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单纯气道损伤或格拉斯哥昏迷评分<8分的小儿创伤患者:患者到达医院后,外科主治医师能否及时到达是否会造成不同结果

世界核心医学期刊文摘（儿科学分册） 2005年第6期1卷 41-42页

作者： Lui.f. Gormley P. Sorrells Jr. D. L. f. i. luks 宁亮 Di.i.i.n of.Pedi.tri. Surgery Brown Med. Sch. Hasbro Children’s H. Providence RI 02905 United States

Opti.al trauma care requi.es an attendi.g pedi.tri. surgeon to head a trauma team f.r the most severely i.jured pati.nts. Recently, the Ameri.an College of.Surgeons-Commi.tee on Trauma has added “Glasgow Coma Scale (GCS) i.way compromi.e”to the exi.ti.g anatomi.al and physi.logi.al cri.eri. f.r i.medi.te attendi.g presence. Thi. report analyzes the outcome of.chi.dren who met these i.olated cri.eri. and were treated bef.re the change i. gui.eli.es was made. The trauma regi.try of.thi. level i.trauma center was queri.d f.r all pedi.tri. pati.nts wi.h GCS i.way compromi.e. Age, sex, i.i.i.l GCS, Revi.ed Trauma Score, i.jury Severi.y Score, outcome, and probabi.i.y of.survi.al (TRi.S methodology) were recorded. The subgroup of.pati.nts f.r whom an attendi.g surgeon was not i.medi.tely present was f.rther analyzed. Over a 5-year peri.d, 2895 trauma pati.nts (aged 0-16 years) were admi.ted. One hundred f.f.een pati.nts had a GCS i.way compromi.e. i. 61 cases, an attendi.g surgeon was not present upon pati.nt arri.al. Of.these pati.nts, 24 di.d (group D), 15 were di.charged to a rehabi.i.ati.n f.ci.i.y (group R), and 22 were di.charged home (group H). Ten pati.nts wi.h a probabi.i.y of.survi.al of.lower than 0.5 survi.ed. Only 4 of.the 24 pati.nts who di.d had a probabi.i.y of.survi.al of.> 0.5 (mean, 0.697). All 4 had an i.jury Severi.y Score > 25 and a GCS ≤4. All deaths were revi.wed through a quali.y i.provement program and were deemed nonpreventable by objecti.e revi.wers. Pati.nt outcome was not af.ected by the presence or absence of.an attendi.g surgeon upon pati.nt arri.al. Outcome of.severely i.jured chi.dren wi.h GCS i.way compromi.e met and, i. some cases, exceeded expectati.ns of.survi.al accordi.g to the TRi.S methodology. The lack of.i.medi.te attendi.g surgeon’s presence does not appear to have negati.ely i.f.uenced the outcome i. these chi.dren. Based on thi. seri.s, there i. no evi.ence to justi.0} mandatory i.medi.te p

关键词：小儿创伤气道损伤创伤评分儿科患者医师学会创伤治疗质量改进生存概率预测值在现场

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小儿外伤患者发生肺检塞危险人群

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世界核心医学期刊文摘（儿科学分册） 2005年第6期1卷 44-44页

作者： Trui.t A. K. Sorrells D. L. Halvorson E. f. i. luks 宁亮 Di.i.i.n of.Pedi.tri. Surgery Brown Med. Sch. Hasbro Children’s H. Providence RI 02905 United States

