闭合性腹部外伤胰腺损伤20例诊断及治疗体会

目的总结胰腺损伤的诊断和治疗经验。方法回顾性分析江阴市人民医院2001年10月—2008年10月收治20例胰腺损伤患者的临床资料。结果据美国创伤协会(AAST)分级标准,其中Ⅰ级3例,Ⅱ级5例,Ⅲ级6例,Ⅳ级5例,Ⅴ级1例。18例手术治疗,术后发生胰瘘6例,假性胰腺囊肿2例,腹腔脓肿3例;治愈18例,死亡2例。结论对腹部闭合性损伤的患者临床医师要保持高度的警惕,应考虑有胰腺损伤的可能。胰腺损伤早期诊断主要依靠外伤史,CT检查及腹腔穿刺液淀粉酶检查。根据MST胰腺损伤分级标准和患者全身情况决定手术方式能明显提高患者的生存率。     

Rectal impalement: a case review

Pediatric impalement injuries to the rectum are rare, and delays in diagnosis can be life threatening. We report the case of a young girl who was accidentally impaled on a dive stick. A review of historical aspects of rectal trauma and current management techniques are discussed. Rectal injuries in the pediatric population most often result from accidental impalement, sexual abuse, or blunt trauma. In contrast, most rectal injuries in adults are caused by missile wounds. Moreover, because rectal injury is fairly uncommon in children, physicians evaluating patients may miss signs of serious injury. Signs of external trauma may be minimal when rectal perforation exists, so delays in diagnosis are not uncommon.     

Injuries Caused by Small Wheel Devices

We wanted to look for characteristics in injuries caused by rollerblades, skateboards and unmotorized kick scooters in order to recommend more targeted injury prevention. From September 2000 we did a two-year prospective registration of all small wheel device injuries attending Bergen Accident and Emergency Department's surgical unit. We registered a total of 273 injuries, and found an obvious difference in injury pattern between the three. Rollerbladers were more prone to fractures in their hands and arms, especially distal radial fractures, but also scaphoid fractures. This fracture is seldom in children, but not in child injuries caused by small wheel devices. Skateboarders were susceptible to ankle sprains and had the lowest injury severity among the three activities. Kick scooter users got mostly wound injuries, but had a high frequency of distal radial fractures with volar angulation, the Smith-type of fracture. There were also differences in user groups; 2/3 of injured rollerbladers were boys, mostly aged 12, a typical, injured skateboarder was a young male aged 13, and an injured kick scooter user was either an 11-year-old girl or boy. The use of effective wrist braces could have prevented most injuries in both rollerblading and kickscootering. Due to the high susceptibility of small wheel devices to uneven grounds resulting in falls, these activities should be prohibited in traffic and darkness. Preventive advice should preferably reach children aged 11 to 13.     

广州地区3～6岁流动儿童意外伤害特征及相关因素分析

目的了解流动儿童意外伤害的特征及影响因素,为制定流动儿童伤害的预防和控制措施提供依据。方法采用随机整群抽样法对广州市3~6岁流动儿童进行伤害特征及影响因素调查。结果学龄前流动儿童伤害发生率为34.97%,一年内发生2次及以上伤害发生率为9.30%,男女比例为1.14∶1。跌落是伤害主要原因,家庭是发生伤害的重要场所,发生伤害时多数儿童在娱乐活动或行走,父母在身边看护。流动儿童伤害受儿童班级、母亲年龄、母亲文化程度等因素影响。结论流动儿童意外伤害发生较普遍,应针对流动儿童伤害特点尽早开展相应的干预措施,提高儿童父母的安全意识和监管力度,加强对家庭环境的干预,防止儿童伤害。     

