Análise dos fatores preditivos de complicações após trauma hepático penetrante

Analysis of predictive factors for complications after penetranting hepatic trauma

ARTIGO ORIGINAL

Análise dos fatores preditivos de complicações após trauma hepático penetrante

Analysis of predictive factors for complications after penetranting hepatic trauma

Átila Varela Velho, TCBC-RS^I; Raffael Allencastro Brandão Ostermann^II; Francisco Marques Dacanal^III; Leohnard Roger Bayer^III

^IProfessor Auxiliar da FFFCMPA; Mestre em Gastroenterologia; Cirurgião e Preceptor da Residência em Cirurgia do Trauma do HPS

^IIDoutorando da FFFCMPA; Bolsista da FAPERGS

^IIIDoutorando da FFFCMPA

^{Endereço para correspondência}

RESUMO

Com o objetivo de analisar, na amostra, fatores que influenciaram a morbidade pós-operatória após trauma hepático penetrante, realizou-se um estudo prospectivo com 61 pacientes submetidos a cirurgia por trauma hepático penetrante no Hospital de Pronto Socorro (HPS) durante 12 meses. Foram excluídos os óbitos ocorridos nas primeiras 24 horas após o trauma. As seguintes variáveis foram estudadas: idade, mecanismo de trauma, choque, grau de lesão hepática, lesões intra- abdominais associadas, técnica cirúrgica e drenagem peri-hepática. Utilizou-se um modelo de regressão logística múltipla para avaliar a correlação entre esses fatores e a ocorrência de complicações pós-operatórias. A média de idade foi de 26± 3,49 anos, variando entre 17 e 63 anos. Trauma por arma de fogo ocorreu em 34 casos (55,7%) e por arma branca em 27 (44,3%). O choque esteve presente em 37 casos (60,7%). As lesões hepáticas de grau II e III (42,6% e 41 %) foram as mais comuns, e as lesões intra-abdominais associadas mais freqüentes foram de estômago (18 casos - 29,5% ) e cólon (nove casos - 14,7% ). O ATI médio foi 20,5 ±17. As complicações pós-operatórias mais comuns foram broncopneumonia (dez casos - 25%) e abscesso intra-abdominal (seis casos - 9,8%). Houve dois óbitos na série. Foram fatores preditivos de complicações, nessa amostra, o choque, os ferimentos por projetis de arma de fogo e a complexidade da cirurgia hepática.

Unitermos: Trauma hepático; índice de trauma abdominal; Abscesso abdominal.

ABSTRACT

This study is a prospective analysis of 61 patients who suffered penetrating hepatic trauma followed by surgery, and the aspects that influenced the post-surgical morbidity. The study was developed during 12 months at Hospital de Pronto Socorro de Porto Alegre, RS, Brazil, and did not consider the deaths which occurred along the first 24 hours after the trauma. The following aspects were studied: age, trauma mechanism, shock, hepatic lesion grade, associated intra-abdominal lesions, surgical technique and peri-hepatic drainage. We employed a multiple logistic regression model to evaluate the relationship between these events and the occurrence of post-surgical morbidity. The average age was 26:1: 3.49, varying from 17 to 63 years. Gunshot wounds occurred in 34 cases (55.7%) and stab wound in 27 cases (44.3%). Shock was present in 37 cases (60.7%). Grade I and II hepatic lesions (42.6% and 41% respectively) were the most frequent while the most commonly associated intra-abdominal lesions were those of stomach (18 cases/29.5%) and colon (9 cases/14.7%). The average ATI was 20.5 ± 17. Pneumonia (10 cases/25%) and intra-abdominal abscess (6 cases/9,8%) were the most frequent post-surgical complications. The series presented two deaths. Shock, gunshot wounds and the complexity of the surgical procedure were considered to be predictive factors of morbidity.

Key words: Hepatic trauma; Abdominal trauma index; Abdominal abscess.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Recebido em 28/5/98

Aceito para publicação em 4/1/99

Trabalho realizado no Hospital de Pronto Socorro Municipal de Porto Alegre (HPS) e Fundação Faculdade Federal de Ciências Médicas de Porto Alegre (FFFCMPA) com apoio da Fundação de Amparo à Pesquisa do Rio Grande do Sul (FAPERGS).

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Datas de Publicação

• Publicação nesta coleção
  09 Fev 2010
• Data do Fascículo
  Abr 1999

Histórico

• Aceito
  04 Jan 1999
• Recebido
  28 Maio 1998