ministerio de S= alud Pública, Hospital Vicente Corral Moscoso, Cuenca, Ecuador

andremarn@gmail.com

5

Katherine Gisselle Bravo Tobar.

https://orcid.org/0000-0002-468= 1-8743

 

 <= /span>

Ministerio de S= alud Pública, Hospital Vicente Corral Moscoso, Cuenca, Ecuador.  kathebravo1024@gmail.com

&nb= sp;

 

Artículo de Investiga= ción Científica y Tecnológica

Enviado: 23= /03/2021

Revisado:<= span style=3D'font-size:10.0pt;font-family:"Times New Roman",serif;mso-fareast= -font-family: "Times New Roman";mso-ansi-language:ES-EC;mso-fareast-language:EN-US'> 05= /04/2022

Aceptado:<= span style=3D'font-size:10.0pt;font-family:"Times New Roman",serif;mso-fareast= -font-family: "Times New Roman";mso-ansi-language:ES-EC;mso-fareast-language:EN-US'> 11= /05/2022

Publicado:= 17/= 05/2022

DOI:= https://doi.org/10.3326= 2/anatomiadigital.v5i2.2156   =       

 

 

 

 

Cítese:

 

 

badango Ávila, D. G., Velasco Basantes, M. A., Fernández Morocho, = J. E., Marín Rodas, D. A., & Bravo Tobar, K. G. (2022). Efectividad de la cirugía de control de daños versus cirugía convencional en pacientes con trauma abdominal grave hospital de especialidades Abel Gilbert Pontón. Anatomía Digital, 5(2), 69-85. https://doi.o= rg/10.33262/anatomiadigital.v5i2.2156

 

 

 

ANA= TOMÍA DIGITAL, es una Revista Electónica, Trimestral, que se publicará en sopor= te electrónico tiene como misión contribuir a la   formación de&nb= sp; profesionales competentes con visión humanística y crítica que sean capac= es de  exponer  sus resultados  investigativos y científicos = en la misma medida que se promueva mediante su intervención cambios positivos en  la sociedad. https://anatomiadigital.org=  

La revista es editada por la Editorial Ciencia Digital (Editorial de prestig= io registrada en la Cámara Ecuatoriana de Libro con No de Afiliación 663) www.celibro.org.ec

 

 

 

Esta revista está protegida bajo una licencia Creative Commons AttributionNonCommercialNoDerivatives 4.0 International. Copia de la licencia: http://creati= vecommons.org/licenses/by-nc-nd/4.0/

 

Pal= abras claves: control de daño, trauma abdominal, cirugía convencional.

 

Resumen

Introdu= cción. La cirugía de control de daños ha constituido una estrategia de pasos ordenados que permite dar una segunda oportunidad al paciente gravemente traumatizado, con la finalidad de impedir la triada mortal (coagulopatía, acidosis, hipotermia), en el presente trabajo se compara la cirugía convencional con la cirugía de control de daños Obj= etivo: Analizar la efectividad de la cirugía de control de daños (CCD) versus la cirugía convencional (CC) en pacientes con trauma abdominal grave. Met= odología: Se incluyeron a pacientes con trauma abdominal grave sometidos a cirugía = de control de daños y cirugía convencional, en el Servicio de Cirugía del Hospital Abel Gilbert Pontón de enero 2016 a diciembre 2018. Para lo que = se revisaron datos del sistema informático, historias clínicas y récords operatorios. Resultados: De la población estudiada representada po= r 58 pacientes el 79% se realizó cirugía de control de daños y el 21% cirugía convencional, con graves alteraciones hemodinámicas valoradas por escalas= de ISS, RTS, índice de Shock. El tipo de trauma más frecuente en la CCD fue = el penetrante en un 59%, en tanto que en la CC fue más frecuente el trauma cerrado representado por el 58%. Dentro del estudio se observó que hubo alteración de la coagulopatía en mayor porcentaje en los pacientes someti= dos a cirugía de control de daños con un 61%. En ambos grupos el tiempo quirúrgico más frecuente este dado entre los rangos de 61 a 120 min. Y los días de estancia en UCI fueron mayor a 7 días con una totalización en sus días de hospitalización fueron mayor a 15 días para ambas estrategias quirúrgicas. Del grupo estudiado el que obtuvo menor mortalidad fue en CCD con el 33%, y el de mayor mortalidad lo alcanzó en los pacientes con lesi= ones mixtas 60% en CCD y en minoría 36% en CC. Según la escala RTS hubo una me= jor supervivencia en los pacientes con CCD con el 72%, además se estableció e= n la mortalidad ajustada al ISS que hay mejores resultados en la CCD ya que al aumentar su índice no aumenta su mortalidad. Conclusiones: La ciru= gía de Control de daños tiene mejor resultado ante el escenario de pacientes = con trauma abdominal grave penetrante. Palabras claves: control de daño, trau= ma abdominal, cirugía convencional.

