208例儿童颅脑损伤的临床特征及入住ICU的危险因素分析  

Clinical characteristics of 208 cases of pediatric traumatic brain injuries and risk factors for ICU admission

作　　者：冯雅笛 田永吉[1] 张冉[1] 刘智明 Feng Yadi;Tian Yongji;Zhang Ran;Liu Zhiming(Department of Critical Care Medicine,Beijing Tiantan Hospital,China Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院重症医学科,北京100070

出　　处：《创伤外科杂志》2023年第8期602-607,共6页Journal of Traumatic Surgery

基　　金：首都卫生发展科研专项基金(首发2020-2-2047)。

摘　　要：目的分析颅脑损伤患儿急性入院的临床特征及入住ICU的影响因素。方法回顾性收集2015年1月1日—2020年12月31日首都医科大学附属北京天坛医院收治的208例儿童创伤性颅脑损伤(pediatric traumatic brain injury,PTBI)临床资料。分析不同年龄组颅脑损伤患儿急性入院的临床特征(包括患者的人口学特征、致伤机制和住院相关变量)并探索患儿入住ICU的影响因素。结果不同年龄段的儿童受伤地点不同,主要受伤地点均为公共场所。致伤原因排在前三位的为:跌倒伤102例、道路交通伤60例和高处坠落伤25例。受伤类型以单纯性颅脑损伤为主(195/208,93.75%),住院时间的中位数为6d,住院结局以痊愈和好转为主(200/208,96.15%),不同年龄段患儿的住院时间和结局的差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,头部受伤程度为重度(OR=37.646,95%CI:6.799~208.443)、行气管插管(OR=8.362,95%CI:1.619~43.185)和机械通气(OR=17.323,95%CI:1.515~198.114)是影响患儿入住ICU的独立危险因素。结论跌倒为PTBI的首位致伤原因,且在每个年龄段的致伤原因分类中占比最高。PTBI的严重程度以轻度为主,住院结局主要为痊愈和好转。根据患儿不同年龄段的致伤特点采取对应的预防措施至关重要。同时,头部受伤程度为重度、行气管插管和机械通气是影响患儿入住ICU的独立危险因素。Objective To analyze the clinical characteristics and risk factors for ICU admission among pediatric traumatic brain injuries(PTBI).Methods A total of 208 PTBI cases admitted in Beijing Tiantan Hospital from Jan.1,2015 to Dec.31,2020 were selected.Clinical characteristics were retrospectively analyzed based on age,including patient demographics,mechanism of injury,and hospitalization-related variables.The risk factors of ICU admission were also explored.Results Children of different age groups had different injury places,and the main injury place was public.The top three causes of PTBI were falls in 102 cases,traffic accidents in 60 cases and falls from height in 25 cases.Isolated TBI was the dominant injury type(195/208,93.75%);median length of hospital stay was 6 d;and main hospitalization outcome was excellent or good recovery(200/208,96.15%).PTBI patients of different age groups showed significantly different length of hospital stay and outcomes(both P<0.05).Multivariate logistic regression indicated that severe PTBI(OR=37.646,95%CI:6.799-208.443),endotracheal intubation(OR=8.362,95%CI:1.619-43.185)and mechanical ventilation(OR=17.323,95%CI:1.515-198.114)were independent risk factors for ICU admission of PTBI patients.Conclusion Falls is the leading cause of PTBI among all age groups.PTBI is mainly of mild severity and good hospital recovery.It is very important to take corresponding preventive measures according to the PTBI injury characteristics of different ages.At the same time,severe head injuries,endotracheal intubation and mechanical ventilation are independent risk factors for ICU admission.

关 键 词：颅脑损伤 创伤 临床特征 ICU 儿童 

分 类 号：R651.1[医药卫生—外科学]