Traumatska ozljeda mozga u jedinici intenzivne njege

OBJECTIVES: The aim of the paper was to find out the prevalence of TBI regarding gender, the incidence of focal brain injury, length of stay in the Department of Anesthesiology and Intensive Care and the Department of Neurosurgery, the duration of mechanical ventilation, GCS scores on admission and discharge, type of treatments and the mortality of TBI. MATERIALS AND METHODS: The study is a retrospective study including 131 patients with a diagnosis of TBI. The data were collected from the Department of Anesthesiology and Intensive Care and the Department of Neurosurgery in the University Hospital of Split. The information gathered dated from January 2017. to the end of December 2018. The medical records were collected from the computer database and archives. The medical data were reviewed and the statistical analyses were made using Microsoft Excel and Word. RESULTS: In this study, we followed TBI patients in the Department of Anesthesiology and Intensive Care and the Department of Neurosurgery. Most of the patients in the study were males (72.5%), the most common event leading to TBI are falls (57%). The duration of stay at the Department of Anesthesiology and Intensive Care was from 1 to 10 days for half of the patients (56.5%), while at the Department of Neurosurgery it was from 1 to 30 days for more than half of the patients (82.3%). On average the stay at the Department of Neurosurgery was 18 days. Almost all patients with TBI required mechanical ventilation (99.2%), except for one patient, the majority required mechanical ventilation from 1 to 5 days (38.9%). The most common GCS score on admittance for patients was 3 (24.1%). Of the collected GCS scores high mortality was noticed (31%), of the aforementioned patients that died, (48.2%) had GCS scores of 3 on admittance. A majority of the patients had a focal brain injury, the most common being subarachnoid hemorrhage (71%) followed by subdural hemorrhage (58.8%). Some patients presented with multiple focal brain injuries with or without diffuse brain injury. The most common diffuse brain injury was edema (26%). Twenty-nine percent of patients did not require surgery and were treated by conservative therapy, while a majority of the patients (71%) underwent surgery, craniotomy is the most common type of surgical procedure (46.6%) and craniectomy being less common (7.6%). The mortality in our study was quite high for a small number of patients (29.8%). Out of patients that died more than half were males (71.8%). CONCLUSION: TBI is a complex intracranial injury occurring when an external force injures the brain, it is more commonly seen in males. The mortality of TBI is high, indicating the severity of TBI. Due to the complexity of the injury and the multitude of cascades of pathological cellular pathways, TBI does lead to a long recovery and thus a long stay in the hospital. The average length of stay in the Department of Anesthesiology and Intensive Care was 9 days, while in the Department of Neurosurgery 18 days. Furthermore, knowing the severity of TBI, the most common GCS score on admission and discharge was 3. The patients that presented with a GCS score of 3 on admission had high mortality and more than half died due to its severity. The injured brain, nonetheless, induces respiratory system changes, with the patients requiring assisted ventilation, on average being ventilated 7 days. Furthermore, due to the shearing and damage produced to blood vessels, the most common focal brain injury occurring following a TBI is subarachnoid hemorrhage, with more than half of the patients requiring the need for surgical treatment, with craniotomy being the most common type of surgical