 

 

 

Keywords:<= span lang=3DEN-US style=3D'font-size:12.0pt;line-height:115%;font-family:"Time= s New Roman",serif; mso-fareast-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-far= east-language: EN-US'> damage control, abdominal trauma, conventional surgery.

 

 

 

Abstract

Introduction Damage control surgery has constituted an orderly step strategy that allows a severely traumatized patient to be given a second chance, with t= he purpose of preventing the deadly triad (coagulopathy, acidosis, hypotherm= ia), in this paper the surgery is compared Conventional with damage control surgery Objective: To analyze the effectiveness of damage control surgery (CCD) versus conventional surgery (CC) in patients with severe abdominal trauma. Methodology: Patients with severe abdominal trau= ma undergoing damage control surgery and conventional surgery were included = in the Surgery Service of the Abel Gilbert Pontón Hospital from January 2016= to December 2018. For which data from the computer system, medical records w= ere reviewed. and operating records. Results: Of the studied population represented by fifty-eight patients, 79% underwent damage control surgery= and 21% conventional surgery, with severe hemodynamic alterations assessed by= ISS scales, RTS, Shock index. The most frequent type of trauma in the CCD was= the penetrating in 59%, while in the CC the closed trauma represented by 58% = was more frequent. Within the study it was observed that there was an alterat= ion of coagulopathy in a greater percentage in patients undergoing damage con= trol surgery with 61%. In both groups the most frequent surgical time is given= between the ranges of 61 to 120 min. And the days of stay in the ICU were greater than 7 days with a totalization in their hospitalization days were greater than 15 days for both surgical strategies. Of the group studied, the one = with the lowest mortality was in CCD with 33%, and the one with the highest mortality was in patients with mixed lesions 60% in CCD and in a minority= 36% in CC. According to the RTS scale, there was a better survival in patients with CCD with 72%, it was also established in the mortality adjusted to t= he ISS that there are better results in the CCD since increasing their index does not increase their mortality. Conclusions: Damage Control sur= gery has a better outcome in the scenario of patients with severe penetrating abdominal trauma. Keywords: damage control, abdominal trauma, conventional surgery.

 

 

 

 

 

