儿童多发伤ICU救治138例.docVIP

儿童多发伤ICU救治138例作者单位：266000 山东省青岛市儿童医院（李友）；青岛大学医学院附属医院（潘晓，李?，王爱荣，王蕾） 通讯作者：李友 【摘要】 目的 总结儿童多发性创伤ICU的救治经验。方法 对2005～2010年收治的138例多发伤患儿的伤情、诊断、治疗结果进行回顾性分析，总结多发伤的救治经验。结果 本组病例138例患儿115例撤离呼吸机，休克纠正、循环稳定、凝血功能恢复正常、内环境稳定，病情平稳，无明显其它并发症后，转回原科室。死亡23例（16.67% ）,死亡原因为脑疝及心脏与大血管损伤，如严重肝、脾、胰损伤、重度失血性休克和 MODS等。结论 损伤控制策略在ICU成功救治多发伤患儿的生命中起重要作用；严重多发伤患儿经外科处理后应转至ICU综合治疗，在整个抢救过程中，应严密监护，紧急处理休克、创伤、呼吸衰竭等主要问题，同时尽量兼顾全身情况，促进患儿康复。 【关键词】 多发伤； 治疗； 重症监护病房； 儿童 ICU treatment of multiple injuries of Children：138 cases LI You1,PAN Xiao,LI Yang,WANG Ai-rong, WANG Lei.1Qingdao Children Hospital, Qingdao 266000,China 【Abstract】 Objective To summarize the treatment of children with multiple trauma in ICU.Methods 138 children with multiple trauma, treated between 2005 and 2010, were retrospectively analyzed in injuries、diagnosis and the result of treatment.Results 115 cases of 138 cases returned to the original department successfully after ventilator withdrawal, shock correction, cyclic stability, coagulation returned to normal, the environment is stable, condition stable, no other complications; death in 23 cases （16.67%）,cause of death was cerebral hernia formation, heart and vascular injury, severe liver、 spleen、 pancreas damage, severe hemorrhagic shock and MODS and so on.Conclusion The damage control strategy play an important role in the treatment of ICU patients with multiple trauma in children; Children with severe multiple trauma should be transferred to ICU treated after surgical treatment.In the whole rescue process, intensive care should be supplied. The major issues，such as shock、trauma and respiratory failure，must be urgently handled to promote the recoverment of children, taking into account general condition as possible in the mean time. 【Key words】 Multiple Trauma； Therapy; Intensive care unit; Children 儿童是意外伤害发生的高危人群，目前意外伤害已经成为儿童死亡的第一位原因。多发伤更是小儿意外死亡的主要原因，给家庭带来灾难，给社会造成巨大负担［1］。多发伤是在同一外因的打击下，人体同时或相继有两个或两个以上解剖部位的组织或器官受到严重创伤，其中之一即使单独存在创伤也可能危及生命。相比单发伤而言，多发伤患儿病情更加复杂多变，严重多发伤来势凶险，患儿失血量大，