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2013, Número 1

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Cir Plast 2013; 23 (1)


Estrategia para tratar quemaduras en pacientes obesos. Estudio comparativo

Cuenca-Pardo J, Álvarez-Díaz CJ

Idioma: Español
Referencias bibliográficas: 44
Paginas: 24-31
Archivo PDF: 313.76 Kb.


RESUMEN

Estudiamos a 87 pacientes obesos quemados: 43 hombres y 44 mujeres con edad de 18 a 82 años, promedio de 48.4, atendidos en la Unidad de Quemados del Hospital de Traumatología «Dr. Victorio de la Fuente Narváez» del IMSS. Se formaron dos grupos: el Grupo I, integrado por 51 pacientes (58.6%). atendidos del año 2000 al 2008 y tratados en forma tradicional, y el Grupo II, formado por 36 pacientes (41.4%), de 2009 a 2011, tratados con una estrategia consistente en hidratación personalizada, escisión precoz de la totalidad del tejido quemado, cobertura de las lesiones, injertos y zonas donadoras con parches de plata; además de movilización temprana fuera de la cama, baño diario, aplicación de heparina de bajo peso molecular y nutrición inmunoreguladora y antiinflamatoria. Con esta estrategia se logró reducir el número de cirugías promedio por paciente de 3.47 a 1.92% (p=0.008); las complicaciones, del 54.9 al 25% (p=0.005) y la mortalidad del 31.37% al 11.11% (p=0.012). Aunque hubo una disminución en la estancia hospitalaria, no tuvo una diferencia estadística significativa. Encontramos que los pacientes tratados en forma conservadora tienen un riesgo 9.29 veces mayor de complicarse y un 12.09 mayor de fallecer. La estrategia implementada es efectiva en el tratamiento integral del obeso quemado, ya que aumenta su supervivencia y disminuye las complicaciones, la estancia hospitalaria y el número de cirugías.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Kraft R, Herndon DN, Williams FN, Al-Mousawi AM, Finnerty CC, Jeschke MG. The effect of obesity on adverse outcomes and metabolism in pediatric burn patients. Int J Obes (Lond) 2012; 36(4): 485-490.

  2. Bray GA. Contemporary diagnosis in management of obesity. New-Town Pa. Handbook in health care; 1998.

  3. Pi-Sunyer FX. Obesity: criteria and classification. Proc Nutr Soc. 2000; 59(4): 505-509.

  4. Rosenbaum M, Liebel LR, Hirsch J. Obesity. New Eng J Med. 1997; 337:396.

  5. Bray GA. Etiology and Pathogenesis of Obesity; Clinical Cornerstone. Excerpta Med. 1999; 2(3): 1-15.

  6. Darryl YS. Obesity and Pulmonary Function: More or Less? Chest. 1997; 111(4): 844-845.

  7. Susan ZY. Overweigth, Obesity, and Health Risk. Arch Intern Med. 2000; 160(7): 898-904.

  8. Burns K, Murrock CJ, Graor CH. Body Mass Index and Injury Severity in Adolescent Males. J Pediatr Nurs. 2011; 9: 508-513.

  9. Clark JM, Brancati FL. The Challenge of Obesity-related Chronic Diseases. J Gen lntern Med. 2000; 15(11): 828-829.

  10. Expert Panel on Overweight and Obesity in adults. Arch lnt Med. 1998; 158(17): 1855.

  11. Neville AL et al. Obesity is an Independent risk factor of mortality in severely injured blunt trauma patients. Arch Surg. 2004; 139(9): 983-987.

  12. Cuenca-Pardo J, Luján-Olivar F, Castañeda-Rodríguez H. Quemaduras en pacientes obesos. Estudio comparativo. Cir Plast. 2008; 18(1): 6-12.

  13. Farrell RT, Gamelli RL, Aleem RF, Sinacore JM. The relationship of body Mass Index and functional outcomes in patients with acute burns. J Burn Care Res. 2008; 29: 102-108.

  14. Goutos I, Sadideen H, Pandya AA, Ghosh SJ. Obesity and Burns. J Burn Care Res. 2012; 20: 1-12.

  15. Patel L, Cowden JD, Dowd D, Hampl S, Felich N. Obesity: influence on length of hospital stay for the pediatric burn patient. J Burn Care Res. 2010; 31(2): 251-256.

  16. Carpenter AM, Hollett LP, Jeng JC, Wu J, Turner DG, Jordan MH. How long a shadow does epidemic obesity cast in the burn unit? A dietitian’s analysis of the strengths and weaknesses of the available data in the National Burn Repository. J Burn Care Res. 2008; 29(1): 97-101.

  17. Coen JR, Carpenter AM, Shupp JW, Matt SE, Shaw JD, Flanagan KE, Pavlovich AR, Jeng JC, Jordan MH. The results of a national survey regarding nutritional care of obese burn patients. J Burn Care Res. 2011; 32(5): 561-565.

  18. Purdue GF, Hunt JL, Lang ED. Obesity: a risk factor in the burn patient. J Burn Care Rehab. 1990; 11(1): 32-34.

  19. Gottschlich MM, Mayes T, Khoury JC, Warden GD. Significance of obesity on nutritional, immunologic, hormonal, and clinical outcome parameters in burns. J Am Diet Assoc. 1993; 93(11): 1261-1268.