Introducción

Según la Organización mundial de la Salud (OMS) (1= ), los traumatismos produjeron 4,9 millones de defunciones en 2016 y represent= ando el 29 % los accidentes de tránsito. La mortalidad por accidentes mundialmen= te es de 18,8 defunciones por cada 100.000 habitantes, es más evidente en los países de bajos ingresos, en el cual obtiene las 29,4 defunciones por cada 100.000 habitantes. En el año 2017 en Ecuador, la enfermedad isquémica del corazón es la primera causa de muerte en los hombres con 4.230 defunciones, seguido de los accidentes de transporte terrestre con 2.419 defunciones. Los Accidentes de tránsito son la sexta causa de muerte en el país, las provinc= ias de Pichincha y Guayas han mostrado mayor número de sucesos. El Instituto Nacional de Estadísticas y Censos (INEC), ha informado que en 2016 hubo 30.= 269 contravenciones y 1.967 fallecidos (6,5 %), mientras que en el 2017 se produjeron 28.967 accidentes, dejando 2.153 muertos (7,4 %) (2). En el 2018 según reporte de la Comisión de Tránsito del Ecuador, en la costa se presentaron 6.935 accidentes de tránsito donde hubieron 6.902 lesionados y = 776 fallecidos en el sitio de los accidentes (11,2 %). Para dicho año se report= ó un aumento en la tasa de mortalidad del 8,49 por cada 100 accidentes de tránsi= to (1.058 fallecidos en 12.460 siniestros) (2,3). En un estudio realizado por Chica R. y García E. en el período 2009-2011 en el hospital Dr. Verdi Ceval= los Balda (Portoviejo), el 72.94% del trauma abdominal afectó principalmente a pacientes jóvenes de sexo masculino. El 58,62% de las heridas penetrantes fueron causadas por armas de fuego y los accidentes de tránsito por moto fu= eron la primera causa de 2 traumatismo abdominal cerrado (54.39%). El 32% de los pacientes fueron tratados con manejo clínico y observación continua. La tas= a de mortalidad fue de 5.26%. En otro estudio en Guayaquil Bucheli D. encontró q= ue el órgano más afectado en el trauma cerrado es el hígado (45%), seguido por= el bazo (44%) (4). Por los datos referidos el paciente con politraumatismo sig= ue siendo una consulta frecuente en los servicios de emergencia de nuestros hospitales. De todos los pacientes ingresados por politraumatismo la mayoría pueden ser resuelto con una sola laparotomía, pero hay un grupo de pacientes que están gravemente heridos o sus lesiones son tan complejas que no se los puede resolver en un solo tiempo quirúrgico, una de esas estrategias de man= ejo para el paciente críticamente lesionados es la Cirugía de control de daños (CCD). La cirugía de control de daños surge en la marina de guerra norteamericana en referencia a la capacidad de un buque de absorber el daño= y mantener la integridad de este, el enfoque de esta estrategia se basa en evitación, intentos enérgicos para corregir por completo o controlar el trastorno, y maniobras temporales de sostén (5,6). La cirugía de control de daños fue referida por primera vez en 1983 por Harlan Stone, cuando los pacientes con trauma severo deberían ser tratados en forma aligerada. Al in= icio no tuvo éxito la misma, pero durante la II Guerra Mundial fue cuando tuvo su apogeo la Cirugía de Control de Daños la cual se fue modificando y obtenien= do mayor eficacia esta y otras técnicas, permitiendo cierta estabilización fisiológica antes de una reparación definitiva (7). La cirugía de control de daños es una técnica quirúrgica que intenta evitar la tríada de la muerte: coagulopatía, hipotermia y acidosis. Consiste en tres 3 fases: laparotomía inicial, estabilización en unidad de cuidados intensivos (UCI) y cirugía definitiva (8). Si bien no existen características definidas para la indica= ción de la Cirugía de Control de Daños, los más admitidos son: temperatura corpo= ral < 35 °C (hipotermia), gasometría arterial con pH < 7,2 o déficit de b= ase > 8, lactato de 5 (acidosis) y la evidencia clínica o por laboratorio de coagulopatía; la reposición de 4.000 ml de concentrado de glóbulos rojos o 5.000 ml cuando se maneja una combinación de glóbulos rojos y sangre total,= la reposición de fluidos de 12 L, la alta cinemática del trauma o la presencia= de traumatismos toracoabdominales de alta energía asociados o no a fracturas pélvicas o hematomas retroperitoneales expansivos; lesiones hepáticas de al= to grado; lesiones penetrantes del área duodeno pancreática, lesiones combinad= as vasculares, de órganos sólidos o víscera hueca así como un tiempo de cirugía mayor a 90 minutos deben ser estimados para proyectar como estrategia quirúrgica la Cirugía de Control de Daños (9). Un estudio descriptivo prospectivo y transversal en la Clínica Multiperfil, Luanda, Angola en 147 pacientes con traumatismo abdominal; los que fueron clasificados en los gru= pos siguientes: trauma abdominal abierto (38 %) y trauma abdominal cerrado (61,= 9 %) con supremacía de este último, el estudio revelo que el órgano más afectado= fue el hígado con 37,6 % seguido del intestino delgado con el 25,8. Se manejó la estrategia quirúrgica a un total de 57,1 %, de los cuales un 36,7 % forman parte del trauma abierto, de ellos se realizó laparotomía terapéutica en el 39,4 % de los pacientes, seguido de la cirugía de control de daños (14,2 %). Fallecieron un total de 12,2 % pacientes y en las iniciales 24 horas un 5,4= %. Con una influencia en los casos mayores de 50 años (66,6 %) con signos de s= hock al ingreso (100 %). Un GCS inferior a 8 (88,8 %), y la ISS más de 25 (100 %) (10). Sin embargo, en el 2016, un estudio, descriptivo, retrospectivo, observacional realizado en 15 pacientes desde el año 2010 al 2014 en el Hospital 4 Maciel en Montevideo (Uruguay) concluyó que, aunque este nuevo enfoque ha manifestado ser beneficioso en comparación al abordaje quirúrgico tradicional el porcentaje de mortalidad de los pacientes sigue siendo domin= ante con un 46.66 % (11).

