Associated head injury should not prevent nonoperative management of spleen or liver injury in children.
Associated head injury should not prevent nonoperative management of spleen or liver injury in children.
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相关的头部损伤不应妨碍儿童脾脏或肝脏损伤的非手术治疗。
DOI：
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发表时间：
1996
期刊：
影响因子：
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通讯作者：
D. Vane
中科院分区：
文献类型：
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作者：
M. Keller;K. Sartorelli;D. Vane
钝性创伤后肝脾损伤合并头部损伤儿童的恰当治疗仍存在争议。为评估非手术治疗的成功率以及这种方法对腹部和头部损伤预后的影响，对国家儿童创伤登记处记录的儿童病例进行了回顾。从1994年1月1日至1995年4月1日，确定了107名（年龄<19岁）因钝性创伤导致肝、脾及相关头部损伤的儿童。45名（42%）儿童有头部和脾脏联合损伤，51名（48%）有头部和肝脏损伤，11名（10%）有头部、肝脏和脾脏损伤。只有18名（17%）需要进行剖腹手术（头部和脾脏损伤9名（8%）；头部和肝脏损伤5名（5%）；头部、肝脏和脾脏损伤4名（4%））。总体而言，需要剖腹手术的儿童与保守治疗的儿童在格拉斯哥昏迷评分上没有差异（13分对14分，P>0.05）。对于所有组，需要剖腹手术的儿童平均损伤严重程度评分显著更高（19分对31分，P<0.05）。然而，当按损伤类型和严重程度对各组进行分层比较时，非手术治疗的儿童在输血需求、死亡率以及腹部和神经系统发病率方面均有所改善。与以往文献中关于钝性腹部实质器官损伤患者选择非手术治疗的指南相反，头部损伤导致的精神状态改变与肝脾损伤的关联不应影响观察性治疗的决策。
The appropriate management of children with liver or spleen injuries and associated head injury after blunt trauma remains controversial. To evaluate the success rates for nonoperative management and the impact this approach has on both abdominal and head injury outcome, children recorded in the National Pediatric Trauma Registry were reviewed. From January 1, 1994 to April 1, 1995, 107 children (aged < 19) were identified with liver, spleen, and associated head injury from blunt trauma. Forty-five (42%) children had combined head and spleen injury, 51 (48%) had head and liver injury, and 11 (10%) had head, liver, and spleen injury. Only 18 (17%) required laparotomy (head and spleen injury, 9 (8%); head and liver injury, 5 (5%); and head, liver, and spleen injury, 4 (4%)). Overall, there were no differences in Glasgow Coma Scale scores for children requiring laparotomy compared with those managed conservatively (13 vs. 14, p > 0.05). For all groups, the mean Injury Severity Score was significantly higher for children requiring laparotomy (19 vs. 31, p < 0.05). However, when comparison of the groups was stratified for type of injury and severity, the transfusion requirements, mortality, and abdominal and neurologic morbidity were all improved in children managed nonoperatively. Contrary to previous guidelines in the literature for selection of patients for nonoperative management of blunt solid organ abdominal injury, the association of altered mental status from head injury with liver and spleen injuries should not impact the decision for observational management.