Ulus Travma Acil Cerrahi Derg. 2008; 14(2): 132-138

Travmatik diyafragma rüptürlerinde mortaliteyi etkiyen faktörler

Arife Polat Düzgün, Mehmet Mahir Özmen, Barýþ Saylam, Faruk Coþkun
Ankara Numune Eðitim Ve Araþtýrma Hastanesi, 3. Genel Cerrahi Kliniði, Ankara

AMAÇ
Diyafragma rüptürleri sýk görülmeyen fakat yüksek morbidite ve mortalite ile seyreden ciddi yaralanmalardýr.
GEREÇ VE YÖNTEM
Acil serviste son beþ yýl içinde travmatik diyafragma rüptürü saptanan 58 hastanýn dosyasý mortaliteyi etkileyen faktörleri belirlemek için incelendi.
BULGULAR
Hastalarýn ortalama yaþý 33, mortalite oraný %21 ve en sýk diyafragmatik rüptür nedeni penetran yaralanmalardý (%52). Sadece 12 hasta (%20) ameliyat öncesi dönemde diyafragma rüptürü tanýsý alýrken kalan 46 hasta ise cerrahi sýrasýnda taný aldý. Kýrk iki hastada sol diyafragma rüptürü saptandý. Ýntratorasik herniasyon 11 hastada saptandý. Herniasyon varlýðý mortaliteyi etkilemedi (p=0,155). Mortalite ile seyreden tüm hastalarda künt travma vardý ve en yaygýn ölüm nedeni hemorajik þok idi. Hastalarýn %88’inde eþlik eden yaralanmalar vardý ve mortal seyreden hastalarýn %92’sinde eþlik eden yaralanma mevcut idi.
SONUÇ
Travmalý hastada diyafragma yaralanmasýnýn tanýsý yüksek morbidite ve mortalite nedeni ile önemlidir. Travmatik diyafragma rüptürlerinde mortaliteyi etkileyen faktörler; künt travma, yüksek yaralanma þiddeti, þok varlýðý, üç üniteden fazla kan transfüzyonu ve dalak yaralanmasýdýr.

Anahtar Kelimeler: Diyafragma rüptürü, eþlik eden yaralanma; mortalite; revize edilmiþ travma skoru; sistemik enflamatuvar yanýt sendrom skoru.

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Factors influencing mortality in traumatic ruptures of diaphragm

Arife Polat Düzgün, Mehmet Mahir Özmen, Barýþ Saylam, Faruk Coþkun
Ankara Numune Teaching And Research Hospital, 3rd Surgery Department, Turkey.

BACKGROUND
Diaphragmatic injuries are infrequent but severe injuries, associated with high morbidity and mortality.
METHODS
The hospital records of 58 patients with traumatic rupture of diaphragm which was diagnosed during surgery in emergency department during last five years were re-evaluated, in order to identify the factors on mortality.
RESULTS
The mean age of patients was 33 years. The most common cause of diaphragmatic rupture was penetrating injury (52%). The overall mortality rate was 21%. Preoperative diagnoses were accurately made in only twelve (20%) patients and remaining 46 patients were diagnosed during surgery. Rupture was located on the left side in 42 patients. Intrathoracic herniation was seen in eleven cases. Presence of herniation has no effect on mortality (p=0.155). All cases with mortal course were blunt trauma and the most common cause of death was haemorrhagic shock. Associated injuries were present in 88% of the patients; 92% of the mortal cases had an associated injury.
CONCLUSION
The diagnosis of diaphragmatic injury is important due to increased morbidity and mortality in traumatic victims. Blunt trauma, increased grade of injury, presence of shock, blood transfusions over three units and splenic injury are factors influencing mortality in traumatic ruptures of diaphragm.

Keywords: Diaphragmatic rupture, revised trauma score (RTS), SIRS (systemic inflamatory response syndrome) score, associated injury, mortality.

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