小儿肝外伤的治疗及新评分方法的应用价值

目的 评价小儿肝外伤的临床评价系统,探索新的评价指标.方法 回顾性分析本院92例小儿肝外伤的临床资料,将所有病例分为肝脏手术组和非肝脏手术组.对二组入院后首次检测的血压、脉搏、血红蛋白、血清谷丙转氨酶及AAST肝损伤分级情况进行比较分析,并结合统计结果,提出新评分指标:收缩压值+血红蛋白值-AAST分级×50-25,正值提示可非手术治疗,负值提示需手术治疗.结果 本组14岁以下小儿肝外伤92例,非手术治疗81例,手术治疗11例,二组平均年龄均为5.5岁.手术组与非手术组间收缩压、血红蛋白差异均有统计学意义(P＜0.01),舒张压、脉压和血清谷丙转氨酶的差异无统计学意义(P＞0.05),而二组间肝损伤分级的构成比有明显差别.采用我们的新评分指标,非手术组仅1例为负值,准确率为98.8%,手术组仅1例为正值,准确率为90.9%.结论 小儿肝外伤是否需要手术治疗与入院后首次测量的收缩压、血红蛋白及AAST肝损伤分级有关,综合三者的新评分指标对决定治疗方法有一定价值.

The treatment of 92 children with hepatic trauma and evaluation of a new scoring index

Objective To evaluate the clinieal scoring system of hepatic trauma in children and to establish a new scoring index.Methods The clinical data of pediatric hepatic trauma in our hospital were analyzed retrospectively.Patients were divided into tWO groups,non-operative group and opera-tive group.Blood pressure,pulse rate,hemoglobin,alanine aminotransferase(ALT)and the grading of hepatic trauma according to the American Association for the Surgery of Trauma(AAST)at admis-sion were compared and analyzed.Based on the above statistical results,a new scoring index was pro-posed.Results Of the 92 patients under 14 years of age,81 were in non-operative group,and eleven were in operative group,with the mean age of both groups being 5.5 years.The difference in systolic blood pressure and hemoglobin between non-operative and operative group was statistically significant (P<0.01),while the differences in diastolic blood pressure,pulse pressure and alanine aminotrans-ferase(ALT)were not statistically significant(P>0.05).The AAST grading between two groups was significant.Under the new scoring index system,only one patient in non-operative group was negative,with an accuracy of 98.8% and one patient was positive in the operative group,with an ac-curacy of 90.9%.Conclusions The need for an operation in the treatment of children with hepatic trauma depends on the initial systolic blood pressure,hemoglobin and the AAST grading for hepatic trauma.A new scoring index that takes into account the above three indices is helpful in deciding the treatment for pediatric hepatic trauma.