112例儿童多发伤的临床特点分析

Clinical manifestations and outcomes of 112 children with multiple traumas

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2．70,4）。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1～66d，平均26d。其中在ICU收治时间1～22d，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。

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 aver- age 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）, pel- vic fractures （n = 26）, spinal injuries （n = ll）, 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 in- juries and one of them I case due to multiple organ failure. Conclusions Multiple injuries occur fre- quently in preschoolers and children aged 11-14 years as a result of road traffic accidents and fall in}u ries. 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 multidiscipli- nary medical management mode is essential.