Ulus Travma Acil Cerrahi Derg. 2006; 12(1): 43-50

Noninvasive management strategy in hemodynamically unstable patients with blunt trauma

F Cem GEZEN, Tarýk G ÇÝNÇÝN, Mustafa ÖNCEL, Selahattin VURAL, Ayhan ERDEMÝR, Gülay DALKILIÇ, Cengiz MENTEÞ, Barýþ TÜZÜN
1st Department of General Surgery Dr. Lütfi Kýrdar Kartal Training and Research Hospital, Ýstanbul, Turkey.

BACKGROUND
Non-operative management in abdominal injuries may reduce non-therapeutic laparatomies without increasing mortality. The aim of this study is to evaluate the results of a recently used non-invasive management strategy, in trauma patients in our institution.
METHODS
A retrospective chart review was performed. The sixty-three patients (50 males; 13 females; range 8 to 61 years) with abdominal injuries who were unstable during their admissions to our institution between July 1st, 2000 and July 1st, 2001 (the first year of the NIMS implementation) were identified and divided into three groups according to the presence or absence of surgical intervention and the timing of the operation.
RESULTS
There were 63 blunt abdominal trauma patients who were unstable during admission. Patients in Group 1 (n=14) and Group 2 (n=10) had urgent laparotomy during the resuscitation therapy or after a median observation period of 7 hours (range, 2 to 20). Group 3 patients (n=39) did not require surgical intervention.
CONCLUSION
Most of the trauma patients who respond to initial fluid replacement do not require surgery. Close monitoring and repeated abdominal examinations (NIMS) can be the main criteria for surgical intervention, although they are not the most reliable techniques in the diagnosis of solid organ injuries in all patients and of hollow organ injuries in conscious patients.

Keywords: Abdominal injuries; accidents, traffic; diagnosis, differential; follow-up studies; hemodynamic processes; injury, blunt; wounds, nonpenetrating/mortality/surgery/ultrasonography.

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Hemodinamik yönden stabil olmayan künt travmalý hastalarda noninvaziv tedavi

F Cem GEZEN, Tarýk G ÇÝNÇÝN, Mustafa ÖNCEL, Selahattin VURAL, Ayhan ERDEMÝR, Gülay DALKILIÇ, Cengiz MENTEÞ, Barýþ TÜZÜN
1st Department of General Surgery Dr. Lütfi Kýrdar Kartal Training and Research Hospital, Ýstanbul, Turkey.

AMAÇ
Batýn yaralanmalarýnda cerrahi dýþý yaklaþýmlar; mortalite riskini artýrmadan, hastalarýn cerrahi giriþim uygulanmadan tedavisini amaçlar. Bu çalýþmada invaziv olmayan tedavi stratejisiyle tedavi edilen hastalar sunuldu.
GEREÇ VE YÖNTEM
Bu çalýþmada 1 Haziran 2000 ile 1 Haziran 2001 (invaziv olmayan tedavi yaklaþýmý uygulamasýnýn ilk yýlý) tarihleri arasýnda baþvuru anýnda hemodinamik olarak anstabil olan 63 batýn travmalý hasta (50 erkek; 13 kadýn; daðýlým 8-61 yaþ) deðerlendirildi. Olgular erken cerrahi, geç cerrahive konservatif yaklaþýmla tedavi edilenler olmak üzere üç grupta incelendi.
BULGULAR
Baþvuru anýnda instabil 63 künt batýn travmalý hasta saptandý. Grup 1 (n=14) ve Grup 2'deki (n=10) hastalar erken veya geç [ortalama 7 saat (2 ile 20 saat) gözlem süresi sonrasý] ameliyata alýndý. Grup 3 (n=39) hastalarýna cerrahi giriþim gerekmedi.
SONUÇ
Travma hastalarýnýn çoðu baþvuru anýnda instabil olsalar da baþlangýç sývý replasmanýna cevap verirler ve cerrahi tedavi gerektirmezler. Bu hastalarda solid organ yaralanmalarýný, bilinci açýk hastalarda ise içi boþ organ yaralanmalarýný gösteren en önemli teknik olmasada yakýn monitörizasyon ve tekrarlayan batýn muayeneler içeren invaziv olmayan tedavi stratejisi cerrahi giriþim gerekecek hastalarýn seçiminde uygun bir yöntem olabilir.

Anahtar Kelimeler: Batýn yaralanmasý; kaza, trafik; taný, ayýrýcý;izlem çalýþmasý; hemodinamik süreç; yara, künt; yara, penetran olmayan/mortalite/cerrahi/ultrasonografi.

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