Meto= dología

El presente estudio fue de tipo retrospectivo, observacional, longitudinal. La población considerada fue todos los pacient= es con trauma abdominal grave sometidos a cirugía de control de daños y cirugía convencional, en el Servicio de Cirugía del Hospital Abel Gilbert Pontón de= enero 2016 a diciembre 2018.

Criterios de inclusión

Trauma toracoabdominal GRAVE (ISS > 12) que se realizó cirugía de control de daños como estrategia quirúrgica inicial.

·&nb= sp;        Trauma toracoabdominal GRAVE (ISS > 12) que se realizó cirugía convencional como estrategia quirúrgica inicial.

·&nb= sp;        Utilización de bolsa de Bogotá, vacum o cierre primario en pacientes de trauma abdominal. Criterios de exclusión

·&nb= sp;        Pacientes embarazadas.

·&nb= sp;        Pacientes con hemofilia.

·&nb= sp;        Pacientes que abandonaron el hospital sin recibir tratamiento quirúrgico.

·&nb= sp;        Pacientes de trauma que fallecieron en el área de emergencia antes de ser llevados a quirófano.

El instrumento para utilizar en este estudio fue u= na ficha de recolección de datos y una base de datos en Excel 2010 con las variables descritas en los objetivos específicos la misma que nos permitirá obtener datos para realizar análisis estadístico en el programa estadístico= , 35 SPSS; determinar significancia estadística se tomará en cuenta una p < 0= ,05 entre las variables a estudiar. Los datos se recabarán del sistema informát= ico Hospital del Hospital Abel Gilbert Pontón y el archivo estadístico mediante revisión de historias clínicas, récords operatorios y de anestesiología ade= más de datos registrados en las carpetas durante su hospitalización, mediante u= na hoja de recolección de datos que contará con las variables necesarias para probar los objetivos específicos.

Resultados

Tabla 1 =

Distribución de pacientes según características generales,

cirugía convencional y cirugía de control de daños

Variables

Cirugía convencional (n=3D 12)

%

Cirugía de control de daños (n=3D 46)

%

Edad

15 - 34

7

58

30

65

35 - 54

2

17

11

24

Mayor 55

3

25

5

11

Género

Masculino

11

92

36

78

Femenino

1

8

10

22

Comorbilidades

Si

3

25

8

17

No

9

75

38

83

Tipo de trauma

Cerrado

7

58

19

41

Penetrante

5

42

27

59

ISS

Menor 15

0

0

0

0

 

Tabla 1

Distribución de pacientes según características generales,

cirugía convencional y cirugía de control de daños (continuación)

Variables

Cirugía convencional (n=3D 12)

%

Cirugía de control de daños (n=3D 46)

