Indicadores clínicos e laboratoriais como determinantes de um padrão na evolução das infecções orais graves: estudo retrospectivo de 3 anos
Carregando...
Data
2022-08-15
Autores
Saizaki, Marcelo Teruyoshi
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
O objetivo desta pesquisa foi avaliar possíveis indicadores clínicos e laboratoriais que podiam determinar um padrão na evolução das infecções e orientar os profissionais a tomarem uma melhor conduta para o caso. Foram colhidos os dados de 440 prontuários que apresentaram diagnóstico compatível e confirmado de infecção oral grave atendidos durante 3 anos no Hospital Municipal Alípio Correa Netto na cidade de São Paulo – SP. O período de coleta de dados foi compreendido entre 01 julho de 2018 até 01 julho de 2021. Foram analisados a presença de doenças de base e o trismo, o número de espaços bucais acometidos e se as alterações de exames laboratoriais podiam ou não determinar um padrão no curso do tratamento das infecções orais graves. A idade média dos pacientes foi 26,5 anos, e a origem da infecção foi a pulpar em 80%. Os principais sinais e sintomas observados foram: Dor, Prostração, Trismo, Febre, Odinofagia e a dispneia. Em 65% dos casos, múltiplos espaços estavam envolvidos na infecção, sendo os espaços submandibular (68,4%) e o bucal (53,7%) os mais frequentemente envolvidos. A variante doença de base foi uma das que mais apresentaram significância estatística em nosso trabalho. Observamos que a maioria dos pacientes com doença de base precisaram ser tratados com anestesia geral devido ao maior grau de gravidade dos casos. A média de dias de internação foi de 8,1 dias para pacientes sistemicamente comprometidos, contra 4,2 dos pacientes hígidos. O valor da PCR também foi fortemente influenciado pela doença de base, apresentando uma média de 45 mg/L para pacientes comprometidos contra menos de 20 mg/L dos pacientes sem alteração. Podemos concluir, portanto, que os pacientes sistêmicos devem ser tratados com uma atenção maior, porque tendem a apresentar maior trismo, maiores valores da PCR, maior necessidade de tratamento em centro cirúrgico, maior tempo de internação clínica e principalmente nas unidades de terapias intensivas, o que demonstra uma maior gravidade dos casos.
The objective of this research was to evaluate possible clinical and laboratory indicators that could determine a pattern in the evolution of infections and guide professionals to take a better approach to the case. Data were collected from 440 patients with a compatible and confirmed diagnosis of severe oral infection treated for 3 years at the Hospital Municipal Alípio Corrêa Netto in the city of São Paulo – SP. The data collection period was from July 1, 2018 to July 1, 2021. The presence of underlying diseases and trismus, the number of affected mouth spaces and whether or not changes in laboratory tests could determine a pattern were analyzed. in the course of treating serious oral infections. The mean age of the patients was 26.5 years, and the origin of the infection was the pulp in 80%. The main signs and symptoms observed were: Pain, Prostration, Trismus, Fever, Odynophagia and dyspnea. In 65% of the cases, multiple spaces were involved in the infection, with the submandibular (68.4%) and buccal (53.7%) spaces being the most frequently involved. The underlying disease variant was one of the most statistically significant in our study. We observed that most patients with underlying disease needed to be treated with general anesthesia due to the greater degree of severity of the cases. The mean length of hospital stay was 8,1 days for systemically compromised patients versus 4,2 for healthy patients. The CRP value was also strongly influenced by the underlying disease, with an average of 45 mg/L for compromised patients versus less than 20 mg/L for patients without change. We can conclude, therefore, that systemic patients should be treated with greater attention, because they tend to have greater trismus, higher CRP values, greater need for treatment in the operating room, longer clinical stays, especially in intensive care units, which demonstrates a greater severity of the cases.
The objective of this research was to evaluate possible clinical and laboratory indicators that could determine a pattern in the evolution of infections and guide professionals to take a better approach to the case. Data were collected from 440 patients with a compatible and confirmed diagnosis of severe oral infection treated for 3 years at the Hospital Municipal Alípio Corrêa Netto in the city of São Paulo – SP. The data collection period was from July 1, 2018 to July 1, 2021. The presence of underlying diseases and trismus, the number of affected mouth spaces and whether or not changes in laboratory tests could determine a pattern were analyzed. in the course of treating serious oral infections. The mean age of the patients was 26.5 years, and the origin of the infection was the pulp in 80%. The main signs and symptoms observed were: Pain, Prostration, Trismus, Fever, Odynophagia and dyspnea. In 65% of the cases, multiple spaces were involved in the infection, with the submandibular (68.4%) and buccal (53.7%) spaces being the most frequently involved. The underlying disease variant was one of the most statistically significant in our study. We observed that most patients with underlying disease needed to be treated with general anesthesia due to the greater degree of severity of the cases. The mean length of hospital stay was 8,1 days for systemically compromised patients versus 4,2 for healthy patients. The CRP value was also strongly influenced by the underlying disease, with an average of 45 mg/L for compromised patients versus less than 20 mg/L for patients without change. We can conclude, therefore, that systemic patients should be treated with greater attention, because they tend to have greater trismus, higher CRP values, greater need for treatment in the operating room, longer clinical stays, especially in intensive care units, which demonstrates a greater severity of the cases.
Descrição
Palavras-chave
infecção, Angina de Ludwing, Abscesso, abscess, oral diagnosis, angina Ludwing