Deep vei. thrombosi. and pulmonary emboli.m (DVT/PE) are rare i. pedi.tri. trauma pati.nts, and gui.eli.es f.r prophylaxi. are scarce. The authors sought to i.enti.0} subgroups of.pati.nts who may be at hi.her ri.k of.developi.g DVT/PE. Case-control study of.pedi.tri. trauma pati.nts wi.h DVT/PE. Odds rati.s (ORs) and conf.dence i.tervals (Ci.) were calculated f.r known ri.k f.ctors of.PE usi.g matched trauma controls (χ2 analysi.). A total of.3637 pedi.tri. trauma pati.nts was admi.ted over the last 7 years. Three pati.nts developed DVT/PE (overall i.ci.ence, 0.08%). There were 2 gi.ls and 1 boy, aged 15, 15, and 9 years, respecti.ely. All 3 had an i.jury Severi.y Score (i.S) ≥25 and an i.i.i.l Glasgow Coma Score (GCS) ≤8. None of.the known and potenti.l ri.k f.ctors si.ni.0}cantly i.creased the OR f.r developi.g DVT/PE: age 9 years or older (OR, 3.6; Ci. 0.4-26), presence of.head i.jury (OR, 2.9; Ci. 0.3-22), f.male sex (OR, 1.2; Ci. 0.15-9.1), GCS ≤8 (OR, 9.2; Ci. 0.9-230), except i.S ≥25 (OR, 82; Ci. 7.6-2058). The OR f.r a combi.ati.n of.age and GCS was 106, and the OR f.r the 3 ri.k f.ctors (age, i.S, GCS) common to all 3 pati.nts was 114 (Ci. 10-5000; P i.ci.ence of.DVT/PE i. pedi.tri. trauma pati.nts i. i.e prophylaxi. i. not recommended. Chi.dren aged 9 years or older wi.h an i.i.i.l GCS ≤8 and pati.nts wi.h an esti.ated i.S ≥25 may consti.ute a hi.h-ri.k group i. whi.h prophylaxi. could be consi.ered.

关键词：小儿外伤肺栓塞比值比可信区间高危人群头部损伤指导方针预防措施

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微创外科时代的先天性多囊肺的围生期管理

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世界核心医学期刊文摘（儿科学分册） 2006年第A10期2卷 36-37页

作者： Trui.t A.K. Carr S.R. Cassese J. f.i. luks 刘凯 Program i. f.tal Medi.i.e Brown Medical School Providence RI 02905 United States

Background: Most congeni.al cysti. lung lesi.ns (CCLLs) do not requi.e i. utero or peri.atal i.terventi.n. The management of.asymptomati. lesi.ns i. controversi.l: the theoreti.al ri.k of.i.f.cti.n and mali.nancy i. of.set by whether thoracotomy i. asymptomati. chi.dren i. justi.0}ed. We exami.ed our recent experi.nce and the role of.mi.i.ally i.vasi.e surgery. Methods: We analyzed the pre- , peri. , and postnatal f.ndi.gs of.all consecuti.e CCLLs di.gnosed between 1997 and 2005. We revi.wed records f.r pre- , and postnatal i.agi.g, management, and outcome. Results: Thi.ty- f.ve CCLL were di.gnosed prenatally. Si.ce 2000, all asymptomati. lesi.ns were removed endoscopi.ally at 6 to 18 months (thoracoscopy f.r 6 extralobar sequestrati.ns, 3 i.tralobar sequestrati.ns/- congeni.al cysti. adenomatoi. malf.rmati.ns, 5 bronchogeni. cysts, and retroperi.oneal laparoscopy f.r 2 i.traabdomi.al sequestrati.ns). Congeni.al cysti. adenomatoi. malf.rmati.n elements were present i. more than 70% . Two abdomi.al lesi.ns have regressed, and 2 pati.nts are awai.i.g i.terventi.n. One symptomati. i.f.nt underwent thoracotomy f.r congeni.al lobar emphysema. Conclusi.ns: i. has been argued that the ri.ks associ.ted wi.h congeni.al lung lesi.ns (i.f.cti.n and mali.nancy) justi.0} i.terventi.n i. the asymptomati. pati.nt. i. our experi.nce, all these lesi.ns could be saf.ly removed usi.g endosurgi.al techni.ues. Counseli.g of.(f.ture) parents should be updated to i.clude mi.i.ally i.vasi.e surgery i. the management algori.hm.

关键词：围生期微创外科腔镜治疗叶性肺气肿囊性腺瘤样畸形支气管囊肿开胸术无症状型出生后肺病变

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内镜胎儿手术中的插管及拔管技术能够将早产儿胎膜早破的发生率降到最低

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世界核心医学期刊文摘（儿科学分册） 2006年第A10期2卷 43-44页

作者： Chang J. Tracy Jr.T.f. Carr S.R. f.i. luks 李丹 Program i. f.tal Medi.i.e Brown Medical School Providence RI 02905 United States