Epidemiology of eye injuries in Abidjanian children

Eye injuries, most of them preventable, are particularly severe in Africa, because of the risks of infection and delay in treatment. We report a 16-month (March 1997-June 1998) prospective observational survey of eye injuries in children up to the age of 15 years at Treichville-Abidjan University Hospital. During this period, 62 children were treated for these injuries. Ocular traumas represented 4% (n = 245) of new admissions in ophthalmology, and 29% of these injuries occurred in children. The sex ratio was 5:2 boys to girls, and their mean age was 8.66 +/- 3.56 years. Eye injuries occurred most often during play (84%, n = 52). More than 85% (n = 53) of children were alone or without adult supervision at the time of the injury. The causal agent was most often wood (35%) followed by metal (29%). The mean time from injury to hospital admission was 1.8 +/- 0.77 day. Only 19% of patients were admitted the day of injury. Most patients (66%) first sought treatment in a primary care centre. More than 70% (n = 44) of injuries necessitated hospitalisation. Open eyeball wounds were the most common injury (53%) and were associated with endophthalmitis in 16%. The mean recovery of visual acuity was 0.1. At admission, 40 of the injured eyes (64.5%) had monocular blindness; six recovered, for a final blindness rate of 55%. Injuries associated with wooden objects had a final blindness rate of 77% and play-related injuries 63%. The primary posttraumatic sequelae were corneal scars. Eyeball phthysis (14.5%) was secondary to 8 open wounds of the eyeball and one postcontusion retinal detachment. Eye injuries remain a major cause of monocular blindness in children in Cote d'Ivoire. Most of them can be prevented by relatively simple measures including supervision of children and rapid hospitalisation when injury occurs.     

闭合性胰腺损伤58例临床分析

目的：总结闭合性胰腺损伤的诊治经验,提高其诊断、手术及并发症防治水平。方法：回顾性分析58例闭合性胰腺损伤的一般资料、致伤原因、临床表现、合并伤、诊疗经过与预后,并按损伤严重程度分组,采用x2检验与Fisher确切概率法进行轻、重度伤组间比较分析。结果：轻度胰腺损伤32例、重度胰腺损伤26例。交通意外为最常见的致伤原因（75.9%）,合并伤50例（86.3%）,CT诊断符合率44.0%;1例非手术治疗,57例于伤后2～36小时内剖腹手术。术后23例（40.4%）发生并发症,胰瘘为最常见并发症（26.3%）。治愈53例,死亡5例（8.6%）。结论：闭合性胰腺损伤早期诊断,及时有效手术是治疗成功的关键。     

邯郸市中小学生意外伤害的流行病学调查

为了解邯郸市中学生意外伤害的种类，原因及地点，拟订防治儿童意外伤害的措施。方法采用取多级抽样方法对中小学生过去一学年的意外伤害进行了流行病学调查。结果意外伤害率为１０．８２％，男生高于女生，小学生高于中学生，伤害人次率居前５位的跌伤（４．３１％）、碰伤（３．２４）、车辆伤（２．３２％）、烧烫伤（１．６８％）和刀剪等锐器伤（１６．６８％）。伤害原因主要是体育运动、骑车、玩耍打架和劳动。结论意外伤害的     

凤冈县农村学龄儿童运动伤害现况及危险因素分析

目的 了解遵义市凤冈县农村学龄儿童运动伤害现状及危险因素,为制定相关预防措施提供科学依据。方法 采用多阶段整群随机抽样抽取遵义市凤冈县三所中小学四至七年级学生共465名,用自制问卷调查近一年运动伤害发生情况。结果 凤冈县农村儿童运动伤害年发生率为18.71%,男童高于女童（22.63% vs 14.41%）;七年级儿童运动伤害发生率最高为29.28%,五年级最低为7.76%;留守儿童高于非留守儿童（22.26% vs 12.20%）;住校儿童高于走读儿童（24.53% vs 13.83%）;伤害时的主要活动是奔跑（33.33%）;损伤类型主要是擦伤（40.23%）。多因素Logistic回归分析显示:运动前未热身（OR=3.834,95% CI:1.362～10.792）,无人陪护（OR=2.403,95% CI:3.742～30.616）,在水泥地板上运动（OR=4.175,95% CI:1.457～11.964）,穿皮鞋（OR=7.301,95% CI:1.736～30.705）或者凉鞋（OR=4.316,95% CI:1.245～14.966）是伤害发生的危险因素。关于“扭伤后冷敷”,未发生伤害儿童的知晓率高于发生伤害儿童（χ2=5.36,P=0.021）,其它问题的知晓率差异无统计学意义（均有P>0.05）。结论 凤冈县农村儿童运动伤发生的危险因素较为明确,应给予针对性的干预措施,从而降低伤害发生率。     