%

Mayor 15

12

100

46

100

RTS

Menor 5

1

8

3

7

Mayor 5

11

92

43

93

Índice de shock  

menor 0,9

6

50

18

39

mayor 0,9

6

50

28

61

Coagulopatía

Si

6

50

28

61

No

6

50

18

39

Fuente: Base de datos hospital Abel Gilbert Pontón, Guayaq= uil – Ecuador

&nbs= p;

Tabla 2 =

Distribución de pacientes según hallazgos transquirúrgico, en

cirugía convencional y cirugía de control de daños

Variables

Cirugía convencional (n=3D 12)

%

Cirugía de control de daños (n=3D 46)

%

Tiempo quirúrgico

Menor 60

0

0

1

2

61 -120

8

67

34

74

mayor 121

4

33

11

24

Órgano afecto

Solida

3

25

17

37

Hueca

4

33

4

9

Mixta

5

42

25

54

Hemoperitoneo

Menor 750

1

8

8

17

751 - 1500

5

42

18

39

1501 - 2000

3

25

10

22

Mayor 2001

3

25

10

22

hemo neumotórax

Si

3

25

18

39

No

9

75

28

61

Fuente: Base de datos hospital Abel Gilbert Pontón, Guayaquil – Ecuador

Tabla 3<= /h2>

Distribución de pacientes según e= stancia hospitalaria, tipo de cirugía y complicaciones<= span style=3D'font-size:12.0pt;line-height:150%;font-family:"Times New Roman",se= rif; color:windowtext;text-transform:uppercase;mso-ansi-language:ES-EC'>

Variables

Cirugía convencional (n=3D12)

%

Cirugía de control de daños (n=3D46)

%

Estancia UCI

menor 7

7

58

21

46

8 - 14

4

33

15

33

mayor 15

1

8

10

22

Estancia hospitalización

Menor 7

4

33

7

15

8 - 14

3

25

13

28

Mayor 15

5

42

26

57

Complicaciones

Clínicas

4

33

10

22

Quirúrgicas

2

17

11

24

Combinadas

6

50

25

54

Fuente: <= /span>Base de datos hospital Abel Gilbert Pontón, Guayaq= uil – Ecuador

 

Tabla 4

Distribución de pacientes según el tipo de cirugía y mortalidad

Tipo de Cirugía

Vivo

%

Muerto

%

Total

Cirugía convencional

7

58

5

42

12

Cirugía de control de daños

31

67

15

33

46

Fuente: Base de datos hospital Abel Gilbert Pontón, Guayaq= uil – Ecuador

Tabla 5

Distribución de pacientes según t= ipo de trauma, tipo de cirugía y mortalidad

Tipo de trauma

Vivo

%

Muerto

%

total

Cirugía convencional

Cerrado

7

100

0

0

7

Penetrante

0

0

5

100

5

Cirugía de control de daños=

Cerrado

12

63

7

37

19

Penetrante

19

70

8

30

27

Fuente: Base de datos hospital Abel Gilbert Pontón, Guayaq= uil – Ecuador

Tabla 6

Distribución de pacientes según ó= rgano afecto, tipo de cirugía y mortalidad

Órgano afecto

Vivo

%

Muerto

%

Total

Cirugía convencional

Solida

3

100

0

0

3

Hueca

2

50

2

50

4

Mixta

2

40

3

60

5

Cirugía de control de daños=

Solida

13

76

4

24

17

Hueca

2

50

2

50

4

Mixta

16

64

9

36

25

Fuente: Base de datos hospital Abel Gilbert Pontón, Guayaq= uil – Ecuador

 

Tabla 7

Distribución de pacientes según tipo de cirugía, presencia de coagulopatía al ingreso hospitalario y mortalidad<= i>

Coagulopatía al Ingreso a Hospitalario

Vivo

%

Muerto

%

Total

Cirugía convencional

Si

3

50

3

50

6

No

4

67

2

33

6

Cirugía de control de daños=

Si

16

57

12

43

28

No

15

83

3

17

18

Fuente: Base de datos hospital Abel Gilbert Pontón, Guayaq= uil – Ecuador

Tabla 8

Distribución de pacientes según, tipo de cirugía, estancia en la unidad de cuidados intensivos y mortalidad

