背景:墨西哥平民的枪伤非常罕见。目前,有组织犯罪集团之间的冲突是用武器进行的,这被认为是国家军队的独家使用。
目的:描述我们机构的经验,并分享影响患者预后的临床和放射学因素的结果。
方法:颅骨枪伤(GSW)患者的观察性和回顾性研究,穿透了duramater,从2009年1月-2013年1月治疗。我们考虑了几个人口统计学变量,格拉斯哥昏迷量表(GCS),一被录取,学生的状态,手术类型和减压的大小,出院时的格拉斯哥结果评分(GOS),6个月后。
结果:在68例患者中,我们排除了那些duramater没有被穿透的人,52名患者平均年龄28.7岁,男性占80.8%。所有人都接受了手术干预,一般死亡率的8%。GCS3至5分组的死亡率为43%,从6到8点是6%,在9到15点没有死亡。在两个瞳孔都固定的患者中,截尾和截尾,死亡率为67%,7%,3%,分别。双半球,在90.9%的病例中,子弹加心室损害的多叶和单半球轨迹与出院时的格拉斯哥预后评分≤3相关。
结论:入院时GCS和学生的状态是影响预后的最主要因素。入院时GCS>8<13分的患者,正常的瞳孔反应,在没有心室损害的情况下,早期和积极的手术治疗可以受益。
BACKGROUND: Gunshot wounds in civilian population of México were quite rare. Currently, conflicts amongst organized crime groups are carried out with weapons, which are considered as exclusive use by the natiońs army.
OBJECTIVE: Describe the experience of our institution and share results of clinical and radiological factors influencing the prognosis of the patients.
METHODS: Observational and retrospective study of patients with cranial gunshot wounds (GSW), which penetrated the duramater, treated from January 2009 - January 2013. We considered several demographic variables, Glasgow Coma Scale (GCS), upon admission, state of pupils, type of surgery and size of decompression, Glasgow Outcome Score (GOS) upon discharge, and after 6 months.
RESULTS: Of 68 patients, we excluded those whose duramater was not penetrated, leaving 52 patients. The average age was 28.7 years, and 80.8% were males. All were surgically intervened, with 8% of general mortality. Mortality in the GCS 3 to 5 points group was 43%, from the 6 to 8 points it was 6%, and no deaths in the 9 to 15 points. In patients with both pupils fixed, anisocoric and isocoric, mortality was 67%, 7%, and 3%, respectively. Bihemispheric, multilobar and unihemispheric trajectory of the bullet plus ventricular compromise was related to a Glasgow Outcome Score ≤ 3 upon discharge in 90.9% of the cases.
CONCLUSIONS: GCS upon admission and state of the pupils are the most influential factors in the prognosis. Patients with a GCS > 8 < 13 points upon admission, normal pupillary response, without ventricular compromise can benefit with early and aggressive surgical treatment.