上海市浦东新区2011-2012年0~6岁婴幼儿伤害情况分析

目的 分析2011-2012年上海市浦东新区0~6岁婴幼儿伤害情况, 为制定相应的伤害预防措施提供科学依据。方法 采用描述性研究方法, 以2011-2012 年上海市浦东新区0~6岁婴幼儿伤害患者为研究对象, 分析患者年龄、性别和伤害类型、原因、发生地点和伤害发生时的活动的关系。结果 共报告1 336 例0~6岁婴幼儿伤害病例, 平均年龄为(3.83±1.61)岁, 男女童比为1.73∶1;婴幼儿伤害患者前3 位的伤害类型依次为挫伤或擦伤(46.48%)、锐器伤或咬伤或开放伤(32.49%)、扭伤/拉伤(10.25%), 主要发生原因依次为跌倒或坠落(54.49%)、刀或锐器伤(19.16%)和钝器伤(12.20%);有64.82%的伤害发生在家中, 36.08%的患者伤害部位是头部, 多在休闲活动时发生伤害(74.93%)。结论 浦东新区婴幼儿伤害主要是在家中休闲活动时跌落受到的伤害(尤其挫伤或擦伤), 因此, 婴幼儿伤害预防的优先领域是家庭内跌落伤预防。     

湖南农村学龄儿童意外伤害及影响因素多水平模型分析

目的 了解湖南农村学龄儿童意外伤害发生现状及可能影响因素。方法 采用分层整群抽样的方法,于2013年4月～8月,在我省经济发达程度不同的三个区域抽取12个村合计1 083名学龄儿童作为调查对象,收集、整理资料并运用SPSS 17.0和MLwiN 2.0软件进行统计分析。结果 在过去一年内,农村61.0%的学龄儿童发生过意外伤害,71.6%的伤害发生在家里或学校,56.7%的儿童伤后仅自行处理或未处理,63.3%的伤害无资金花费,21.0%的伤害会影响美观、导致活动长期受限或致残;多水平模型显示,年龄、性别、民族、性格、体质指数、父母外出务工情况等6个因素对意外伤害发生情况有影响。结论 应以8岁以上、男童、性格外向、体质指数异常、留守儿童为重点监护对象,树立其安全防护意识,提高意外伤害的预防和救助水平,大力加强经济欠发达区域对农村儿童意外伤害的投入力度。     

Children with hearing loss and increased risk of injury

PURPOSE Few studies have tested the hypothesis that children with sensory disabilities such as deafness may be at increased risk of injuries. To test this hypothesis, this study compared rates of emergency department or hospital treatment for injury among Medicaid-insured South Carolina children with and without a diagnosis of hearing loss.METHODS Medicaid billing data for 2002–2003 were obtained from the South Carolina Office of Research and Statistics. International Classification of Diseases, Ninth Revision, Clinical Modification billing codes were used to identify children with and without hearing loss, and episodes of injury-related emergency department or hospital treatment were compared for the 2 groups.RESULTS Rates of injury treatment in children with hearing loss were more than twice that of the control group (17.72 vs 8.58 per 100, respectively). The relative rate (RR) remained significantly higher (RR = 1.51, 95% confidence interval, 1.30–1.75) after adjusting for age, race, sex, and the number of hospital or emergency department encounters for treatment of non–injury-related conditions. Children with hearing loss had significantly higher treatment rates for every injury type, bodily location, and external cause, with a cell size sufficient for valid comparison.CONCLUSIONS Children with hearing loss may be at increased risk of injury. Additional study is needed to determine whether children with hearing loss are at increased risk (as opposed to simply seeking hospital care for injuries more often). If so, targeted injury prevention efforts for these children and their families would be warranted.     

Bicycle spoke-related injuries in children: emphasise prevention

Three children, a 6-year-old boy and two girls aged 5 and 4 years, were seen at an emergency department due to distal lower-leg injuries sustained from the spokes of bicycle wheels. All three patients had been passengers on rear carrying seats of moving bicycles. Only the third bicyclist had used a special child safety seat. The second girl had drawn her foot up from underneath a strap and suffered a tibial fracture later treated with an osteosynthetic plate. The other two patients recovered after conservative casting treatment. Bicycle spoke-related injuries are sustained when the foot or lower limb makes contact with the spokes of a bicycle wheel and usually by children who are bicycle passengers. In the Netherlands, approximately 4600 children are seen at emergency departments with such injuries each year. Bicycle spoke-related accidents can cause severe damage that can result in lengthy recovery periods. Not only physical complications but also psychological ones can occur. The latter are often overlooked but do deserve proper treatment. The physician treating a spoke-related injury is in a good position to advice parents as to preventive measures, particularly on the use of special child safety seats.     

Three children with pancreatic (pseudo)cysts as the cause of undefined abdominal pain

Three children, two boys aged 5 years and one 2-year-old girl, who were referred because of abdominal pain of variable duration, were found to have cystic malformations that arose from the pancreas. In the first boy, a traumatic pseudocyst was found that eventually turned out to have been caused by child abuse. The second boy had pseudocysts complicating chronic pancreatitis of presumably hereditary origin. In the girl, a congenital pancreatic cyst was found. Pancreatic disease, although rare, should be considered in the differential diagnosis of abdominal pain in children.     