Estancia UCI

Frecuencia

%

Cirugía convencional

menor 7

7

58

8 – 14

4

33

mayor 15

1

8

Cirugía de control de daños

menor 7

21

46

8 – 14

15

33

mayor 15

10

22

Fuente: Base de datos hospital Abel Gilbert Pontón, Guayaq= uil – Ecuador

Tabla 9

Distribución de pacientes según, = estancia hospitalaria, tipo de cirugía y mortalidad

Estancia Hospitalización

frecuencia

%

Cirugía convencional

Menor 7

4

33

8 -14

3

25

Mayor 15

5

42

Cirugía de control de daños

Menor 7

7

15

8- 14

13

28

Mayor 15

26

57

Fuente: Base de datos hospital Abel Gilbert Pontón, Guayaq= uil – Ecuador

 

Tabla 10<= /h2>

Distribución de pacientes según, tipo de cirugía, RTS (REVISED TRAUMA SCORE) probabilidad de supervivencia

Probabilidad de supervivencia según RTS =

Vivo

%

Muerto

%

total

Cirugía convencional

RTS > 5

7

64

4

36

11

RTS < 5

0

0

1

100

1

Cirugía de control de daños=

RTS > 5

31

72

12

28

43

RTS <5

0

0

3

100

3

Fuente: Base de datos hospital Abel Gilbert Pontón, Guayaq= uil – Ecuador

Discusión

En el presente estudio de un total de 278 pacientes con trauma abdominal, de e= stos el 5.17 % (n=3D12) fue llevado a cirugía convencional y el 16.5 % (n=3D46) a cirugía de control de daños, en varios estudios indican que los pacientes in extremis, que sufren este tipo de traumas deben beneficiarse de la estrateg= ia de cirugía de control de daños como lo reportado en nuestro estudio y en la mayoría de estudios reportados; el principal factor de decisión basado en la decisión del cirujano general de turno en el área de emergencia , en la pre= sencia de múltiples lesiones con inestabilidad hemodinámica; en el estudio reporta= do en un hospital público de Uruguay por Laguzzi reportó 15 casos que fueron llevados a cirugía de control de daños y en el estudio de Gómez durante 7 a= ños se realizaron 1.795 cirugías por trauma y en 149 pacientes (8.3 %) se aplic= ó la cirugía de control de daños (8,9,12) En el Hospital de Kennedy la distribuc= ión del trauma cerrado fue de 25 casos (17%) y el trauma penetrante por arma de fuego presentó 83 casos (56%); en este estudio el 54.2% que corresponde a 59 casos fueron por trauma penetrante por arma de fuego; el órgano afecto principal fue víscera solida (hígado) con el 77 %, en contraste con este estudio donde el mayor número de casos se evidencio lesiones mixtas (víscera sólida, hueca o vascular) en el 52% de este en el 42% se realizó cirugía convencional y 54% cirugía de control de daños (13,14,15,16). La planificac= ión de llevar un paciente a cirugía convencional o cirugía de control de daños = está supeditada al criterio del cirujano ante la clínica e inestabilidad de sus parámetros fisiológicos, en varios estudios los autores han tratado de estandarizar las indicaciones para la aplicación de la estrategia y la mejor toma de decisión (17,18,19,20). Entre los hallazgos quirúrgicos en el estud= io Rosario Colombia, el hemoperitoneo fue de menor a 2000 ml en 65 pacientes correspondiendo al 43.6%; el rango de hemoperitoneo para este estudio fue de 751 a 1500 ml y en este rango presento el 40 % con 23 pacientes y distribui= do en cirugía de control de daños 39 % y cirugía convencional 42%. Las lesiones concomitantes en los pacientes con trauma abdominal grave son predominantes= a nivel de tórax, en el presente estudio el hemo nuemo tórax existió en el 36= %, 21 casos y se distribuyó en cirugía convencional 3 (25 %) y cirugía de cont= rol de daños 18 (39 %); en la literatura reporta este tipo de trauma asociado e= n un 23 %. La cirugía convencional presentó el 42 % de mortalidad en comparación= con los pacientes que se sometieron a cirugía de control de daños con una mortalidad de 33 %. Laguzzi