76例小儿胸部损伤的急救处理

目的分析临床病例，探讨小儿胸部损伤的急救治疗原则。方法回顾我院小儿科和胸心外科2000～2004年收治的76例胸部损伤患儿，其中男57例(75％)，女19例(25％)，总结其临床特点。结果76例患儿中，60例保守治疗，16例接受手术，无死亡病例。结论小儿胸部损伤的诊断和治疗有别于成人。正确及时的急救处理对抢救患儿生命尤为重要。     

重症小儿胸部损伤诊治的临床观察

目的 探讨重症小儿胸部损伤的诊断治疗原则.方法 回顾分析1998年3月～2007年10月收治的117例重症胸部损伤患儿,其中男83例(71%),女34例(29%),车祸伤50例,锐器伤46例,高处坠落伤15例,挤压伤4例,枪弹伤2例.发生休克29例(32%).92例(79%)给予胸腔闭式引流等保守治疗,25例(21%)接受剖胸手术.结果 109例(93%)患儿治疗后恢复良好,8例(7%)死亡,均为多发伤,其中手术中死亡2例,分别为合并颅脑损伤和脾破裂.结论 小儿胸部损伤病情多样,正确及时的诊治措施是抢救患儿生命的关键.     

小儿颅脑外伤的临床特点与急救

报告52例小儿颅脑外伤的急救治疗结果。轻型颅脑损伤21例(40.4%),中型颅脑损伤19例(36.5%),重型颅脑损伤12例(23.1%)。41例(90.4%)有昏迷史,5例(9.6%)表现意识朦胧、嗜睡。手术治疗20例(38.5%),非手术治疗32例(61.5%)。恢复良好者27例(51.9%),中残16例(30.8%),重残4例(7.7%),死亡3例(5.8%),退院2例(3.9%)。作者认为正确掌握小儿颅脑外伤特点、手术和非手术治疗适应症及急救措施有助于指导临床工作。     

小儿急性中毒68例临床分析

目的对我院近三年收治的68例小儿急性中毒病例进行总结,分析急性中毒的相关因素及临床特点。方法对68例急性中毒患儿按中毒发生的原因等不同情况进行归类分析。结果小儿急性中毒中药物中毒占69.1%(47/68),一氧化碳中毒占19.1%(13/68),食物中毒占11.8%(8/68)。2~7岁为小儿中毒的高发人群。较大儿童急性中毒多系有意识行为。结论急性中毒的预防和急救是儿科急诊抢救的关键。     

感染所致小儿高颅压445例临床分析

颅内高压征是儿科常见急症,处理不当可导致患儿死亡。现将本科近年来收治的445例感染所致高颅压病例分析如下:临床资料一、一般资料:男257例,女188例,男:女=1,4:1,～1岁76例,～3岁96例,～7岁110例,～14岁163例,其中中枢感染402例(化脑199例,病脑86例,结脑117例)。其余43例均为中毒性痢疾,二、诊断:根据全国小儿急救医学会议所定之临床诊断标准。三、临床表现:头痛215例(48.3%)呕吐330例(74.1%),视乳头水肿8例(1.8%),呼吸不规则47例(11%),     

损伤控制外科技术在小儿严重胸部创伤急救中的应用

目的 探讨损伤控制外科技术(damage control surgery,DCS)在小儿严重胸部创伤急救中的应用疗效.方法 回顾性分析我科应用损伤控制外科技术救治的10例严重胸部创伤的小儿患者与常规外科手术治疗的5例胸部外伤小儿患者临床资料,分为DCS组和对照组.比较两组患者术前创伤严重程度评分(ISS)及复苏期患者体温、血pH值、PT值和血氧饱和度值变化情况.结果 术前DCS组和对照组ISS评分分别为24.28±6.43和23.54±5.96,两组差异无统计学意义(P＞0.05);复苏期体温变化两组分别为(37.04±0.62)℃和(36.46±0.94)℃,差异无统计学意义(P＞0.05),DCS组体温变化更趋于平稳;DCS组和对照组复苏期血pH值分别为7.38±0.10和7.26±0.07、PT值分别为21.34±5.20和29.82±6.25和血氧饱和度值分别为(96.43±4.38)％和(90.18±3.25)％,两组相比差异有统计学意义(P＜0.05);两组患儿术后康复情况比较,DCS组明显优于对照组.结论 对于严重胸部创伤的小儿患者采用损伤控制外科手术处理效果明显优于传统常规手术,在挽救生命的同时对促进术后患儿康复亦起着重要作用.     

