重症监护病房中意外伤害患儿病因及影响因素的分析
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摘要
目的分析儿童重症监护病房(PICU)收治的意外伤害患儿的病因及影响因素,为预防儿童意外伤害和降低儿童意外伤害的病死率提供指导依据。方法回顾性分析2012年12月至2017年12月PICU收治的意外伤害患儿的临床资料。结果该阶段共收治意外伤害患儿102例,占PICU收治患儿总数的3.30%(102/3087)。儿童意外伤害的类型居前三位分别为食物/药物中毒、溺水、气道/食道异物。儿童意外伤害发生情况与性别和年龄密切相关,男孩意外伤害发生比例明显高于女孩,年龄越小意外伤害发生占比越高(P<0.05)。儿童意外伤害类型与年龄也有明显的相关性,不同年龄组常见的意外伤害类型有差异。不同类型意外伤害的发生比例在城乡间差异无统计学意义(P>0.05)。意外伤害后发生器官功能障碍的数量,以及呼吸、心血管、神经、肾脏、血液五大器官功能障碍与患儿死亡的发生密切相关(P<0.05),但不是导致患儿死亡的独立危险因素(P>0.05)。结论预防是降低儿童意外伤害发生的关键,应根据性别、年龄特点和不同意外伤害类型,采取有针对性的预防措施。同时应该普及急救知识,完善急救转运系统,PICU医生应该重视意外伤害患儿器官功能的保护,以降低意外伤害患儿的病死率。
Objective To investigate the etiology and risk factors for unintentional injuries in children admitted to the pediatric intensive care unit(PICU), and to provide a basis for preventing these injuries and decreasing the mortality rate. Methods A retrospective analysis was performed on the clinical data of children with unintentional injuries admitted to the PICU from December 2012 to December 2017. Results A total of 102 children with unintentional injuries were admitted to the PICU, which accounted for 3.30%(102/3 087) of the overall PICU patients. The top three causes of unintentional injuries were food or drug poisoning, drowning, and foreign body ingestion and aspiration.The proportion of unintentional injuries in boys was significantly higher than in girls(P<0.05). The younger children had a significantly higher proportion of unintentional injuries(P<0.05). The cause of unintentional injuries was also related to age, and the common causes of unintentional injuries varied between different age groups. The proportion of unintentional injuries was not significantly different between children from urban and rural areas(P>0.05). The logistic regression analysis showed that the number of organs with dysfunction after unintentional injuries, especially respiratory,cardiac, neurological, renal and hematological involvement, was closely associated with the mortality rate of children with unintentional injuries(P<0.05); however, it is not an independent risk factor(P>0.05). Conclusions Prevention is the key to decreasing the incidence of childhood unintentional injuries. Preventive measures should be taken based on patient's sex and age and the cause of unintentional injuries. The spread of first aid knowledge, improvement in emergency transportation, and more attention to organ protection may be useful for decreasing the mortality rate of children with unintentional injuries.
Objective To investigate the etiology and risk factors for unintentional injuries in children admitted to the pediatric intensive care unit(PICU), and to provide a basis for preventing these injuries and decreasing the mortality rate. Methods A retrospective analysis was performed on the clinical data of children with unintentional injuries admitted to the PICU from December 2012 to December 2017. Results A total of 102 children with unintentional injuries were admitted to the PICU, which accounted for 3.30%(102/3 087) of the overall PICU patients. The top three causes of unintentional injuries were food or drug poisoning, drowning, and foreign body ingestion and aspiration.The proportion of unintentional injuries in boys was significantly higher than in girls(P<0.05). The younger children had a significantly higher proportion of unintentional injuries(P<0.05). The cause of unintentional injuries was also related to age, and the common causes of unintentional injuries varied between different age groups. The proportion of unintentional injuries was not significantly different between children from urban and rural areas(P>0.05). The logistic regression analysis showed that the number of organs with dysfunction after unintentional injuries, especially respiratory,cardiac, neurological, renal and hematological involvement, was closely associated with the mortality rate of children with unintentional injuries(P<0.05); however, it is not an independent risk factor(P>0.05). Conclusions Prevention is the key to decreasing the incidence of childhood unintentional injuries. Preventive measures should be taken based on patient's sex and age and the cause of unintentional injuries. The spread of first aid knowledge, improvement in emergency transportation, and more attention to organ protection may be useful for decreasing the mortality rate of children with unintentional injuries.
引文
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[2]Theurer WM,Bhavsar AK.Prevention of unintentional childhood injury[J].Am Fam Physician,2013,87(7):502-509.
[3]蒋竞雄,丁宗一.中国儿童意外伤害研究现状分析[J].中国儿童保健杂志,2000,8(1):53-55.
[4]董景五.疾病和有关健康问题的国际统计分类(ICD10)[M].第2版.北京:人民卫生出版社,2013:23-25.
[5]江载芳,申昆玲,沈颖,等.诸福棠实用儿科学[M].第8版.北京:人民卫生出版社,2015:2740.
[6]向伟,祝益民.实用儿科急诊手册[M].北京:人民卫生出版社,2003:426.
[7]He S,Lunnen JC,Puvanachandra P,et al.Global childhood unintentional injury study:multisite surveillance data[J].Am JPublic Health,2014,104(3):e79-e84.
[8]任玉倩,崔云,张育才,等.儿童意外伤害病因及预后[J].中国急救复苏与灾害医学杂志,2015,10(2):104-107.
[9]刘国群,王学珍.儿童意外中毒影响因素分析与干预[J].中国妇幼保健,2014,29(4):556-558.
[10]莫庆仪,黄东明,谢广清,等.儿童意外伤害924例分析[J].中国当代儿科杂志,2013,15(7):559-562.
[11]张丽萍,胡亚梅,杨淑云,等.70例儿童意外伤害临床分析[J].中华灾害救援医学,2018,6(10):549-551.
[12]朱忠生,周少明,蔡华波.PICU264例小儿意外伤害临床分析[J].中国小儿急救医学,2015,22(8):579-581.
[13]董珊君.儿童意外伤害315例分析[J].中国小儿急救医学,2013,20(3):321-322.