Lesiones isquémicas en la fase aguda de los traumatismos craneoencefálicos graves (lesiones difusas)
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array:22 [ "pii" => "S1130147391709111" "issn" => "11301473" "doi" => "10.1016/S1130-1473(91)70911-1" "estado" => "S300" "fechaPublicacion" => "1991-01-01" "aid" => "70911" "copyright" => "Sociedad Española de Neurocirugía" "copyrightAnyo" => "1991" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Neurocirugia. 1991;2:313-22" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1646 "formatos" => array:3 [ "EPUB" => 12 "HTML" => 770 "PDF" => 864 ] ] "itemSiguiente" => array:18 [ "pii" => "S1130147391709123" "issn" => "11301473" "doi" => "10.1016/S1130-1473(91)70912-3" "estado" => "S300" "fechaPublicacion" => "1991-01-01" "aid" => "70912" "copyright" => "Sociedad Española de Neurocirugía" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Neurocirugia. 1991;2:323-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2036 "formatos" => array:3 [ "EPUB" => 11 "HTML" => 875 "PDF" => 1150 ] ] "es" => array:9 [ "idiomaDefecto" => true "titulo" => "Astrocitomas de ventrículo lateral" "tienePdf" => "es" "tieneTextoCompleto" => 0 "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "323" "paginaFinal" => "328" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Isla, F. Alvarez, C. Morales, J. Muñoz, R. Frutos, M.G. Blázquez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Isla" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Alvarez" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Morales" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Muñoz" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Frutos" ] 5 => array:2 [ "nombre" => "M.G." "apellidos" => "Blázquez" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147391709123?idApp=UINPBA00004B" "url" => "/11301473/0000000200000004/v1_201305151330/S1130147391709123/v1_201305151330/es/main.assets" ] "es" => array:11 [ "idiomaDefecto" => true "titulo" => "Lesiones isquémicas en la fase aguda de los traumatismos craneoencefálicos graves (lesiones difusas)" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "313" "paginaFinal" => "322" ] ] "autores" => array:2 [ 0 => array:3 [ "autoresLista" => "J. Sahuquillo, M.A. Poca, E. Rubio" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Sahuquillo" ] 1 => array:2 [ "nombre" => "M.A." "apellidos" => "Poca" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Rubio" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Neurocirugía, Unidad de Vigilancia Intensiva Hospital de Traumatología. Barcelona" ] ] ] 1 => array:3 [ "autoresLista" => "A. Robles, M. Baguena, C. Triginer, M.C. Pelegri" "autores" => array:4 [ 0 => array:3 [ "nombre" => "A." "apellidos" => "Robles" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">+</span>" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Baguena" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">+</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Triginer" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">+</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "M.C." "apellidos" => "Pelegri" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Bioquímica. Barcelona" "etiqueta" => "<span class="elsevierStyleSup">+</span>" "identificador" => "aff0010" ] 1 => array:3 [ "entidad" => "Hospital Vall d’Hebron. Barcelona" "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0015" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec160486" "palabras" => array:5 [ 0 => "Traumatismo craneoencefálico" 1 => "Lesión difusa" 2 => "Isquemia" 3 => "Diferencias arteriovenosas de oxígeno" 4 => "Metabolismo cerebral" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec160487" "palabras" => array:5 [ 0 => "Head injury" 1 => "Diffuse brain injuy" 2 => "Ischemia" 3 => "Brain metabolismo Arteriovenous differences of oxygen" 4 => "Jugular bulbo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La incidencia de lesiones isquémicas no se ha reducido de forma significativa en los traumatismos cranoencefálicos graves (TCEG) a pesar de mejoras evidentes en la recogida, traslado y atenciones prehospitalarias. Estas lesiones secundarias, sobreañadidas a la lesión de impacto, contribuyen a aumentar la tasa de morbi/mortalidad que estos pacientes presentan. Durante un período consecutivo de 6 meses hemos seleccionado 15 pacientes afectos de un TCEG (Glasgow inferior o igual a 8) en los cuales el examen tomodensitométrico demostraba una lesión difusa de severidad variable. La edad media de los pacientes fue de 25.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11 años, con una mortalidad del 33% y unos malos resultados, valorados de acuerdo con la escala de resultados de Glasgow del 53%.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">En todos los casos, se procedió a la colocación de un cateter retrógrado en el bulbo de la yugular derecha para la determinación de diferencias arteriovenosas de oxígeno (AVDO 2) y de lactatos (AVDL). A partir de estos parámetros efectuamos una estimación del flujo sanguíneo cerebral y determinamos la existencia o no de un metabolismo anaerobio incrementado dentro de las primeras 24 horas del traumatismo. Dentro de este intervalo de tiempo, 2 pacientes presentaban un índice lactato-oxígeno (LOI) superior o igual a 0.08, traduciendo la existencia de un metabolismo anaerobio considerablemente incrementado y por Jo tanto la existencia de una lesión isquémica precoz. En los 13 casos en que el LOI fue inferior a 0.08, las AVDO2 demostraron un flujo aumentado (hiperemia) en 2 pacientes (AVDO2 < 1.3<span class="elsevierStyleHsp" style=""></span>μmol/ml), normal en 8 (AVDO2 entre 1.3 – 3.0<span class="elsevierStyleHsp" style=""></span>μmol/ml) y un patrón de hipoperfusión compensada (AVDO2 > 3.0<span class="elsevierStyleHsp" style=""></span>μmol/ml) en 3.