小儿广朴止泻口服液治疗婴幼儿轮状病毒肠炎76例疗效观察

目的观察小儿广朴止泻口服液治疗婴幼儿轮状病毒性肠炎的疗效。方法 126例轮状病毒性肠炎患儿随机分为观察组76例和对照组50例。对照组给予常规治疗,观察组在常规治疗的基础上加用小儿广朴止泻口服液治疗,治疗期间观察两组体温、大便性状及次数、脱水、呕吐、腹胀及副反应。结果治疗后观察组总有效率97.36%(74/76),对照组82.0%(41/50),两组比较差异有统计学意义(P<0.05)。两组均无副反应出现。结论小儿广朴止泻口服液治疗婴幼儿轮状病毒性肠炎疗效确切,值得临床推广使用。     

推拿疗法治疗小儿肌性斜颈32例疗效观察

目的观察推拿治疗小儿肌性斜颈的临床疗效。方法选取32例门诊肌性斜颈患儿,采用推拿治疗,观察治疗前后临床症状的变化。结果 32例肌性斜颈患儿,痊愈25例(78.13%),好转7例(21.87%),总有效率100%。结论推拿治疗能明显改善小儿肌性斜颈的临床症状,值得推广使用。     

小儿院外心跳停止的病因及预后分析

目的了解小儿院外心跳停止(OHCA)的病因及影响预后的因素。方法2000年1月～2003年4月我院急诊创伤中心接受OHCA67例,全部病例经过正规的心肺复苏(CPR)。详细记录患儿原发病史和或急性发病经过,从心跳呼吸停止到CPR的间隔时间,转运方式,院前有无CPR,复苏前后心电图。创伤患儿记录脊柱、颈椎保护措施。结果死亡65例(97%),存活2例(3.0%)。OHCA主要死亡原因:意外伤害22例(32.8%),伴有原发基础疾病者21例(31.3%),急性感染性疾病14例(20.9%)。心跳停止到CPR平均时间15min(5～30min)。全部病例没有院前CPR经历。创伤患儿院前无脊柱、颈椎保护措施。患儿转送医院方式以乘坐公交车为多,由120救护车转入占10%。来院时ECG无电活动60例(89.6%),心电机械分离7例(10.4%)。结论小儿OHCA发生率低、病死率高、预后差。小儿心跳停止的EKG波型以心室无收缩、一直线等电位为主。小儿OHCA病因顺位的前三位分别是意外伤害、原发基础疾病、急性感染性疾病。要降低OHCA病死率首先应降低意外伤害的发生率。全民普及急救知识,加强医疗人员高级生命支持的培训,加强急诊治疗服务体系的建设,尤其是建立完善的院前急救和转运系统,从而提高小儿OHCACPR的成功率。     

98例儿童滑雪运动损伤的临床特点及处理策略分析

目的分析并总结我国儿童滑雪伤的临床特点。方法回顾性分析2019年12月至2020年12月因滑雪运动损伤就诊于北京积水潭医院小儿骨科的98例患儿临床资料。其中男62例(63.3%, 62/98), 女36例(36.7%, 36/98);患儿平均年龄为9.8岁, 范围在4.4～14.0岁;单板滑雪运动致伤患儿51例(52.0%, 51/98), 双板滑雪致伤患儿47例(48.0%, 47/98)。分析患儿的年龄性别分布、损伤部位、损伤类型、受伤至就诊时间及治疗方案的选择, 总结儿童冰雪运动损伤的临床特点。结果 98例患儿中, 软组织损伤15例(15.3%, 15/98), 以膝关节扭伤(33.3%, 5/15)及大腿损伤(20.0%, 3/15)最为多见;骨折83例(84.7%, 83/98), 以胫腓骨干骨折(38.6%, 32/83)和尺桡骨远端骨折(20.5% , 17/83 )发生率最高。单板滑雪损伤最常见的部位为腕关节周围(27.5%, 14/51)及小腿(27.5%, 14/51), 而双板滑雪以小腿损伤最为常见(40.4%, 19/47)。35.7%(35/98)的患儿因不慎...     

