常规创伤实验室在儿童创伤复苏中的作用。
The utility of routine trauma laboratories in pediatric trauma resuscitations.
作者信息
Keller Martin S, Coln C Eric, Trimble Jennifer A, Green M Christine, Weber Thomas R
机构信息
Department of Pediatric Surgery, Cardinal Glennon Children's Hospital, 1465 South Grand Boulevard, St. Louis, MO 63104, USA.
出版信息
Am J Surg. 2004 Dec;188(6):671-8. doi: 10.1016/j.amjsurg.2004.08.056.
BACKGROUND
Because of the difficulties in evaluating injured children, screening blood tests are recommended.
METHODS
Resuscitation blood tests (complete blood count, chem12, coagulation panel, urinalysis) were reviewed for abnormality frequency, injury correlation, managements, and outcome.
RESULTS
Panels were obtained on 240 children (age < 16 years) meeting trauma system criteria. Abnormalities were identified as follows: white blood cell/hematocrit/platelets (41%, 27%, 1%), Na/K/Cl/CO(2) (3%, 30%, 23%, 14%), blood ureal nitrogen/creatinine (6%, 0%), prothrombin time/international normalized ratio/partial thromboplastin time (22%, 16%, 6%), aspartate aminotransferase/alanine transferase (43%, 35%), amylase (2%), glucose (77%), and urinalysis (31%). Organ-specific chemistries predicted injury poorly. Transaminasemia correlated with liver injury when levels exceeded 400 U/L. Two children (1%) with hyperamylasemia had abdominal injuries. Coagulation abnormalities correlated with intracranial injury (43%) and Glasgow Coma Scale (GCS 3 to 8; 56%, GCS 9 to 14; 20%, GCS 15; 14%, P <0.05). Only 25 (10%) had interventions for test abnormalities (11 transfusions, 8 fresh frozen plasma, 3 tests repeated, 3 KCl).
CONCLUSIONS
Routine laboratory panels are little value in the management of injured children.
背景
由于评估受伤儿童存在困难，建议进行筛查血液检查。
方法
对复苏血液检查（全血细胞计数、chem12、凝血指标、尿液分析）的异常频率、损伤相关性、处理措施及结果进行回顾。
结果
对符合创伤系统标准的240名儿童（年龄<16岁）进行了检查。发现的异常情况如下：白细胞/血细胞比容/血小板（41%、27%、1%），钠/钾/氯/二氧化碳（3%、30%、23%、14%），血尿素氮/肌酐（6%、0%），凝血酶原时间/国际标准化比值/活化部分凝血活酶时间（22%、16%、6%），天冬氨酸转氨酶/丙氨酸转氨酶（43%、35%），淀粉酶（2%），葡萄糖（77%），以及尿液分析（31%）。器官特异性化学指标对损伤的预测效果不佳。当转氨酶水平超过400 U/L时，转氨酶升高与肝损伤相关。两名儿童（1%）出现高淀粉酶血症，伴有腹部损伤。凝血异常与颅内损伤相关（43%），与格拉斯哥昏迷量表评分相关（格拉斯哥昏迷量表评分为3至8分；56%，格拉斯哥昏迷量表评分为9至14分；20%，格拉斯哥昏迷量表评分为15分；14%，P<0.05）。只有25名（10%）儿童因检查异常接受了干预措施（11次输血、8次输注新鲜冰冻血浆、3次重复检查、3次补充氯化钾）。
结论
常规实验室检查对受伤儿童的处理价值不大。
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