ABSTRACT
El trauma craneoencefálico tiene relevancia a nivel global, con incidencia mundial estimada de 200 casos por 100 000 personas, generando una carga importante también para el sistema de salud de Latinoamérica. El objetivo del presente documento es describir la experiencia exitosa en un Centro de Trauma en la atención de un paciente con trauma craneoencefálico penetrante con objeto a "baja velocidad", un destornillador, realizándose además una sucinta revisión acerca de la literatura relacionada actual.
Trauma brain injury has relevance at the global level, with worldwide estimated incidence of 200 cases per 100 000 people, also generating a significant burden to the health system in Latin America. The aim of this document is to describe the successful experience in a Trauma Center in the management of a patient with penetrating brain trauma injury secondary to a "low speed" object, a screwdriver, in addition a concise review about the current related literature is performed.
Subject(s)
Wounds and InjuriesABSTRACT
Objective To explore the effects of autologous blood transfusion on coagulation function,in-flammatory factors and immune function in patients with traumatic brain injury.Methods 85 patients taken autologous blood transfusion were selected as the observation group,30 cases with allogeneic blood transfusion were taken as control group.The blood transfusion volume,perioperative hematocrit,prothrombin time and postoperative complications were observed and compared between the two groups.Results In the observation group,the total amount of autologous blood transfusion in the observation group was 36 338mL,averaged (427.5 ± 28.3)mL,the total amount of allogeneic blood transfusion was 8 747 mL,averaged (102.9 ± 12.7) mL,and the autologous blood accounted for 80.6% of the total transfusion.61 patients only transfused autolo-gous blood,accounting for 71.8%.In the control group,the total allogeneic blood transfusion volume was 15 918 mL,averaged (530.6 ± 22.8)mL,the consumption of banked blood in the observation group was signifi-cantly less than that in the control group (P< 0.05).The levels of platelet (PLT) and plasma fibrinogen (FIB)in the control group increased significantly at 3 d after operation compared with those before operation (P<0.05);while activated partial thromboplastin time (APTT) began to decrease significantly at 3 d after operation (P<0.05);the prothrombin time (PT) and thrombin time (TT)decreased significantly at 7 d after operation(P<0.05),and the level of PLT and FIB in the observation group began to increase significantly at 1 d after operation (P<0.05).PT,APTT and TT were significantly reduced 1 d after operation.Compared with the control group,the level of PLT and FIB in each phase of the observation group was significantly high-er than that of the control group (P<0.05),and the PT,APTT and TT were significantly lower than those in the control group (P<0.05).After operation,the level of pro-inflammatory factors in the observation group was significantly lower than that of the control group.The level of anti inflammatory factors and immune function were significantly higher than that of the control group (P<0.05),and the incidence of complications in the observation group was 2.4%(2/85),which was significantly lower than 16.7%(5/30)of the control group,and the difference was statistically significant (P<0.05).Conclusion Autologous blood transfusion has the advantages of rapidness,timeliness and safety in the operation for patients with brain trauma.It is helpful to save blood,reduce the effect of trauma and blood transfusion on blood coagulation function and im-mune function,and reduce the risk of blood transfusion complications and postoperative infection,which is worth of clinical application.
ABSTRACT
El trauma craneoencefálico severo representa por lo menos la mitad de las muertes relacionadas con trauma, la patofisiología celular y clínica esta extensamente estudiada y documentada, las opciones de monitorización y tratamiento constituyen los paradigmas actualmente para la el progreso en la sobrevida disminuyendo la probabilidad de secuelas, junto con los principios de manejo general que incluyen entre otros el control de la temperatura, tensión arterial, sedación, ventilación, nutrición hacen posible la calidad en la atención de nuestros pacientes.
Severe brain trauma accounts for at least half of the deaths related to trauma, cellular pathophysiology and clinic it is extensively studied and documented , the monitoring and treatment options are currently paradigms for progress in decreasing the likelihood of survival sequels along with general management principles which include among others the temperature control, blood pressure, sedation, ventilation, nutrition enables quality care for our patients.
Subject(s)
Humans , Intracranial Hypertension/therapy , Monitoring, Physiologic/methods , Craniocerebral Trauma/surgery , Craniocerebral Trauma/complications , Craniocerebral Trauma/physiopathology , Diagnostic Imaging/methods , Intensive Care Units , Prehospital CareABSTRACT
El trauma craneoencefálico [TCE] es la causa más frecuente de daño cerebral, cuyas secuelas a nivel cognitivo conllevan a alteraciones en la atención. El estudio tuvo como objetivo evaluar los efectos de un programa de intervención en la atención en pacientes con TCE Moderado. El programa se aplicó a 3 hombres con escolaridad promedio de 9 años, con una media de 31,6 años de edad y un Glasgow entre 9-12 puntos; sin antecedentes neurológicos o psiquiátricos. Se incluyeron paciente con una media de 100 en la Evaluación Neuropsicológica Breve en Español [Neuropsi]; que tenían fallas en tareas de atención, memoria y funciones motoras. Para la evaluación pre y post de la atención, se aplicó el test de clasificación de tarjetas del Wisconsin [WCST], el Trail Making Test A y B [TMTA-TMTB], Stroop Test [STROOP], y el Test de Cancelación de Letras [Letter CancelationTest]. Fue un estudio cuasi - experimental con un diseño Pre y Post para un sólo grupo; el efecto de la intervención fue evaluado por la diferencia entre las medidas Pre y Post. Se encontraron cambios estadísticamente significativos en el WCST en un paciente. Sin embargo, cualitativamente todos los pacientes mejoraron los tiempos de reacción e implementaron herramientas cognitivas como la planificación, la categorización y la clasificación.
Brain Trauma Injury [BTI], is the most common cause of brain injury which consequences, in a cognitive level, leads to attention disorders. The aim of this study is to evaluate the effect of a BTI intervention program in the attention of patients who have a moderated BTI. This program was applied to 3 men with an average of 9 years of education, with a media of 31, 6 years old, a Glasgow result between 9 to 12 points, and no neurological nor psychiatric antecedents. Also, the Brief Neuropsychological Test Battery [Neuropsi], was applied as a sift, in which, the patients obtained a media of 100, finding errors in the attention, memory and motor skills tasks. The instruments used to determine the pre and post evaluation in the attention function were: the Wisconsin Card Sorting Test [WCST], the Trail Making Test A and B [TMTA-TMTB], the Stroop task and the Letter Cancellation Test. This research was quasi-experimental with a design of only one group; the efficacy of the intervention was evaluated through the difference between the pre and post media, once the program was applied. After the intervention, there were found changes statistically significant in the WCST in just one patient. However, all patients improved their reaction time and carried out cognitive tools such as planning, categorization and classifying.