  20. Sheridan RL, Rue LW 3rd, McManus WF, Pruitt BA Jr. Burns in morbidly obese patients. J Trauma. 1992; 33(6): 818-820.

  21. Bowen KA, Bray JG, Witt PD. Fatal pulmonary embolism in a young morbidly obese patient with small burns. Plast Reconstr Surg. 2003; 112(3): 930-931.

  22. Ghanem AM, Sen S, Philp B, Dziewulski P, Shelley OP. Body Mass Index (BMI) and mortality in patients with severe burns: is there a “tilt point” at which obesity influences outcome? Burns. 2011; 37(2): 208-214.

  23. Farrell RT, Gamelli RL, Aleem RF, Sinacore JM. The relationship of body mass index and functional outcomes in patients with acute burns. J Burn Care Res. 2008; 29(1): 102-108.

  24. Livingston EH, Lee S. Percentage of burned body surface area determination in obese and non obese patients. J Surg Res. 2000; 91(2): 106-110.

  25. Ireton-Jones C. Comparison of the metabolic response to burn injury in obese and non obese patients. J Burn Care Rehab. 1997; 18: 82-85.

  26. Wahl WL, Brandt MM. Potential risk factors for deep venous thrombosis in Burns patients. J Burn Care Rehab. 2001; 22: 128-131.

  27. Trop M, Novak M, Rodl S, Hellbom B, Kroell W, Goessler W. Silver-coated dressing Acticoat caused raised Liver enzimes and Argyria-like symptoms in burns patients. J Trauma Inj Inf Crit Care. 2006; 60: 648-652.

  28. Tredget E, Shankowsky H, Groeneveld A, Burrell R. A matched-pair randomized study evaluating the efficacy and safety of acticoat silver coated dressing for treatment of burn wounds. J Burn Care Rehab. 1998; 19: 531-537.

  29. Marazzi M, De Angelis A, Ravizza A, Ordanini MN, Falcone L, Chiaratti A, Crovato F, Calo D, Veronese S, Rapisarda V. Successful management of deep facial burns in patients of extensive third-degree burns: the roll of nanocrystaline silver dressing in facilitating resurfacing. Int Wound J. 2007; 4: 8-14.

  30. Percival S, Thomas J, Slone W, Linton S, Corum L, Okel T. The efficacy of silver dressing and antibiotics on MRSA and MSSA isolated of burn patients. Wounds Rep Reg. 2011; 19: 767-774.

  31. Caruso DM, Silverstein P, Antimarino JR, Bauer G, Blome-Eberwein SAQ et al. Randomized controlled study of silver dressing effects on partial thickness burns outcomes. J Burn Care Res. 2006; 27(2): S60.

  32. Nguyen TT, Gilpin DA, Meyer NA, Kerndon DN. Current treatment burned patients. Ann Surg. 1996; 225: 14-25.

  33. Kara M, Peters WJ, Douglas LG, Morris SF. An early surgical approach to burns in the elderly. J Trauma. 1990; 30: 429-432.

  34. Kim DS, Luce EA. Early excision and grafting versus conservative management of burns in the elderly. Plast Reconstr Surg. 1998; 102: 1013-1017.

  35. Chamania S, Patidar GP, Dembani B, Baxi MA. A retrospective analysis of early excision and skin grafting from 1993-1995. Burns. 1998; 24: 177-180.

  36. Jansekovic Z. A new concept in early excision and immediate grafting of burns. J trauma. 1970; 15: 42-67.

  37. Burke JF, Boudoc CC, Quinby WC. Primary burn excision and immediate grafting: a method shorting illness. J Trauma. 1974; 14: 389-395.

  38. Engrav LH, Heimbach DM, Reus JL et al. Early excision and grafting vs. non operative treatment of burn of indeterminate depth: A randomized prospective study. J Trauma. 1983; 23: 1001-1007.

  39. Still J, Law E. Primary excision of the burn wound. Clin Plast Surg. 2000; 27: 23-47.

  40. Barret JP, Herndon DN. Effects of Burn Wound Excision on Bacterial Colonization and Invasion. Plast Reconstr Surg. 2003; 111: 744-750.

  41. Cole JK, Engrav LH. Early Excision and Grafting of Face and Neck Burns in Patients over 20 Years. Plast Reconstr Surg. 2002; 109: 1266-1273.

  42. Yee SO, Miny S, Colin S. Meta-analysis of early excision of burns. Burns. 2006; 32: 145-150.

  43. Cuenca-Pardo J, Álvarez-Díaz CJ. Costo-beneficio de la cirugía precoz del paciente quemado, comparado con cirugía tardía. Cir Plast. 2000; 10: 5-7.

  44. Cuenca-Pardo J, Álvarez-Díaz CJ, Luján-Olivar F, Escalona-Mancilla A. Trujillo-González J. Quemaduras extensas en niños tratadas con escisión precoz y aloinjertos de epidermis humana cultivada. Estudio comparativo. Cir Plast. 2011; 21: 62-71.




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