Ulus Travma Acil Cerrahi Derg. 2013; 19(2): 127-132 | DOI: 10.5505/tjtes.2013.54782

Künt Toraks Travmasýnda Mortaliteye Etki Eden Faktörler

Mustafa Hasbahceci¹, Adnan Ozpek¹, Fatih Basak¹, Mujgan Caliskan¹, Behcet Kemal Ener², Orhan Alimoglu^1
1Ümraniye Eðitim Ve Araþtýrma Hastanesi Genel Cerrahi Kliniði
²Ümraniye Eðitim Ve Araþtýrma Hastanesi Göðüs Cerrahisi Bölümü

Amaç: Künt toraks travmasý, travma hastalarýnda sýklýkla toraks dýþý yaralanmalarla birlikte görülmekte fakat mortaliteye etkisi tam olarak bilinmemektedir.
Gereç ve Yöntem: Künt toraks travmalý hastalar, klinik özellikler ve mortaliteye etki eden faktörler açýsýndan deðerlendirildi.
Bulgular: Çalýþma grubu 76 hastadan (37.2±15 yýl) oluþtu. Trafik kazasý %63 oranýyla en sýk görülen travma sebebiydi. Hastalarda görülen torasik yaralanmalar pnömotoraks (%54), kot fraktürü (%42), hemotoraks (%22) ve akciðer kontüzyonu (%22) olarak tespit edildi. Ekstremite (%46) ve abdomen (%40) toraks dýþý travmalarýn en sýk görüldüðü bölgeler idi. Glasgow Koma Skoru, Yaralanma Þiddet Skoru ve Revize Edilmiþ Travma Skoru ortalamalarý sýrasý ile 14±2.6, 19±13 ve 7.4±1.5 olarak hesaplandý. Sadece nonoperatif yönetim 37 (%48.7) hastada yeterli olurken, 37 (%48.7) hastada tüp torakostomi ve 2 (%2.6) hastada torakotomi gerekli oldu. Toplam 8 hastada (%10.5) mortalite görüldü. Ýlk baþvuruda 90 mmHg’nin düþük sistolik kan basýncý deðeri, yüzeyel ve apneik solunum ve travma skorlama sistemi sonuçlarýnýn mortalite üzerinde anlamlý etkisi olduðu tespit edildi (P<0.05).
Sonuç: Künt toraks travmalarý toraks dýþý sistem yaralanmalarý ile genellikle beraber görülmektedir. Toraks patolojisinin tipi ve sayýsý ile mortalite arasýnda bir iliþki gösterilememiþtir. Yüzeyel ve apneik solunum, 90 mmHg’den düþük sistolik kan basýncý ve travma skorlama sistemi sonuçlarý mortalite ile yakýndan iliþkilidir. Nonoperatif yönetim ve tüp torakostomi, tedavi açýsýndan çoðu hastada yeterli olmaktadýr.

Anahtar Kelimeler: Torasik travma, künt, travma þiddet indeksleri, mortalite.

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Factors Affecting Mortality in Blunt Thoracic Trauma

Mustafa Hasbahceci¹, Adnan Ozpek¹, Fatih Basak¹, Mujgan Caliskan¹, Behcet Kemal Ener², Orhan Alimoglu^1
1Umraniye Education And Research Hospital Dept Of General Surgery
²Umraniye Education And Research Hospital Thoracic Surgery

Background: Blunt thoracic trauma is usually associated with extra-thoracic injuries, but effect of blunt thoracic trauma on mortality is not known in.
Methods: Patients with blunt thoracic trauma were evaluated with regard to clinical findings and factors affecting mortality
Results: There were 76 patients (37.2±15 years) in study group. Traffic accidents (63%) were the most common reason. Pneumothorax (54%), rib fracture (42%), hemothorax (22%) and lung contusion (22%) were common thoracic injuries. Extra-thoracic injuries were most commonly seen in extremities (46%) and abdomen (40%). Glasgow Coma, Injury Severity and Revised Trauma Scores were 14±2.6, 19±13 and 7.4±1.5, respectively. Only non-operative management was effective in 37 (48.7%) patients, tube thoracostomy and thoracotomy were performed in 37 (48.7%) and 2 (2.6%) patients, respectively. Mortality rate was 10.5%. Systolic blood pressure lower than 90 mmHg and superficial and apneic respiration at the first admission, and values of trauma scoring systems had significantly related with mortality (p<0.05).
Conclusion: Effect of thoracic trauma on mortality with regard to thoracic pathology is not shown, although it is usually associated with extra-thoracic injuries. There were close relationship between pattern of respiration, values of systolic blood pressure and trauma scoring systems, and mortality. Non-operative management and tube thoracostomy were effective in most of the cases.

Keywords: Thoracic trauma, blunt, trauma severity indices, mortality.

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ATIF KOPYALA