Background: Premature rupture of.membranes (PROM) remai.s a si.ni.0}cant compli.ati.n of.f.tal surgery. Rates of.40% to 100% have been reported af.er both open and endoscopi. f.tal surgery. We descri.e a techni.ue of.endoscopi. port i.serti.n and removal that mi.i.i.es trauma to the membranes. Methods: Twenty- seven consecuti.e pati.nts undergoi.g endoscopi. laser ablati.n f.r twi.- to- twi. transf.si.n syndrome were revi.wed. i. each case, a mi.i.laparotomy was perf.rmed, and the amni.ti. cavi.y was entered under di.ect vi.i.n of.the uterus usi.g a Seldi.ger techni.ue. The entry si.e was caref.lly di.ated to accommodate a 4.0- mm- di.meter cannula. A gelati. sponge plug was placed at port removal. Postoperati.e management and outcome were evaluated. Results: Medi.n gestati.nal age at operati.n was 21.3 weeks. Medi.n operati.g ti.e was 60 mi.utes. One pati.nt deli.ered i.traoperati.ely because of.f.tal di.tress. Seventeen (65.4% ) pati.nts requi.ed postoperati.e tocolysi. (medi.n durati.n, 12 hours). Medi.n postoperati.e gestati.n was 6.5 weeks (range, 1- 20 weeks). Only 1 (4.2% ) of.24 pati.nts wi.h successf.l gelati. sponge placement developed PROM. Conclusi.ns: Meti.ulous techni.ue and atraumati. i.serti.n and removal of.ports help mi.i.i.e the ri.k of.postoperati.e amni.ti. leak af.er endoscopi. f.tal surgery. Our PROM rate of.4.2% contrasts sharply wi.h previ.usly reported rates af.er si.i.ar operati.ns.

关键词：胎膜早破胎儿期拔管手术时间平均胎龄明胶海绵保胎治疗激光消融剖腹术小切口

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对肺挫伤患者进行CT单独诊断与其患病率的升高无关

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世界核心医学期刊文摘（儿科学分册） 2006年第5期2卷 37-37页

作者： Kwon A. Sorrells Jr. D.L. Kurkchubasche A.G. f.i. luks 刘凯 Di.i.i.n of.Pedi.tri. Surgery Brown Medical School ProvidenceRI 02905United States

Background: i.creased uti.i.ati.n of.computed tomography (CT) has led to a ri.e i. the di.gnosi. of.pulmonary contusi.n. i.s cli.i.al si.ni.0}cance, i. the absence of.f.ndi.gs on chest radi.graph (CXR), has not been def.ned. Thi. study exami.es the cli.i.al course of.pati.nts wi.h CT-only di.gnosi. of.pulmonary contusi.n and compares i. wi.h that of.pati.nts wi.h CXR-proven pulmonary contusi.n. Methods: The trauma database i.enti.0}ed all chi.dren undergoi.g chest CT f.r blunt thoraci. trauma duri.g a 3-year peri.d. Records were revi.wed f.r age,mechani.m of.i.jury, i.jury Severi.y Score (i.S), length of.hospi.al stay (LOS), need f.r i.tensi.e care uni. admi.si.n, and need f.r endotracheal i.tubati.n. A pedi.atri. radi.logi.t revi.wed all f.lms i. a bli.ded f.shi.n. Stati.ti.al analysi. was perf.rmed usi.g analysi. of.vari.nce and f.sher’s Exact test f.r 2 ×3 tables. Results: Ei.hty-two pati.nts were i.enti.0}ed. There were no CXR-posi.i.e, CT-negati.e cases. A CT di.gnosi. of.pulmonary contusi.n was made i. 46 pati.nts. Of.these, 31 had a contusi.n on CXR as well (CXR+group) and 15 had a normal CXR (CT+only group). Mean i.S score di. not di.0}er si.ni.0}cantly between the two groups (27±12.3 and 22±10.3, respecti.ely). Thi.ty-si. pati.nts had a normal CT (control). Mean LOS was si.ni.0}cantly longer i. the CXR+group (13±12.0 days) than i. the CT+only and control groups (5±3.6 and 9±9.5 days, respecti.ely; P f.chi.dren requi.i.g i.tensi.e care uni. admi.si.n and i.tubati.n were also si.ni.0}cantly hi.her i. the CXR+group. Conclusi.n: The f.ndi.g of.pulmonary contusi.n by CT alone does not i.crease pati.nt morbi.i.y and appears to be of.li.i.ed cli.i.al si.ni.0}cance.

关键词：胸部CT检查肺挫伤伤患者诊断患病率胸部X线照片创伤严重度评分重症监护室

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