Thoracotomies in children

Thoracotomies in children have been less extensively studied, as the incidence of diseases necessitating thoracotomies is low in the pediatric age group. This study reviews childhood thoracic diseases, thoracotomy approaches, indications, and complications. Surgical procedures and complications of a total of 196 children below 16 years of age who underwent thoracotomy for various reasons at the Department of Thoracic Surgery, Ataturk Chest Diseases and Chest Surgery Training and Research Hospital, between January 2000 and December 2004, were reviewed in this study. Out of the 196 patients, 77 were female (39%) and 119 (61%) were male. The most commonly encountered indications for surgery were hydatid cyst (35%), bronchiectasis (25%), chronic nonspecific pleuritis (13%), chest wall deformities (10%), and mediastinal cystic formations and masses (10%). The other indications included tuberculosis (3%), aspergilloma (0.5%), fibrohyalinized cyst (0.5%), resection of trachea (0.5%), bronchogenic cyst (0.5%), inflammatory pseudo-tumor (0.5%), sequestration (1%), lipoblastoma (0.5%), and eosinophilic granuloma (1%). Out of the 196 patients, 176 underwent lateral thoracotomy and 20 patients with a chest wall deformity underwent midsternal incision. Complications were seen in 35 patients (18%): atelectasia and secretory retention (54%), wound infection (17%), hemorrhage (3%), chylothorax (3%), intrathoracic space (3%), and postoperative extended air leakage (20%). The mean hospital stay was 15 days and we did not encounter any mortality. The physiology and anatomy of the respiratory system and especially the respiratory control mechanism in pediatric patients vary from those of the adults, resulting in a more morbid course after thoracic surgery in children. Despite severe postoperative pain, posterolateral thoracotomy is the preferred approach in adults because of an advanced intrathoracic exposure and easy manipulation. On the other hand, lower pain threshold and the different types of diseases seen in children make lateral thoracotomy a more appropriate choice for thoracotomy, which, at the same time, spares the serratus anterior muscle decreasing its negative impact on postoperative respiratory function.     

Clinical profile of thoracic trauma in children--a study from Aligarh, N. India

A total of 60 cases of thoracic trauma in children, treated over a period of 4.5 years (January 1983 to June 1987), were analysed. Blunt-impact trauma was the major cause in 58.33% cases, stressing that bullock-cart accidents and bull-horn and buffalo-hoof injuries are still a continuing cause of chest injury in developing countries. Haemo- and/or pneumothorax were the main injuries (78.33%), but cardiac and oesophageal involvement were seen, in two cases each. Isolated first rib fracture was another surprising finding. Except for three, all the cases presented within 24 h of injury. Cyanosis and profound shock were found in five patients each. The majority of the patients (60%) were treated with intercostal tube drainage and major surgical operations were needed in 30%. In the remaining 10%, observation was sufficient. There were two deaths (3.33%), with a success rate of 96.67%.     

Gastroesophageal reflux and diaphragmatic motility after repair of congenital diaphragmatic hernia.

At the Department of Pediatric Surgery in Graz, 31 boys and 23 girls were operated on for congenital diaphragmatic hernia (CDH) from 1978 to 1994. In 49 patients the defect was on the left, in five on the right side. In 46 cases, the hernia was diagnosed within the first week of life; in eight children at a later date. 19 children (35%) died. 25 of the 35 survivors (71%) came to a follow-up examination on average 9.4 (1-17) years after the operation. 24 h pH-monitoring or manometry and Upper G.I. series revealed pathological gastroesophageal reflux (GER) in 16 patients. Nine children were treated conservatively; in seven patients an antireflux procedure was performed. A thoracic position of the stomach or left liver lobe, presence of a hernial sac, gestational age, prenatal diagnosis, use of a patch or severity of lung hypoplasia did not significantly influence the incidence of GER. In three patients, a hiatal hernia was found. The motility of the diaphragm was documented with M-mode sonography (n = 18); a restricted motility could be demonstrated in five patients. GER is very common in patients after repair of CDH. We recommend long-term follow-up with special interest in respect of GER.     

