Turkiye Klinikleri Archives of Lung

.: ORIGINAL RESEARCH
Kot Fraktürlü Hastalarda Geç Ortaya Çıkan Plöroparankimal Komplikasyonların Risk Faktörleri: Tanımlayıcı Araştırma
Risk Factors for Delayed Pleuroparenchymal Complications in Patients with Rib Fractures: Descriptive Research
Hıdır ESMEa
aSağlık Bilimleri Üniversitesi Konya Şehir Hastanesi, Göğüs Cerrahisi Kliniği, Konya, Türkiye
Turkiye Klinikleri Arch Lung. 2022;21(3):69-73
doi: 10.5336/archlung.2022-92647
Article Language: TR
Full Text
ÖZET
 Amaç: Kot kırıklarında hastaneye ve yoğun bakıma yatış ihtiyacı ve komplikasyonlarda artışa neden olan risk faktörleri konusunda tartışmalar vardır. Bu çalışmanın amacı, hasta yatışından sonraki ilk günlerde plöroparankimal komplikasyonların ortaya çıkışını öngörebilecek faktörleri analiz etmek ve kaburga kırıklarının sayısının bu komplikasyonların ortaya çıkmasıyla ilişkili olup olmadığını belirlemeye çalışmaktır. Gereç ve Yöntemler: 2015 Ocak ile 2020 Aralık ayı arasında künt travma sonrası kliniğimize başvuran ve toraks bilgisayarlı tomografi ile multipl kot kırıkları tanısı alan 155 hasta çalışmaya dâhil edildi. Hastaların yaş, cinsiyet, travma nedeni, eşlik eden kronik obstrüktif akciğer hastalığı (KOAH), sigara kullanımı, fraktür sayısı, hastane yatış süresi, yatıştan 24 saat sonra ortaya çıkan plöroparankimal komplikasyonlar ve tüp torakostomi ihtiyacı arşiv dosyaları ve otomasyon sisteminde kayıtlı bilgilerden elde edildi. Yatıştan 24 saat ve sonrasında plöroparankimal komplikasyon gelişen hastalar Grup 1, komplikasyon gelişmeyen hastalar ise Grup 2 olarak kabul edildi. Bulgular: Çalışmaya dâhil edilen hastaların 104'ü erkek iken, 51'i kadın idi. Yaş ortalaması 64,5±13,3 idi. Yapılan istatistiksel çalışmada hastanın yatışından 24 saat ve sonrasında plöroparankimal komplikasyon çıkmasını etkileyen risk faktörleri saptanmaya çalışıldı. Plöroparankimal komplikasyonlar ile KOAH varlığı (p=0,030), immobilizasyon (p=0,020), 3-4 kot (p=0,030) veya 5-6 kot fraktürü (p=0,000) ve bilateral kot fraktürü (p=0,150) arasında anlamlı istatistiksel ilişki vardı. Plöroparankimal komplikasyonlar ile yaş (p=0,980), cinsiyet (p=0,240), sigara (p=0,090), travma nedeni (p=0,890) ve 1-2 adet kot fraktürü (p=0,150) arasında istatistiksel olarak anlamlı ilişki yoktu. Sonuç: 3 ve 3'ten fazla kot kırıkları veya bilateral kot kırıkları olan hastalar, KOAH varlığı, diğer travmalar nedeniyle immobil olan hastalarda geç dönem plöroparankimal komplikasyonların ortaya çıkma riskinin yüksekliği nedeniyle hastaların hospitalize edilerek takip edilmeleri uygun olacaktır.

Anahtar Kelimeler: Kot kırığı; plöroparankimal komplikasyon; risk faktörleri
ABSTRACT
 Objective: There are debates about the need for hospitalization and intensive care unit admission and the risk factors that cause an increase in complications in rib fractures. The aim of this study is to analyze the factors that may predict the occurrence of pleuroparenchymal complications in the first days after hospitalization and to try to determine whether the number of rib fractures is associated with the occurrence of these complications. Material and Methods: One hundred fifty-five patients who applied to our clinic after blunt trauma between January 2015 and December 2020 and were diagnosed with multiple rib fractures by thoracic computed tomography were included in the study. The patients' age, gender, cause of trauma, concomitant chronic obstructive pulmonary disease (COPD), smoking, number of fractures, length of hospital stay, pleuroparenchymal complications occurring 24 hours after hospitalization, and the need for tube thoracostomy were obtained from the archive files and the information recorded in the automation system. Patients who developed pleuroparenchymal complications 24 hours after hospitalization were considered as Group 1, and patients without complications were considered Group 2. Results: While 104 of the patients included in the study were male, 51 were female. The mean age was 64.5±13.3 years. In the statistical study, it was tried to determine the risk factors affecting the occurrence of pleuroparenchymal complications 24 hours and after the hospitalization of the patient. There was statistically significant cerrelation between pleuroparenchymal complications and presence of COPD (p=0.030), immobilization (p=0.020), 3-4 rib (p=0.030) or 5-6 rib fracture (p=0.000) and bilateral rib fracture (p=0.150). There was no statistically significant correlation between pleuroparenchymal complications and age (p=0.980), gender (p=0.240), smoking (p=0.090), cause of trauma (p=0.890), and 1-2 rib fractures (p=0.150). Conclusion: Patients with 3 and more than 3 rib fractures or bilateral rib fractures, the presence of COPD, and patients who are immobile due to other traumas should be hospitalized and followed-up due to the high risk of delayed pleuroparenchymal complications.

Keywords: Rib fracture; pleuroparenchymal complication; risk factors
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