基于社区卫生服务中心报告的浦东新区0～14岁儿童伤害情况分析

目的分析2011年上海市浦东新区社区卫生服务中心报告的0～14岁儿童伤害情况,为制定相应的伤害预防措施提供科学依据。方法采用描述性研究方法,以2011年上海市浦东新区社区卫生服务中心报告的0—14岁儿童伤害患者为研究对象,分析患者年龄、性别与伤害类型、原因、发生地点以及伤害发生时活动的关系。结果共报告1761例儿童伤害病例,平均年龄为（7．72±3．80）岁,男女童比为2．14：1;儿童伤害患者前3位的伤害类型依次为挫伤／擦伤（44．12％）、锐器伤／咬伤／开放伤（31．23％）、扭伤／拉伤（13．34％）;主要发生原因依次为跌倒／坠落（57．47％）、刀／锐器伤（19．82％）和钝器伤（10．96％）;有44．24％的伤害发生在家中,34．41％的患者伤害部位是上肢,多在休闲活动时发生伤害（60．82％）。结论浦东新区儿童伤害主要是在家中休闲活动时受到的伤害（尤其挫伤或擦伤）,发生原因主要是跌倒／坠落,因此,儿童伤害预防的优先领域是家庭内跌落预防。     

Comparing unintentional and intentional injuries in a school setting

This study determined the incidence of violence-related injuries in an urban school district, and compared characteristics of unintentional and intentional school injuries. A sample of student Accident Report Forms completed for a school district in 1997 were reviewed for demographic characteristics of the student and injury characteristics. Injuries were categorized as unintentional, intentional, or of unknown intent. Annual incidence rates of injury per 100 students were calculated by intention, grade, and gender. Comparisons between unintentional and intentional injuries were made using odds ratios and 95% confidence intervals. Of 11,674 annualized injuries, 77.2% were unintentional, 16.8% were intentional, and 6.0% were of unknown intent. The overall annualized injury rate was 1.74 injuries per 100 students/year. The unintentional injury rate was almost five times the intentional injury rate of 0.29 injuries per 100 students/year. High school students had both the highest unintentional and intentional injury rates. Males in all grade levels had the highest rates of injury. Most injuries occurred during school hours. Intentional injuries were almost three times more likely to be associated with unstructured play or after school playground hours; were less likely to be witnessed events; and were more likely to occur on the surrounding school grounds than unintentional injuries. Unintentional injuries represent a greater risk to school children than do intentional injuries. A potential area to focus interventions for intentional injuries are modifications of the school environment and surrounding grounds to improve supervision and monitoring.     

慈溪市儿童意外伤害流行特征分析

目的了解慈溪市0～6岁儿童意外伤害发生的流行特征,为制定有针对性的儿童意外伤害干预措施提供科学依据。方法收集2006-2009年慈溪市3家国家医院伤害监测点所有初诊的0～6岁儿童意外伤害病例报告卡片,统计分析儿童意外伤害发生的原因、性质等特征。结果因意外伤害初诊的儿童7 564例,其中男童占65.04%,明显多于女童(34.96%)。2～4岁年龄段(52.62%)是0～6岁儿童发生意外伤害的高峰年龄段,儿童发生意外伤害的前三位原因是跌倒和坠落(53.46%)、动物咬伤(22.50%)、烧烫伤和机动车车祸(5.42%和5.25%)。儿童伤害的发生在家中(58.28%)最多,其次是街道公路上(13.96%)。伤害最严重的性质前三位是挫伤擦伤(46.13%),锐器伤、咬伤、开放伤(30.12%),扭伤、拉伤(7.52%)。结论意外伤害是危害儿童生命和健康的主要原因,加强儿童意外伤害教育和预防工作,是全社会的责任。     

