SPLENÝK TRAVMALI HASTALARDA PROGNOSTÝK FAKTÖRLER

Dalak yaralanmalarýnda genellikle künt travmalar neden olurken yüksek mortalite oraný bildirilmiþtir. Bu çalýþmada biz dalak yaralanmasý saptanan 122 hastamýza yaklaþým ve sonuçlarý gözden geçirdik. Yaralanmalarýn nedenleri çoðunlukla trafik kazalarý idi. Yirmi iki hastada yaralanma basit dalak yaralanmasý olarak sýnýflandýrýldý idi. %8.5'lik mortalite oraný ile splenorafi uygulanarak tedavi edildi. Bu grupta mortaliteden özelikle birlikte bulunan diðer yaralanmalar sorumlu idi. Geri kalan hastalar Grade 3,4 ve 5 olarak sýnýflandýrýldý. Toplam 19 hasta eks oldu, mortalite oraný %15.7 idi. Yaralanma ciddiyet skoru splenorafi yapýlan grupta 14 idi. Bu skor yaþayan ve ölen gruplardaki deðerden daha iyi idi. Bu dalak yaralanmalarýnda beþ önemli prognoz belirleyici faktör belirledik. Bu faktörler yaþ, hematokrit, birlikte bulunan ekstraabdominal yaralanmalar, þok indeksi ve yaralanma ciddiyet skoru idi. Bunlar kolayca belirlenebilir ve hastaya saðlýklý yaklaþýma olanak verir.

THE PROGNOSTIC FACTORS IN PATIENTS WITH SPLENIC INJURY

The splenic injuries are usually caused by blunt trauma, and high mortality rate is generally reported. In this study we reviewed the management and outcome of 122 patients with splenic injury. The reason of splenic injury were traffic accidents at all blunt trauma cases. Twenty-two patients were classified as simple splenic injury and managed by splenoraphy with a mortality rate of 8.5percent. In this group, associated injuries were found to be the most important factor, upon the mortality. The rest of the patients were classified as Grade 3,4 and 5 injuries. Nine-teen of the patients died and the mortality rate was 15.7 percent. Injury severity score was 14 in the group which splenoraphy was performed, but this score was better than that of survivor and non-survivor groups. We determined five important prognostic criteria in these blunt splenic injuries. These factors were age, heamatocrit, associated extraabdominal injuries, shock index and injury severity score. These factors can be easily determined and patient and his/her injury easily and rapidly managed.