Trauma toracico : estudo comparativo das complicações pleuropulmonares com e sem uso de antibioticoterapia

AUTOR(ES)
DATA DE PUBLICAÇÃO

2000

RESUMO

The continous growth of violence which attempts the major cities, patients with chest trauma became much more likely to attend the emergency units of the specialized centers. These patients can frequently be treated with low complexity surgical procedures, like closed pleural drainage, in 85 percent of the cases is the most appropriate conduct. Although technicalIy simple, this procedure is not free of complications, because 1 to 25 percent of the patients develop some type of intra or post-operatory complications, specialIy those of infectious nature. In this manner, there is still a lot of controversy about the use of antibiotic therapy associated with pleural drainage. Therefore, the objective of this study was to analyse comparatively the incidence horacic complications with or without antibiotic presence, in patients with isolated blunt or penetrating thoracic injuries requiring closed tube thoracostomy. A total of 167 patients were admitted in the emergency unit, during the period from January 1998 to June 1999, alI included on the survey obeying to previously stablished attendance protocol. The patients were stratified into two groups selected by randomic sampling to a cohorts accompanying study. One hundred and four patients received emergency room tube thoracostomy without antibiotic therapy administration were considered as been the control group; and, 63 patients using cefalotin in post-operatory state as the ~xperimental group. Patients who were admitted in the study were accompanied in pre-operatory state according to the trauma type, the lesion mechanism, the time spent with attendanc~, the clinic diagnostic, vital parameters and TRISS valuation. It was registered in post-operatory state the presence of thoracic infectious complication with emphasis in the clinical, radiographic and laboratorial findings, as welI as the duration of chest intubation and length of hospital stay. The mean age of the patients in thé control group was 26,8:t8.9 years (range, 13 - 53), and 24.9::!:7.9 years (range, 15 - 57) for experimental group, predominating the male sex (95.2%) in both studied groups. The penetrating chest trauma was present in 92.8% of the patients, with a higher incidence of stab wounds (58.7%) in contrast to gunshot wounds (24.6%). Thoracic complications were present in 35 patients (33.7%) of the control group, whereas, in the experimental group, only .18 patients (28.6%) developed this kind of complication. In the statistic significance analysis, the bivariate model indicated that the variable trauma type, whether penetrating or blunt trauma, and the duration of pleurall space drainage were the most relevant ones as predictable factors to infectous complications. In the multivariate logistic regression, the variables blunt chest trauma, length of hospital stay and drainage blood volume higher than 500 ml, when associated, influenciated positively on the occurrence of these complications. Based on the presented model, we can state that the use of antibiotic therapy is indicated in patients with chest trauma submitted to closed pleural drainage, as a preventing method ofthoracics complications

ASSUNTO(S)

analise de regressão analise de corte analise multivariada logistica

ACESSO AO ARTIGO

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