Analysis of horse-related injuries in children

Purpose  The purpose of the present study was to investigate factors affecting the nature, characteristics, severity and outcome of horseback and horse care injuries in paediatric patients and to create guidelines for injury prevention. Methods   Detailed clinical records of 265 children sustained horse-riding related injuries have been analysed. Questionnaires were mailed to provide follow-up information for patients who have been treated in either Department of Paediatric Surgery in Pécs, Hungary, or Department of Paediatric Surgery in Graz, Austria between 1999 and 2003. Those 112 children (42%) who answered the questionnaire were included in the study and further analyses were performed. Results  Female to male ratio of the 112 patients was 101/11. Trauma occurred during horseback riding accounted for 76.8% of all cases; these injuries represented more severe cases comparing to those which happened while handling a horse (23.2%). The mechanism as well as the localisation of injury displayed a close association with age. Conclusions   Prevention strategies targeting horse-related injuries at children should appreciate the age-dependent nature of injury as well as the fact that injury severity is not necessarily associated with the experience of the rider.     

儿童脾脏挫裂伤影像学分级及保守治疗的新认识

目的 虽然美国创伤外科学会在1994年制定脾脏挫裂伤的影像学分级,且已经被广泛应用,但在国内很少有中心对儿童脾挫裂伤进行分级.本文通过回顾性分析儿童创伤性脾破裂伤影像学分级与临床诊治特点,探讨儿童脾挫裂伤影像学分级在临床治疗中的作用,及保守治疗过程中的难点.方法 收集2008年8月至2014年12月复旦大学附属儿科医院收治的急性创伤性脾破裂伤患儿的临床资料,根据影像学资料进行回顾性影像学损伤分级,同时对患儿临床治疗过程中的禁食、抗生素使用、卧床休息等情况进行分析.结果 本组病例共纳入59例,占同期腹部损伤患儿的29.3%(59/201);男41例,女18例;年龄中位数9.5岁(3个月~16岁);跌倒/坠落伤23例,交通伤27例,其他类型损伤9例.影像学分级Ⅰ级5例,Ⅱ级26例,Ⅲ级21例,Ⅳ~Ⅴ级6例,不明确1例.其中25例合并其他脏器损伤.临床治疗包括禁食、绝对卧床、抗生素预防感染等.治疗和随访过程中有49例患儿行2次以上CT检查.59例均行保守治疗,1例中转手术,术后无相应并发症,余58例均保守治疗成功.结论 在严格掌握适应证和密切观察伤情变化的条件下,对儿童创伤性脾损伤行保守治疗较为安全.发病早期行影像学分级可能有助于临床判断病情,减少患儿放射性暴露.     

School accidents in Austria

The aim of this study was to obtain information about the mechanisms and types of injuries in school in Austria. Children between 0 and 18 years of age presenting with injuries at the trauma outpatient in the Department of Pediatric Surgery in Graz and six participating hospitals in Austria were evaluated over a 2-year prospective survey. A total of 28,983 pediatric trauma cases were registered. Personal data, site of the accident, circumstances and mechanisms of accident and the related diagnosis were evaluated. At the Department of Pediatric Surgery in Graz 21,582 questionnaires were completed, out of which 2,148 children had school accidents (10%). The remaining 7,401 questionnaires from peripheral hospitals included 890 school accidents (12%). The male/female ratio was 3:2. In general, sport injuries were a predominant cause of severe trauma (42% severe injuries), compared with other activities in and outside of the school building (26% severe injuries). Injuries during ball-sports contributed to 44% of severe injuries. The upper extremity was most frequently injured (34%), followed by lower extremity (32%), head and neck area (26%) and injuries to thorax and abdomen (8%). Half of all school related injuries occur in children between 10 and 13 years of age. There are typical gender related mechanisms of accident: Boys get frequently injured during soccer, violence, and collisions in and outside of the school building and during craft work. Girls have the highest risk of injuries at ball sports other than soccer.     

