CAJ | 학술논문

目的探讨儿童多发伤的临床特点.方法回顾性分析2006年1月至2011年12月五年间收住我院治疗的112例儿童多发伤患者临床资料.112例中男80例,女32例；年龄8个月至14岁,平均7.1岁.致伤原因:交通事故伤68例,占60.7％.高空坠落伤发生率38例,占33.9％.其他原因6例,占5.4％.损伤部位:颅脑95例(占84.8％)和四肢92例(占82.1％)为最易受伤的部位,其次为胸部67例(占59.8％)、皮肤及软组织28例(占25.0％)、骨盆26例(占23.2％)、腹部25例(占22.3％)、脊柱11例(占9.8％)、颌面部7例(占6.3％)、截瘫3例(占2.7％).就诊时伴失血性休克48例.入院后均由多学科协作进行综合治疗,包括颅内血肿清除16例次、剖腹探查5例(包括脾切除1例,胃肠修补2例,肠造瘘2例)、皮肤及软组织清创及封闭负压引流26例次、截肢及肢体残端修整术4例次、肺修补1例、肢体外固定或骨牵引术13例次以及麻醉科中心静脉置管9例次,尿道吻合术3例次等.后期由各专业针对性治疗包括骨折切开复位内固定术34例次、硬膜下积液颅骨钻孔引流术6例次等.结果 112例住院时间1～66 d,平均26 d.其中在ICU收治时间1～22 d,平均8.2d.救治成活107例(95.5％),院内死亡5例(4.5％).继发肾功能衰竭10例次,应激性溃疡14例次,多脏器功能衰竭7例次.死亡原因包括严重颅脑损伤4例、严重失血性休克伴多脏器衰竭1例.结论儿童多发伤常发生在学龄前期及青少年期,道路交通伤、高空坠落伤是其主要致伤原因.死亡原因多为严重颅脑损伤.儿童多发伤致伤能量大,伤情涉及多系统、多脏器和多部位,需多学科协作急诊处理.ICU为主导对生命的整体救治与外科专科医生对创伤局部处理,是保证儿童多发伤早期救治成功的关键.
목적 탐토인동다발상적림상특점.방법 회고성분석2006년1월지2011년12월오년간수주아원치료적112례인동다발상환자림상자료.112례중남80례,녀32례；년령8개월지14세,평균7.1세.치상원인:교통사고상68례,점60.7％.고공추락상발생솔38례,점33.9％.기타원인6례,점5.4％.손상부위:로뇌95례(점84.8％)화사지92례(점82.1％)위최역수상적부위,기차위흉부67례(점59.8％)、피부급연조직28례(점25.0％)、골분26례(점23.2％)、복부25례(점22.3％)、척주11례(점9.8％)、합면부7례(점6.3％)、절탄3례(점2.7％).취진시반실혈성휴극48례.입원후균유다학과협작진행종합치료,포괄로내혈종청제16례차、부복탐사5례(포괄비절제1례,위장수보2례,장조루2례)、피부급연조직청창급봉폐부압인류26례차、절지급지체잔단수정술4례차、폐수보1례、지체외고정혹골견인술13례차이급마취과중심정맥치관9례차,뇨도문합술3례차등.후기유각전업침대성치료포괄골절절개복위내고정술34례차、경막하적액로골찬공인류술6례차등.결과 112례주원시간1～66 d,평균26 d.기중재ICU수치시간1～22 d,평균8.2d.구치성활107례(95.5％),원내사망5례(4.5％).계발신공능쇠갈10례차,응격성궤양14례차,다장기공능쇠갈7례차.사망원인포괄엄중로뇌손상4례、엄중실혈성휴극반다장기쇠갈1례.결론 인동다발상상발생재학령전기급청소년기,도로교통상、고공추락상시기주요치상원인.사망원인다위엄중로뇌손상.인동다발상치상능량대,상정섭급다계통、다장기화다부위,수다학과협작급진처리.ICU위주도대생명적정체구치여외과전과의생대창상국부처리,시보증인동다발상조기구치성공적관건.
Objective To explore the clinical manifestations and outcomes of multiple traumas in children.Methods A retrospective study was performed for 112 inpatients with multiple traumas at our hospital from January 2006 to December 2011.There were 80 males and 32 females with an average age of 7.1 years.The causes of multiple traumas were traffic injury (n =68),fall injury (n =38),tumbling injury (n =3) and crushing injury (n =3).According to sites,there were head injuries (n =95),extremity fractures (n =92),thoracic traumas (n =67),blunt abdominal injuries (n =25),pelvic fractures (n =26),spinal injuries (n =11),skin or soft tissue injuries (n =28) and paralysis (n =3).There were 48 cases of hemorrhagic shock.After admission,they were immediately diagnosed and treated by a team of multidisciplinary surgeons in intensive care unit (ICU).Results The average hospital stay was 26 (1-66) days and the average length of ICU stay 8.2 (1-22) days.Among them,107 (95.5％) cases were rescued successfully.The outcomes were acute kidney failure (n =10),stress ulcer (n =14),multiple organ failure (n=7) and death (n =5).Four died from severe head injuries and one of them 1 case due to multiple organ failure.Conclusions Multiple injuries occur frequently in preschoolers and children aged 11-14 years as a result of road traffic accidents and fall injuries.Head and extremities injuries are the most common types.And multiple injuries are complicated with diverse clinical manifestations,numerous complications and high mortalities so that multidisciplinary medical management mode is essential.