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创伤治疗：对情况不稳定儿童的处理

Authors
Lois K Lee, MD, MPH
Gary R Fleisher, MD
Section Editor
Richard G Bachur, MD
Deputy Editor
James F Wiley, II, MD, MPH
Translators
赵程, 副主任医师

引言

在美国，每年有超过17,000名儿童和青少年死于故意性和非故意性损伤，使得创伤成为该年龄段人群的首要死因[1]。该病也是该人群急诊科(emergency department, ED)就诊患者的首要死因，占到所有15岁以下儿童就诊者的高达1/3[2-4]。

钝性伤大约占所有儿科创伤的90%。当钝性力量作用于儿童幼小的身体时，经常会发生多系统的创伤。尽管大多数损伤的严重程度为轻度到中度，但是救助儿童的临床医生应当准备好对伴有严重和致命创伤的患者进行快速的评估和治疗。另外，由于儿童的解剖和生理与成人不同，因此在高级创伤护理中需要进行特别关注。 (参见“创伤管理：儿科的特殊注意事项”)

本文将论述严重创伤的非稳定性儿童患者的初始治疗方法。对于最初病情稳定的创伤儿童患者的治疗以及损伤儿童创伤的分类将单独讨论。 (参见“初始稳定的钝挫伤或穿透性损伤儿童的治疗”和“儿童创伤分类”)

概述

创伤患者的初始治疗的标准方法已经由美国外科医师学会经高级创伤生命支持(Advanced Trauma Life Support, ALTS)方案发布(图 1和表 1)。ATLS治疗方案是基于死亡的三峰分布概念(Trimodal Death Distribution)建立的[5]：

●死亡的第一个高峰出现在创伤后随即数秒到数分钟内，只有防止创伤的发生才能防范这种死亡。

                                                

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-21.
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