Associação da vitamina D e da força de preensão manual com úlceras de pressão e mortalidade em pacientes com fratura de fêmur proximal
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Data
2012-09-28
Autores
Gumieiro, David Nicoletti [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A frequência das fraturas do fêmur proximal tem aumentado nas últimas décadas e existe uma expectativa de que continue aumentando devido ao envelhecimento da população. Elas estão relacionadas à importante diminuição da independência, aumento da morbidade e mortalidade. As úlceras de pressão (UPs) são complicações pós-operatórias frequentes e os pacientes com fratura do fêmur proximal estão especialmente predispostos a elas. O teste da força de preensão manual (FPM) tem sido utilizado para detecção de pacientes com desnutrição energético-protéica e avaliação da força muscular, no entanto é pouco estudado em relação ao desenvolvimento de UPs. Além das alterações relacionadas aos macronutrientes, a deficiência de micronutrientes, como a vitamina D, também é pouco estudada em relação ao desenvolvimento de UPs e à mortalidade em pacientes com fratura do fêmur proximal. O objetivo deste estudo é avaliar se a concentração sérica de vitamina D e a força de preensão manual estão associadas ao aparecimento de úlceras de pressão e à mortalidade em pacientes com fratura do fêmur proximal 6 meses após a mesma. Foram avaliados prospectivamente pacientes consecutivos com fratura do fêmur proximal, com idade 65 anos, internados na enfermaria de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP, no período de janeiro a dezembro de 2010. Nas primeiras 72 horas da admissão hospitalar, foram registrados dados demográficos, dados cirúrgicos referentes às fraturas, realizado questionário de frequência alimentar, avaliação antropométrica e o teste de FPM. Além disso, foi coletado sangue para dosagem de exames laboratoriais e dosagem sérica de vitamina D. No pósoperatório, foram avaliadas a presença ou não de UPs e a taxa de mortalidade em até 180 dias...
The prevalence of hip fractures is rising in the last decades and is expected to keep rising due to the aging of population. This type of fracture is related to a significant loss of independence, high morbidity and mortality. Pressure Ulcers (PU) are an important complication in this kind of patient. The handgrip strength (HGS) has been used to detect patients with malnutrition and to assess the muscle strength, but it’s relation with PU was not evaluated. In addition, the association of micronutrients such as vitamin D with PU development and mortality in patients with hip fractures was not yet studied. The aim of this study is to assess the role of serum levels of vitamin D and the hand grip strength as predictors of PU development and mortality in patients with hip fractures 6 months after the fracture. From January to December 2010, all consecutive patients older than 65 years with hip fractures, who were admitted to the orthopedic unit of the Botucatu Medical School Hospital, were prospectively evaluated. On admission, patient characteristics including age, gender, and concomitant diseases were recorded. Anthropometric measurements and food frequency questionnaire were performed, handgrip strength was measured, and blood samples were taken for analysis of serum biochemistry profile and serum vitamin D levels within the first 72 h of the patient’s admission after clinical stabilization. The PU development and mortality were evaluated during 180 days after fracture. One hundred patients with mean age of 80.7 ± 7.2 years old were studied. Seventy three percent were women and 61% presented PU 6 months after the fracture. Four patients died before surgery. After 6 months, there were 24% of deaths. The median of vitamin D intake corrected by energy was 2,39 (1,79 – 3,47) μg. The needs for ICU care, higher time from admission to surgery... (Complete abstract click electronic access below)
The prevalence of hip fractures is rising in the last decades and is expected to keep rising due to the aging of population. This type of fracture is related to a significant loss of independence, high morbidity and mortality. Pressure Ulcers (PU) are an important complication in this kind of patient. The handgrip strength (HGS) has been used to detect patients with malnutrition and to assess the muscle strength, but it’s relation with PU was not evaluated. In addition, the association of micronutrients such as vitamin D with PU development and mortality in patients with hip fractures was not yet studied. The aim of this study is to assess the role of serum levels of vitamin D and the hand grip strength as predictors of PU development and mortality in patients with hip fractures 6 months after the fracture. From January to December 2010, all consecutive patients older than 65 years with hip fractures, who were admitted to the orthopedic unit of the Botucatu Medical School Hospital, were prospectively evaluated. On admission, patient characteristics including age, gender, and concomitant diseases were recorded. Anthropometric measurements and food frequency questionnaire were performed, handgrip strength was measured, and blood samples were taken for analysis of serum biochemistry profile and serum vitamin D levels within the first 72 h of the patient’s admission after clinical stabilization. The PU development and mortality were evaluated during 180 days after fracture. One hundred patients with mean age of 80.7 ± 7.2 years old were studied. Seventy three percent were women and 61% presented PU 6 months after the fracture. Four patients died before surgery. After 6 months, there were 24% of deaths. The median of vitamin D intake corrected by energy was 2,39 (1,79 – 3,47) μg. The needs for ICU care, higher time from admission to surgery... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Femur - fraturas, Vitamina D, Úlcera por pressão, Fatores etários na doença, Envelhecimento, Age factors in diseases
Como citar
GUMIEIRO, David Nicoletti. Associação da vitamina D e da força de preensão manual com úlceras de pressão e mortalidade em pacientes com fratura de fêmur proximal. 2012. 64 f. Tese (doutorado) - Universidade Estadual Paulista Julio de Mesquita Filho, Faculdade de Medicina de Botucatu, 2012.