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Análisis de los pacientes diagnosticados de isquemia mesentérica en el servicio de urgencias del H. U. san Juan de Alicante en un periodo de 4 años


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Título :
Análisis de los pacientes diagnosticados de isquemia mesentérica en el servicio de urgencias del H. U. san Juan de Alicante en un periodo de 4 años
Autor :
Ruiz Andreu, Nerea
Tutor:
Díaz Fernández, María Elena
Chiner Vives, Eusebi
Editor :
Universidad Miguel Hernández
Departamento:
Departamentos de la UMH::Medicina Clínica
Fecha de publicación:
2024-05-12
URI :
https://hdl.handle.net/11000/35574
Resumen :
Introducción: La Isquemia mesentérica (IM) consiste en una reducción del flujo sanguíneo a nivel intestinal que ocasiona una elevada morbimortalidad. Método: Se realizó un estudio retrospectivo de 4 años analizando el comportamiento de la IM en el servicio de urgencias del HUSJ evaluando las caract...  Ver más
Introduction: Mesenteric ischaemia (MI) consists of reduced blood flow at the intestinal level causing high morbidity and mortality. Method: A 4-year retrospective study was conducted analysing the behaviour of MI in the emergency department of the HUSJ evaluating clinical, epidemiological characteristics and risk factors, in addition to correlating Manchester triage with mortality, as well as time to intervention, risk factors and comorbidities with mortality. Student's t-test or Wilconxon's test and Chi-square test for qualitative variables were used for statistical study. Results: Forty patients, 60 % female and 40 % male, aged 78 ± 14 years, were studied. The incidence was 4/100000/year. Abdominal pain 72.4%, 12.5%, gastrointestinal bleeding 10% and diarrhoea 5%, with a mean symptom evolution time of 21 ± 22 hours. Contrast-enhanced CT was performed in 67.5%, angio CT in 25% and non-contrast in 7.5%, with intestinal pneumatosis in 39%. Elevated D-dimer and acidosis due to increased lactate were observed in 40%. The main risk factors were arrhythmias and peripheral vascular disease (PVD). Surgery was performed by laparotomy 42.5%, thrombectomy 5% and the rest was conservative. Mean time to surgery was 8 ± 2h and pharmacological time 4 ± 1 hour. Mortality was 27.5%. There was a significant relationship between triage and mortality, corresponding to the most severe degrees (p=0.05). Male patients had higher ICU admission (p=0.046) and evp (p=0.032). Mortality was related to arrhythmias (p=0.019), complications (p=0.041), ICU intervention (0.005) and leukocytosis (p=0.02). With tendency in case of occlusive ischaemia, peripheral vascular disease, Dyslipemia, DM and intestinal pneumatosis (p=0.06). Conclusions: Triage of patients was adequate in severity level and mortality. D-dimer and leukocytosis were useful in clinical suspicion and prognosis. The main risk factors were more arrhythmias, PVE, obstructive ischaemia. CT was basic for diagnosis with pneumatosis being the most specific finding and with the worst prognosis. Overall mortality was low, probably due to increased awareness, diagnosis and early treatment.
Palabras clave/Materias:
Isquemia mesentérica
mortalidad
triaje
factores de riesgo
Área de conocimiento :
CDU: Ciencias aplicadas: Medicina
Tipo de documento :
info:eu-repo/semantics/bachelorThesis
Derechos de acceso:
info:eu-repo/semantics/openAccess
Aparece en las colecciones:
TFG- Medicina



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