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se discuten los resultados, haciendo énfasis en el probable desarrollo intrahospitalario de estas lesiones secundarias y en la importancia que tiene la detección precoz de los patrones de hipoperfusión compensada por su potencial reversibilidad. Discutimos el valor que la monitorización precoz puede tener de las AVDO2 y AVDL en el manejo global de los pacientes con un TCEG y en especial en laslesiones difusas.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In spite of better transportation and prehospital care of severe head injury patients, recent neuropathological work has shown that the incidence of ischemic brain lesions has not been significantly reduced. This type of secondary lesions contributes considerably to the poor outcome of patients with traumatic brain injuries.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">During a consecutive period of six months we selected for the study 15 patients (mean age =25.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11 yrs) with severe head injury (score of 8 points or less in the Glasgow Coma Scale) showing difusse brain damage of variable importance in the admission CT scan. The mortality rate in this group of patients was 33% and 53% of them had a poor coutcome (Glasgow Outcome Scale).</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">All patients had a catheter inserted in the right juguiar bulb to measure the arteriovenous differences of oxygen (AVDO2) and lactates (AVDL). Cerebral blood flow and metabolism were estimated from these data. AVDO2 and AVDL allowed to evidenciate the existence of an increased anaerobic metabolism within 24 hours of impact. Two patients had a lactate-oxygen index (LOI) above or equal to 0.08 within this period of time indicating the presence of an early ischemic brain insulto In the 13 patients showing a LOI inferior to 0.08 the AVDO2 revealed an increased cerebral blood flow (hyperemia) in 2 (AVDO2 < 1.3<span class="elsevierStyleHsp" style=""></span>μmol/ml), a normal cerebral blood flow in 8 (AVDO2 =1.3-3<span class="elsevierStyleHsp" style=""></span>μmol/ml) and a state of compensated hypoperfusion in 3 (AVDO > 3<span class="elsevierStyleHsp" style=""></span>μmol/ml).</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Our results suggest that many ischemic lesions develop after admission of the patient into the neurosurgical unit. The importance of an early diagnosis of the compensated hypoperfusion pattern is discussed, and the value of early monitoring of AVDO2 and AVDL in the management of severe head injury patients, especially in those suffering diffuse brain damage, emphasized.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delayed brain injury: Secondary insults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.R. Cooper" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Central Nervous System Trauma Status Report" "paginaInicial" => "217" "paginaFinal" => "228" "serieFecha" => "1985" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 2 | 3 |
| 2018 March | 0 | 1 | 1 |
| 2018 February | 8 | 2 | 10 |
| 2018 January | 13 | 10 | 23 |
| 2017 December | 9 | 12 | 21 |
| 2017 November | 27 | 37 | 64 |
| 2017 October | 5 | 13 | 18 |
| 2017 September | 17 | 13 | 30 |
| 2017 August | 20 | 10 | 30 |
| 2017 July | 13 | 7 | 20 |
| 2017 June | 15 | 10 | 25 |
| 2017 May | 20 | 12 | 32 |
| 2017 April | 11 | 11 | 22 |
| 2017 March | 8 | 5 | 13 |
| 2017 February | 4 | 1 | 5 |
| 2017 January | 10 | 6 | 16 |
| 2016 December | 21 | 10 | 31 |
| 2016 November | 18 | 10 | 28 |
| 2016 October | 25 | 18 | 43 |
| 2016 September | 41 | 23 | 64 |
| 2016 August | 34 | 20 | 54 |
| 2016 July | 37 | 21 | 58 |
| 2015 December | 2 | 0 | 2 |
| 2015 August | 6 | 0 | 6 |
| 2015 July | 2 | 0 | 2 |
| 2015 June | 14 | 12 | 26 |
| 2015 May | 27 | 26 | 53 |
| 2015 April | 11 | 15 | 26 |
| 2015 March | 15 | 16 | 31 |
| 2015 February | 12 | 23 | 35 |
| 2015 January | 15 | 17 | 32 |
| 2014 December | 11 | 17 | 28 |
| 2014 November | 11 | 18 | 29 |
| 2014 October | 16 | 26 | 42 |
| 2014 September | 15 | 22 | 37 |
| 2014 August | 15 | 21 | 36 |
| 2014 July | 14 | 25 | 39 |
| 2014 June | 16 | 29 | 45 |
| 2014 May | 20 | 23 | 43 |
| 2014 April | 11 | 15 | 26 |
| 2014 March | 9 | 22 | 31 |
| 2014 February | 17 | 18 | 35 |
| 2014 January | 10 | 12 | 22 |
| 2013 December | 14 | 11 | 25 |
| 2013 November | 11 | 12 | 23 |
| 2013 October | 14 | 12 | 26 |
| 2013 September | 15 | 18 | 33 |
| 2013 August | 16 | 28 | 44 |
| 2013 July | 16 | 45 | 61 |
| 2013 June | 9 | 27 | 36 |
| 2013 May | 7 | 17 | 24 |
| 2013 April | 8 | 15 | 23 |
| 2013 March | 9 | 22 | 31 |
| 2013 February | 8 | 11 | 19 |
| 2013 January | 11 | 8 | 19 |
| 2012 December | 6 | 12 | 18 |
| 2012 November | 1 | 12 | 13 |
| 2012 October | 0 | 3 | 3 |
| 2012 September | 0 | 2 | 2 |
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