procedure.CILJEVI: Ciljevi ovog istraživanja su bili, utvrditi rasprostranjenost traumatske ozljede mozga među spolovima, učestalost fokalne ozljede mozga, odrediti dužinu boravka na Klinici za anesteziologiju, reanimatologiju i intenzivno liječenje te na Zavodu za Neurokirurgiju, odrediti dužinu mehaničke ventilacije, GKS ljestvicu tijekom prijema i otpusta, način liječenja te stopu smrtnosti traumatske ozljede mozga. MATERIJALI I METODE: Obuhvaća retrospektivni studiju u koju je uključeno 131 bolesnik s dijagnozom traumatske ozljede mozga. Podatci su prikupljeni s Klinike za anesteziologiju, reanimatologiju i intenzivno liječenje te sa Zavoda za Neurokirurgiju u Kliničkoj bolnici Split, u razdoblju od siječnja 2017. do kraja prosinca 2018. Pregledani su protokoli liječenja i povijesti bolesti iz baze podataka s računala i iz arhiva navedenih odjela. U programskim paketima Microsoft Excel i Word obrađeni su podatci te su analizirani. REZULTATI: Ovo istraživanje bavilo se praćenjem bolesnika s traumatskom ozljedom mozga na Klinici za anesteziologiju, reanimatologiju i intenzivno liječenje te sa Zavoda za Neurokirurgiju. Istraživanje je obuhvatilo ukupno 131 bolesnika. Govoreći o spolnoj distribuciji, većina bolesnika bilo je muškog spola (72.5%). Najčešći razlog traumatske ozljede mozga bili su padovi (57%). Najčešći boravak na Klinici za anesteziologiju, reanimatologiju i intenzivno liječenje za pola bolesnika (56.5%) iznosio je od 1 do 10 dana, a na Zavodu za Neurokirurgiju od 1 do 30 dana za više od pola bolesnika (82.3%). U prosjeku su bolesnici boravili na Zavodu za Neurokirurgiju 18 dana. Gotovo svi bolesnici s traumatskom ozljedom mozga (99.2%), osim jednog, bili su na mehaničkoj ventilaciji, većina ih je bilo mehanički ventilirano od 1 do 5 dana (38.9%). Najčešći GKS rezultat tijekom prijema za bolesnike bio je 3 (24.1%). Od umrlih bolesnika njih 48.2% imalo je GKS 3 kod prijema. Tijekom otpusta najčešći GKS bio je 3 (25.7%), a na drugom mjestu GKS 15 (24.3%). Većina bolesnika prezentirala je s fokalnom ozljedom mozga među kojim je subarahnoidalno krvarenje (71%) bilo najčešće, a na drugom mjestu je subduralno krvarenje (58.8%). Neki bolesnici su imali višestruke fokalne ozljede s ili bez difuzne ozljede; najčešća difuzna ozljeda mozga bio je moždani edem (26%). Veliki broj bolesnika bio je podvrgnut kirurškom zahvatu (71%), kraniotomija je bio najčešći izvođeni kirurški zahvat (46.6%), dok se kraniektomiju najmanje izvodilo (7.6%). Veliki dio bolesnika liječen je konzervativno, bez operacije (29%). U istraživanju je primijećena visoka stopa smrtnosti (29.8%), više od pola bolesnika koji su umrli bili su muškarci (71.8%). ZAKLJUČCI: Traumatska ozljeda mozga je kompleksna ozljeda, koja se događa se kada mehanička sila uzrokuje ozljedu i promjene u funkciji mozga. Smrtnost je prilično visoka što ukazuje na ozbiljnost ozljede. Češće se zapaža kod muškaraca. Zbog složenosti ozljede i patofiziologije, traumatska ozljeda mozga zahtjeva dugotrajni oporavak. Duljina boravka na Klinici za anesteziologiju, reanimatologiju i intenzivno liječenje u prosjeku bila je 9 dana, dok na Zavodu za Neurokirurgiju je bila 18 dana. Znajući ozbiljnost ozljede najčešći GKS rezultat tijekom prijema i otpusta bio je 3. Bolesnici s GKS rezultatom 3 na prijemu su imali veliku stopu smrtnosti, manje od pola bolesnika je preživjelo. Traumatska ozljeda mozak izaziva promjene dišnog sustava. Ovi bolesnici se moraju mehanički ventilirati, u prosjeku su bili ventiliran 7 dana. Nadalje, zbog oštećenja krvnih žila, najčešća fokalna ozljeda mozga koja nastaje nakon traumatske ozljede mozga je subarahnoidalno krvarenje, pri čemu su više od polovice bolesnika bili podvrgnuti kirurškim zahvatom, od kojih je kraniotomija bila najčešća