腹腔镜肾盂成形术治疗儿童肾积水并肾外伤6例

目的探讨腹腔镜肾盂成形术处理儿童肾积水并肾外伤的可行性及注意事项。方法总结郑州大学第一附属医院小儿外科2016年8月至2019年8月收治的肾积水并肾外伤患儿6例临床资料,年龄5~11岁,平均年龄7岁,外伤时间为1~4 d,均表现为患侧肾区疼痛,其中血尿4例,肾盂前后径均在25 mm以上,均予腹腔镜肾盂成形术并肾破裂修补术,术中留置输尿管内支架管、腹腔引流管和导尿管。结果患儿手术均顺利完成,均无输血,无中转开放手术,手术时间2.5~3.5 h,术中发现肾下极前方损伤2例,肾下极外后方受损4例,5例出现肾皮质肾盂破裂,1例为肾皮质破裂合并包膜下积血,术后肾周引流管3~5 d拔除,导尿管7~10 d拔除,输尿管内支架6~8周拔除,患儿均恢复顺利,积水均减轻,肾小球滤过率和分肾功能提高。结论腹腔镜一期肾盂成形术治疗儿童肾积水并肾外伤安全有效,儿童肾外伤多发于肾脏下极,外伤后如积水加重、症状持续不缓解等需尽早手术,术中可同时修补肾实质破裂区域。对于三级肾损伤术中出血需要贯穿缝合肾实质,清除坏死组织,方可达到止血效果。     

The lung and pediatric trauma

Thoracic trauma is relatively frequent in children and causes considerable mortality. This is mainly due to the multiorganic nature of the trauma. The lung is more often affected even in the absence of rib fractures because of the considerable pliability of the chest wall that allows direct transfer of energy to this organ. Injuries to the heart, the aorta, the esophagus, and the diaphragm are rare. Lung contusion and laceration cause parenchymal hemorrhage and consolidation sometimes accompanied by pneumothorax and/or hemothorax. Tracheobronchial disruption is rare but life-threatening. Most traumatic lung injuries may be treated with rest, respiratory support, and eventually intercostal drainage. Large hemorrhage may require thoracotomy, and persistent pneumothorax (indicative of tracheobronchial disruption) may require intubation with fiberoptic bronchoscopic assistance and eventually reparative or ablative surgery. Adult respiratory distress syndrome is very rarely seen in children with thoracic trauma, but it remains highly lethal.     

Traumatic chest injury in children: A single thoracic surgeon's experience in two Nigerian tertiary hospitals

Background:

This study was to determine the extent and outcome of childhood chest injury in Nigeria, and to compare results with that of other literatures.

Patients and Methods:

A Prospective study of all children under 18 years of age with chest trauma in two tertiary hospitals in Southern Nigeria from January 2012 to December 2014 was reviewed. The aetiology, type, associated injury, mechanism, treatment and outcome were evaluated. The patients were followed up in the clinic. The data were analysed using SPSS version 20.0 with a significant P < 0.05.

Results:

Thirty-one patients (12.1%) under 18 years of age of 256 chest trauma patients were managed in the thoracic units. The mean age was 9.78 ± 6.77 years and 27 (87.1%) were male. The aetiology in 13 was from falls, 10 from automobile crashes, 3 from gunshots, 4 from stabbing and 1 from abuse. The highest peak of chest injury was on Saturday of the week and April of the year. The pleural collections are as follows: 15 (71.4%) was haemothorax, 4 (19.1%) pneumothorax, 2 (9.5%) haemopneumothorax and 18 patients had lung contusion in combination or alone with the pleural collections. Seven patients who presented >12-h versus 2 who presented <12-h and 6 of children between 0 and 9 years versus 3 at 10-18 years of age had empyema thoracis (P value not significant). One death was recorded.

Conclusion:

Chest trauma in children is still not common, and blunt chest injury from falls and automobile accidents are more common than penetrating chest injury. Treatment with tube thoracostomy is the major management modality with empyema thoracis as the most common complication.Key words: Thoracic trauma, chest injury, children, thoracic surgeon, Nigeria