2006-2010年河北省儿童伤害病例监测分析

目的分析河北省儿童伤害状况和危害程度,为制定有效的干预措施提供科学依据。方法资料来源于秦皇岛市、藁城市各3家不同级别伤害监测哨点医院急诊室。对2006年1月1日至2010年12月31日首次就诊于哨点医院的儿童伤害病例资料进行分析。结果共收集10738例伤害病例,男性多于女性,男女性别比为2．54：1,男、女性别伤害原因构成的差异有统计学意义（χ2=259．72,P〈0．01）;前5位伤害病例的原因依次是跌倒或坠落（38．94％）、机动车车祸（19．04％）、钝器伤（18．69％）、刀或锐器伤（7．15％）和非机动车车祸（6．71％）。钝器伤是15—17岁年龄组的首位伤害原因;火器伤、烧烫伤、窒息或悬吊、溺水和中毒造成的伤害程度较重;伤害部位以头部为主;伤害发生时间有一定规律性;自残或自杀造成的伤害病例78．38％需观察或住院或转院。结论河北省2006—2010年儿童伤害以跌倒或坠落、机动车车祸和钝器伤为主,监测的儿童病例数随年龄的增加而增加。在儿童青少年中应积极开展伤害预防控制工作。     

儿童意外伤害个性倾向特征相关因素研究

【目的】 了解武汉市儿童伤害的发生现状以与个性倾向特征的相关因素,为科学干预提供依据。 【方法】 采用分层随机整群抽样方法,按老街道、城乡结合部(流动人口密集地)、城关、乡镇等四个层次,抽取城区7条街道、郊区的2个城关和4个乡镇,调查表采用了儿童安全联盟(TASC)在亚洲各国普遍应用的调查表为基本模板,根据本市实际情况进行了必要的修订。 【结果】 武汉市儿童伤害的发生率为78.7%,其中郊区儿童多于城区儿童,男童多于女童。个性倾向特征中伤害组儿童性格特征粗心、暴躁、独立、主动的儿童比例显著高于未伤害组(P<0.01),经常打架、受过他人威胁、威胁过他人、喜欢棍棒等追打、喜欢爬到高处玩耍、喜欢独自玩耍的儿童伤害比例也均高于未伤害组(P<0.05)。 【结论】 提示儿童意外伤害的高频发生不容忽视,儿童个性倾向特征部分与儿童意外伤害的发生有关,对控制与干预儿童意外伤害有着一定的指导作用。     

菏泽市东明县农村儿童意外伤害特征及其影响因素研究

目的 了解14岁以下农村儿童非致死性意外伤害的流行特征及其影响因素, 为当地儿童意外伤害的预防干预提供理论依据。方法 采用整群分层抽样方法抽取菏泽市东明县乡镇4所中小学及2所幼儿园的儿童475名为调查对象进行自拟问卷调查, 数据经SPSS 13.0软件进行统计分析。结果 调查的475名农村儿童意外伤害发生率为40%。碰撞(20.53%)、跌落(18.95%)、中毒(13.68%)为农村儿童意外伤害类型的前三位。农村儿童意外伤害的发生地点主要在家中(25.3%)和休闲活动场所(23.7%), 发生部位以上肢和头面部为主, 农村儿童意外伤害发生的严重程度中致残占3.1%。性别、(父)母亲文化程度、儿童性格以及是否留守儿童是农村儿童发生意外伤害的危险因素。伤害组家长的意外伤害认知低于非伤害组, 差异有统计学意义(t=-9.952, P<0.05)。结论 菏泽市农村儿童意外伤害发生率较高, 伤害类型以跌落、碰撞为主;影响儿童意外伤害的因素以家长的文化程度及对伤害的认知最为明显。     

2006-2015年全国伤害监测系统中儿童暴力病例变化趋势及现况特征分析

目的 了解中国儿童暴力门/急诊病例变化趋势及现况特征，为探索儿童暴力危险因素、确定干预优先领域、制定相关干预措施和政策提供依据。方法 利用2006-2015年全国伤害监测系统（NISS）监测数据，对儿童暴力门/急诊病例的变化趋势及人口学、暴力事件和临床等现况特征进行分析。结果 2006-2015年NISS共收集儿童暴力病例44 319例，儿童暴力病例数占儿童伤害总病例数的比例逐年下降。2015年儿童暴力病例中，男童占81.31%，儿童暴力病例占儿童伤害病例比例的男女比为2.22：1；儿童暴力原因为钝器伤病例占65.69%；儿童暴力病例数在2月和7-8月出现两次降低；48.87%的暴力发生在学校和公共场所；伤害性质63.52%为挫伤/擦伤，伤害部位51.18%为头部，轻伤病例占82.66%，伤者83.21%的就医结局为治疗后回家。结论 我国儿童暴力问题不容忽视，应重点关注中学男童，加强健康教育，建设安全校园，防止校园暴力的发生，提高儿童自我保护意识，减少严重暴力的发生。