durante 4 años de estudio evidencio una mortali= dad para la cirugía de control de daños de 46,6 %., la sobrevida de este trabajo para el grupo de cirugía de control de daños porcentualmente es de 67 %, si= endo mayor a la cirugía convencional 58 %; este valor es comparable con estudios colombianos que presentaron para la misma estrategia el 62 % (8,21,22,23,24= ,25). En la literatura los pacientes con lesiones por armas cortopunzantes y de f= uego llevados a cirugía convencional fallecieron, en relación con los pacientes = del grupo de cirugía de control de daños que sobrevivieron con esta estrategia = (26,27,28,29). Se describe en la literatura que el 25 % de los pacientes con trauma grave presentan coagulopatía asociada al trauma; en el presente estudio se eviden= cio el 59 % de casos con alteraciones de la coagulación al ingreso hospitalario; donde el grupo de cirugía de control de daños presento una mejor superviven= cia (57%) en relación al grupo de cirugía convencional (50 %); en los pacientes= que no presentaron coagulopatía se presentó una mayor mortalidad en el grupo de cirugía convencional (33 %) en relación a 50 una disminución en aquellos pacientes con estrategia de cirugía de control de daños (17 %). (22). En el estudio de Ordoñez sobre El Índice de Shock como predictor para la aplicaci= ón de la cirugía de control de daños en trauma penetrante se evidencio que el valor de esta escala fue mucho mayor en el grupo de pacientes de cirugía de control de daños, al igual que se presentó en el presente estudio y manteni= endo su mortalidad a pesar del ascenso del índice (22,29). En un estudio Colombi= ano el promedio de hospitalización en UCI fue de 15,98 días y la de hospitaliza= ción global de 20,34 días, este trabajo evidencio un promedio de estancia hospitalaria de 10,08 ± 16,16 días para la cirugía convencional y 40,41 ± 5= 8,07 para la cirugía de control de daños; se analizó que el rango de menos de 7 = días presento una mayor distribución de casos para ambos grupos con una media de= 6.4 días y una desviación estándar 4 para el grupo de cirugía convencional, y e= n el grupo de cirugía de control de daños presento una media de 10 días y una desviación estándar de 7.8. En cuanto a la estancia hospitalaria la distribución para ambos grupos fue de mayor de 15 días, con una media de 40= .4 días y una desviación estándar de 58 en el grupo de cirugía convencional; e= n el grupo de cirugía de control de daños la media fue de 19.09 días y la desvia= ción estándar de 16.1(8,19,30,31).=

Conclusiones<= /b>

·&nb= sp;        La mortalidad es menor en la Cirugía de Control de Daños, pero sin significancia estadística.

·&nb= sp;        Al valorar el ISS (INJURY SEVERITY SCORE), este es directamente proporcional a la mortalidad en el grupo de cirugía convencion= al no así en el grupo de cirugía de control de daños donde se mantiene la mortalidad alrededor del 40% a pesar de que los pacientes presenten un elev= ado puntaje en el ISS, mientras que en la cirugía convencional aumenta el porcentaje de mortalidad llegando incluso al 100%.

·&nb= sp;        En la cirugía de control de daños realizada en pacientes con trauma de abdomen penetrante grave se evidenció menor mortali= dad versus aquellos pacientes que se les realizó cirugía convencional.

·      =    La mortalidad general en la Cirugía de control de daños se ajusta a la tasa de los estudios internacionales.

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ISSN: 2697-3391

Vol. 5 No. 2,  pp. 69 – 85 , abril – junio 2022

 

 

 

 

 

                                      Salud y Educación                  Página 69<= !--[if supportFields]> | 1

 

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